ACI open最新文献

{"title":"Leveraging Clinical Decision Support in Dental Settings to Bridge HIV Testing Gaps and Contribute to Ending the Epidemic.","authors":"Sharon C Perelman, Tunaidi Ansari, Michael T Yin, Peter G Gordon, Nadia Nguyen, Vicky Evangelidis-Sakellson, Carol Kunzel, Kathrine Meyers, Delivette Castor, Ariel Blanchard, David A Albert","doi":"10.1055/a-2500-7594","DOIUrl":"10.1055/a-2500-7594","url":null,"abstract":"<p><strong>Background: </strong>Columbia University Irving Medical Center (CUIMC) in New York City, in collaboration with the Division of Infectious Diseases and the Dental School, is addressing a critical gap in HIV testing to support the strategy to End the HIV Epidemic (EHE). This strategy emphasizes increasing testing rates and providing patients with information about pre-exposure prophylaxis (PrEP).</p><p><strong>Objectives: </strong>This study aimed to achieve two key objectives: (1) develop a robust clinical decision support system (CDSS) capable of identifying patients who stand to benefit from HIV testing and (2) implement a seamlessly integrated, user-friendly workflow, enabling health care providers to effortlessly order and conduct HIV point-of-care (POC) screening.</p><p><strong>Methods: </strong>A targeted CDSS was developed by identifying a patient population, determining qualifying laboratory tests, interpreting HIV and sexually transmitted infections results, and programming based on conditional statements. A workflow was implemented after careful consideration and collaboration with faculty and residents. POC testing was conducted using the OraQuick Rapid Antibody Test Advanced HIV-1/2.</p><p><strong>Results: </strong>The implementation of this targeted CDSS and associated new protocols demonstrated a promising 11.5% testing rate, normalizing HIV POC testing within the dental ambulatory care setting, and representing a key pillar of EHE.</p><p><strong>Conclusion: </strong>CUIMC's approach presents a promising strategy for bridging gaps in HIV testing disparities and enhancing public health outcomes. By leveraging CDSS and innovative health care delivery methods, CUIMC's desire is to expand the scope and effectiveness of HIV testing to other practices and sites.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"9 1","pages":"e1-e8"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder Perspectives on the Meaningful Integration of Clinical Informatics Interventions Using Patient-Reported Outcomes in Healthcare.","authors":"David Russell, Yashika Sharma, Andrew P Ambrosy, Kelly Axsom, Janejira J Chaiyasit, Margaret O Cuomo, Christi Deaton, Anne J Goldberg, Parag Goyal, Angel Guan, Fernanda C G Polubriaginof, Lucy McGurk, Alexander T Sandhu, John A Spertus, Meghan Reading Turchioe, David K Vawdrey, Ruth Masterson Creber","doi":"10.1055/a-2461-3027","DOIUrl":"10.1055/a-2461-3027","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcomes (PROs) capture where patients are on their disease trajectory and can identify changes in health status from their perspective.</p><p><strong>Objectives: </strong>This study applied the equity and sustainability-informed RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to gain insights into clinical informatics interventions for collection and use of PROs across health systems.</p><p><strong>Methods: </strong>A total of 14 health informatics and clinical professionals were interviewed about the development and use of PROs within their health systems and individual practices. Directed content analysis was performed to highlight patterns, similarities, and differences in stakeholder perspectives across RE-AIM domains.</p><p><strong>Results: </strong>The reach of clinical informatics interventions using PROs varied across clinical practices and settings based upon institutional commitment and support, integration of clinical information systems, and engagement with patients and families. Although interventions using PROs were viewed as effective for enabling focused conversations with patients and facilitating shared decision-making, barriers to adoption included licensing requirements associated with PRO instruments, lack of incentives for their use, limited integration of PRO results into electronic medical record systems, and poor support for patients with low technology and/or health literacy. Implementation of interventions using PROs was facilitated through training and support staff who aided clinicians with clinical workflow integration, availability of questionnaires in multiple languages, identifying thresholds and strategies for action, and presenting interpretable visualizations showing changes over time alongside significant clinical events. Maintenance of interventions using PROs was enabled through multimodal data collection approaches and data governance groups that evaluated organizational requests to track new measures.</p><p><strong>Conclusion: </strong>Initiatives to increase the reach of clinical informatics interventions using PROs will require health system investments into medical record system integration, education, and implementation support for clinicians and patients, and efforts to reach patient populations with language barriers or limited technology literacy.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"8 2","pages":"e79-e88"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Secure Messaging in Electronic Health Records: Evaluating the Impact of Emoji Chat Reactions on the Volume of Interruptive Notifications","authors":"John Will, William Small, Eduardo Iturrate, Paul Testa, Jonah Feldman","doi":"10.1055/s-0044-1788621","DOIUrl":"https://doi.org/10.1055/s-0044-1788621","url":null,"abstract":"\u0000 Background Electronic health record secure messaging (EHRSM) is an increasingly utilized tool for communication among clinicians. However, there is concern about the growing quantity of disruptions it presents via interruptive notification.\u0000 Objectives The primary aim of this study is to assess whether introducing emoji reactions, which do not trigger push notifications in EHRSM, can alleviate the burden of interruptive notifications. The second aim is to use messaging notification metadata to identify subgroups that might benefit from targeted interventions to aid the adoption of this innovation.\u0000 Methods We implemented the emoji reaction feature into EHRSM across a large academic health system. We evaluated the volume of push notifications 11 weeks before (pre-emoji period) and after (post-emoji period) introducing emoji reactions in EHRSM. Notification metadata was categorized by user type, and users were stratified based on notification volume.\u0000 Results There were 1,387,506 fewer push notifications in the post-emoji period (a decrease of 4.7%). Subgroups of users with increasing mean daily push notifications in the pre-emoji period were associated with decreasing mean daily push notifications in the post-emoji period. Among the eight user subgroups, six experienced a significant reduction in interruptive notifications, with the pharmacy and “other” subgroups not observing a reduction. Users in the top quartile of notification volume saw the greatest reduction in burden across each user subgroup.\u0000 Conclusion Integrating emoji reactions into EHRSM across a large academic health system significantly reduced the burden of push notifications among EHRSM users. Utilizing messaging notification metadata allowed us to identify subgroups that require additional intervention.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Electronic Health Record Mortality Data to Promote Goals-of-Care Discussions in Seriously Ill Transferred Patients: A Pilot Study","authors":"N. Mahendraker, Esmeralda Gutierrez-Asis, Seho Park, Linda S. Williams, Titus Schleyer, Elizabeth Umberfield","doi":"10.1055/s-0044-1788652","DOIUrl":"https://doi.org/10.1055/s-0044-1788652","url":null,"abstract":"\u0000 Background Mortality prediction data may aid in identifying seriously ill transferred patients at high risk of dying and facilitate early goals-of-care discussions (GOCD); however, this is rarely evaluated. We recently developed a model for predicting 30-day inpatient mortality, which may be useful for promoting early GOCD.\u0000 Objectives Our objectives were to examine the effects of sharing model-generated mortality risk with hospitalists by assessing (1) if hospitalists agreed with the mortality risk prediction, (2) if they planned to conduct GOCD or consult palliative care within 72 hours of transfer, and (3) if the communication alert affected GOCD timing and other clinical outcomes. We also aimed to measure the association between both the model-generated and hospitalists' stratified risk assessments with patient mortality.\u0000 Methods This was a nonrandomized quasi-experimental pilot study with a historical control group. On the second day of hospitalization, the model-generated risk was communicated to the hospitalists. Hospitalists were asked to answer questions via a HIPAA (Health Insurance Portability and Accountability Act)-compliant mobile communication system, and clinical outcomes were extracted via chart review.\u0000 Results Eighty-four patients (42 in the control and 42 in the intervention group) were included in this study. Hospitalists agreed that all patients in the intervention group were at risk for inpatient mortality. Hospitalists were more likely to indicate a plan to conduct GOCD in the intervention group (n = 9) compared with the control group (n = 4, p < 0.001). In this subset of patients, GOCD was completed within 72 hours in 78% of intervention patients (n = 7) as compared with 50% in the control group (n = 2). The greater absolute value of the model-generated mortality risk was significantly associated with deaths (p = 0.01), similar to the hospitalists' prediction of the mortality risk (p = 0.02).\u0000 Conclusion Communicating model-generated mortality risk to hospitalists is a promising approach to promote timely GOCD.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"43 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Online Tool for Correcting Performance Measures of Electronic Phenotyping Algorithms for Verification Bias.","authors":"Ajay Bhasin, Sue Bielinski, Abel N Kho, Nicholas Larson, Laura J Rasmussen-Torvik","doi":"10.1055/a-2402-5937","DOIUrl":"10.1055/a-2402-5937","url":null,"abstract":"<p><strong>Objectives: </strong>Computable or electronic phenotypes of patient conditions are becoming more commonplace in quality improvement and clinical research. During phenotyping algorithm validation, standard classification performance measures (i.e., sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) are often employed. When validation is performed on a randomly sampled patient population, direct estimates of these measures are valid. However, studies will commonly sample patients conditional on the algorithm result prior to validation, leading to a form of bias known as verification bias.</p><p><strong>Methods: </strong>We illustrate validation study sampling design and naïve and bias-corrected validation performance through both a concrete example (1,000 cases, 100 noncases, 1:1 sampling on predicted status) and a more thorough simulation study under varied realistic scenarios. We additionally describe the development of a free web calculator to adjust estimates for people validating phenotyping algorithms.</p><p><strong>Results: </strong>In our illustrative example, naïve performance estimates corresponded to 0.942 sensitivity, 0.979 specificity, and 0.960 accuracy; these contrast proper estimates of 0.620 sensitivity, 0.999 specificity, and 0.944 accuracy after adjusting for verification bias using our free calculator. Our simulation results demonstrate increasing positive bias for sensitivity and negative bias for specificity as the disease prevalence approaches zero, with decreasing positive predictive value moderately exacerbating these biases.</p><p><strong>Conclusion: </strong>Novel computable phenotypes of patient conditions must account for verification bias when calculating performance measures of the algorithm. The performance measures may vary significantly based on disease prevalence in the source population so use of a free web calculator to adjust these measures is desirable.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"8 2","pages":"e89-e93"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dealing with Diversity in Digital Psychological Interventions for Young People: A Structured Review","authors":"Farzad Jahedi, Paul W. Fay Henman, Jillian C. Ryan","doi":"10.1055/s-0044-1788563","DOIUrl":"https://doi.org/10.1055/s-0044-1788563","url":null,"abstract":"In recent years, despite significant progress in digital psychological interventions (DPIs), the prevalence of psychological issues among young adults remains a concern. While research on the feasibility and effectiveness of DPIs is extensive, there's a growing recognition of the need for a sociotechnical approach to enhance user engagement. This review aims to highlight the importance of integrating diversity, especially sociodemographic characteristics, into DPI design and implementation.The review meticulously examined literature from six academic databases focused on DPIs tailored for users aged 12 to 26, spanning the period between 2009 and 2019. The data extraction process specifically targeted biosocial factors such as gender and ethnicity, as well as sociocultural elements like remoteness and labor force status among users. Among the initial pool of 879 articles, a refined selection of 25 underwent detailed analysis. Intriguingly, 14 of these studies did not treat sociodemographic factors as independent variables, leaving only 11 that did. Notably, gender and ethnicity emerged as the most frequently studied factors, with remoteness and labor force considerations receiving comparatively less attention.Despite the acknowledged importance of user engagement in DPI effectiveness, the review highlights a critical gap: insufficient consideration of young adults' sociodemographic characteristics in intervention design and implementation. Therefore, the findings strongly support further mixed-method studies to fully understand the complex social factors influencing user engagement with DPIs. Closing this gap will undoubtedly refine and optimize DPIs to better meet the diverse needs of young adults dealing with psychological challenges.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"16 S14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back to Babies: Reducing Documentation Time in the NICU.","authors":"Shama Y Patel, Rebecca S Rose, Emily C Webber","doi":"10.1055/s-0044-1782531","DOIUrl":"10.1055/s-0044-1782531","url":null,"abstract":"<p><p><b>Background</b>  There is no accepted best practice for generation and content of daily progress notes in the neonatal intensive care unit (NICU). <b>Objectives</b>  This study aimed to implement a consistent documentation standard process for a neonatology provider group at a level IV tertiary care NICU. The primary aim was to improve timeliness of daily progress note completion. Secondary aims were to maintain or improve clinician satisfaction, reduce variability, and reduce attending neonatologist electronic medical record (EMR) documentation tasks. <b>Methods</b>  We formed a work group including advanced practice providers (APPs) and physicians from the NICU that met over 6 months to define the ideal NICU documentation content, map the workflow for documentation, identify gaps in EMR content, and create solutions for each gap. Baseline assessment included a change readiness survey to identify barriers to workflow change and a review of neonatologist signature timestamp to determine time to note completion. Twenty random progress notes were sampled weekly for 6 months prior to implementation of new workflow as well as 6 months postimplementation. Average time to note completion was compared in the pre- and postintervention groups. <b>Results</b>  In total, 962 notes were sampled, 481 each in the pre- and postintervention states. Twenty neonatologists were captured in the preintervention state, 24 in the postintervention state, 18 were captured in both samples. Final note completion time mean improved from 10 hours and 32 minutes (from starting note to final sign) to 8 hours and 40 minutes ( <i>p</i>  < 0.01). Those sampled in both epochs improved from 10 hours and 6 minutes to 8 hours and 30 minutes ( <i>p</i>  < 0.05). <b>Conclusion</b>  Progress notes generated by neonatologists are completed earlier than those generated by an APP with a Neonatologist addendum. Specialty-specific education and training are critical to high satisfaction in large EMR workflow transitions.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"8 1","pages":"e16-e24"},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Into the Unknown: The Shift in Key Service Performance Indicators after a Clinical Hospital Department Incorporates Virtual Service Delivery Options.","authors":"Angela Vivanti, Eryn Murray, Ra'eesa Doola, Jan Hill, Clair Sullivan","doi":"10.1055/s-0044-1781462","DOIUrl":"10.1055/s-0044-1781462","url":null,"abstract":"<p><p><b>Background</b>  Coronavirus disease 2019 (COVID-19) forced health care services to introduce virtual service delivery. Little is known about the impact on health care service delivery. <b>Objectives</b>  This case study reports the impact of introducing remote access facilitating virtual service delivery. <b>Methods</b>  Key performance indicators of health care service delivery (Nutrition and Dietetic Department, 26.9 full-time equivalents) were monitored over three 6-month periods. These periods were Phase 1 (pre-COVID restrictions), Phase 2 (zero tolerance to COVID), and Phase 3 (living with COVID). Virtual service delivery was initiated between Phases 1 and 2. Virtual service delivery days were defined as days worked virtually in lieu of leave. <b>Results</b>  During Phase 2 and Phase 3, there were 87 and 188 extra days of virtual service delivery achieved and an opportunity cost saving of $26,000 USD and $56,000 USD, respectively. Leave hours reduced between Phases 1 and 2 ( <i>p</i>  < 0.006; mean ± standard deviation [SD] 591 ± 213 and 222 ± 91) and maintained between Phases 1 and 3 ( <i>p</i>  < 0.342; mean ± SD 494 ± 98) despite the pandemic. No adverse clinical events were reported. Professional quality of life scores were maintained. <b>Conclusion</b>  Virtual service delivery through remote access provided many days of otherwise potentially lost productivity, maintained patient care with no adverse events, and sustained Professional Quality of Life despite pandemic challenges. Operationally, lessons learnt included the importance of positive team culture to working effectively, keeping teams connected and adapting different solutions to meet teams' requirements. Incorporating virtual service delivery options into a hospital clinical department showed performance stability across key service performance indicators during the COVID-19 pandemic.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"8 1","pages":"e10-e15"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Usability Survey of a Quality Improvement Data Visualization Tool Among Medical Intensive Care Unit Nurses.","authors":"Abigail M Williams, Claire L Davis, Margot Bjoring, Kris Blackstone, Andrew J Barros, Kyle B Enfield","doi":"10.1055/s-0044-1782604","DOIUrl":"10.1055/s-0044-1782604","url":null,"abstract":"<p><strong>Background: </strong>Cognitive overload is prevalent among intensive care unit (ICU) clinicians. Data visualization may decrease cognitive load by assisting with data interpretation and task prioritization. We developed the Bundle Board to display real-time data from the electronic medical record (EMR), highlighting opportunities for action in standardized ICU patient care. This study evaluates the practical usability of this data visualization tool among nurses in the ICU.</p><p><strong>Methods: </strong>The tool is offered as an application separate from the EMR and was available in the medical ICU for eight months before we surveyed unit nursing staff. To evaluate usability of the tool, we adapted the Health-Information Technology Usability Scale (Health-ITUES) and included an option to provide open-ended feedback. Survey data was analyzed using quantitative and qualitative methods.</p><p><strong>Results: </strong>ICU nurses were invited to participate through email and verbal announcements. Of the potential participants, 38% (N=47) responded. The survey demonstrated that the tool was perceived as usable. For each subscale, mean scores were as follows: Perceived Ease of Use 4.40, Impact 4.14, User Control 4.07, and Perceived Usefulness 3.61. There were no significant differences between core and contracted nurses or after stratifying by duration of Bundle Board use. Fifteen respondents completed the optional free-text portion of the survey. Qualitative analysis revealed six subthemes focusing on perceived impacts on quality and safety, cognitive burden and workload, and emotional impact of the Bundle Board.</p><p><strong>Conclusions: </strong>The Bundle Board demonstrated good usability among ICU Nurses, who provided substantive feedback for its improvement. These observations may be generalizable to other comparable interventions. Iterative feedback from end-users is vital to developing and implementing a digital health intervention. Our study provides a framework for performing a usability analysis within a specific clinician population and environment.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"8 1","pages":"e33-e42"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking Patient Encounters across Primary and Ancillary Electronic Health Record Systems: A Comparison of Two Approaches.","authors":"Marcos A Davila, Evan T Sholle, Xiaobo Fuld, Mark L Israel, Curtis L Cole, Thomas R Campion","doi":"10.1055/s-0044-1782679","DOIUrl":"10.1055/s-0044-1782679","url":null,"abstract":"<p><strong>Background: </strong>To achieve scientific goals, researchers often require integration of data from a primary electronic health record (EHR) system and one or more ancillary EHR systems used during the same patient care encounter. Although studies have demonstrated approaches for linking patient identity records across different EHR systems, little is known about linking patient encounter records across primary and ancillary EHR systems.</p><p><strong>Objectives: </strong>We compared a patients-first approach versus an encounters-first approach for linking patient encounter records across multiple EHR systems.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of 348,904 patients with 533,283 encounters from 2010 to 2020 across our institution's primary EHR system and an ancillary EHR system used in perioperative settings. For the patients-first approach and the encounters-first approach, we measured the number of patient and encounter links created as well as runtime.</p><p><strong>Results: </strong>While the patients-first approach linked 43% of patients and 49% of encounters, the encounters-first approach linked 98% of patients and 100% of encounters. The encounters-first approach was 20 times faster than the patients-first approach for linking patients and 33% slower for linking encounters.</p><p><strong>Conclusion: </strong>Findings suggest that common patient and encounter identifiers shared among EHR systems via automated interfaces may be clinically useful but not \"research-ready\" and thus require an encounters-first linkage approach to enable secondary use for scientific purposes. Based on our search, this study is among the first to demonstrate approaches for linking patient encounters across multiple EHR systems. Enterprise data warehouse for research efforts elsewhere may benefit from an encounters-first approach.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":"8 1","pages":"e43-e48"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11101195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}