The proliferation of electronic health record (EHR) alerts has led to widespread alert fatigue and clinician burnout, undermining the effectiveness of clinical decision support and compromising patient safety. We introduce a comprehensive style guide for designing interruptive alerts (IAs) in EHR systems to improve clinician engagement and reduce alert fatigue that has been approved by our institutional alert governance committees. This style guide addresses critical aspects of IAs, including format, typography, color coding, title brevity, patient identification, and introductory text. It also outlines the use of typographic emphasis, response options, default actions, and opt-out mechanisms, emphasizing the need for clear, concise, and actionable alerts that consider clinician workflow and cognitive burden. A standardized style guide for IAs can enhance clinician experience and clinical outcomes by reducing alert fatigue. Incorporating feedback and continuous evaluation of alert effectiveness is essential for maintaining relevance and supporting patient care within a dynamic clinical environment.

Adolescents are at high risk for sexually transmitted infections (STIs) and frequently present to emergency departments (EDs) for care. Screening for STIs using confidential patient-reported outcomes represents an ideal use of electronic screening methodology. The objectives of this study were to implement a patient-facing, confidential electronic survey to assess adolescent risk for STIs and consent for testing with integrated provider-facing electronic clinical decision support (CDS) across six geographically dispersed pediatric EDs and evaluate implementation based on survey and CDS usage metrics. A pilot site provided code for the electronic survey, data query, and CDS templates to six EDs. Institutions identified necessary information technology (IT) personnel, completed the local build, and made modifications to suit individual site workflow variations with all sites successfully deploying the electronic survey with electronic health record (EHR)-embedded CDS. Out of 79,780 eligible adolescents, 6,165 adolescents completed the confidential health survey between April 12, 2021 and September 25, 2022. The CDS was triggered indicating the patient was at risk or consented to STI testing across all six sites 2,058 times. The average percentage of time the CDS was acknowledged by a provider was 81.6% (range 45.7-97.6%). The median number of providers who acknowledged each instance of the CDS was 2.0. STI testing was ordered from the CDS on average 47.3% of the time. CDS acknowledged selection of "other" and "[testing] already ordered" was the most frequent indication STI testing was not ordered from the CDS. Successful deployment of patient-facing screeners with integrated electronic CDS across multiple healthcare institutions is feasible. A combination of different types of IT and informatics expertise with local knowledge of clinical workflows is essential to success.

The "cancer risk calculator" mobile application aims to inform patients about their personal risks of cancer and the risk factors influencing said risks. The present analysis examines the responses to a questionnaire submitted by oncology patients treated with radiotherapy or their family members. The primary objective was to determine the effect of the app on the user's awareness and potential habit changes related to cancer risk. Further, the study aimed to discern any relationships between respondent characteristics and their questionnaire responses. A total of 162 patients were included in the analysis. Each patient's dataset comprised gender, date of birth, entry date, respondent type, type of cancer, and responses to 12 application-related questions. Statistical methods such as multiple regression models were employed to identify any effects of the respondent's characteristics on their responses. Statistical significance was set at p < 0.05. Responding to the survey questions, 67.1% of respondents found the application useful, and 63.4% reported learning something new. More than half (52.5%) indicated a willingness to change their habits based on the information provided. Respondents also indicated that they were surprised by the number of risk factors shaping their risks and the large influence of some of these risk factors. Variables such as breast cancer diagnosis (p = 0.044) and age (p = 0.049) influenced specific question responses. The "cancer risk calculator" app appears to have a significant utility in educating its users about cancer risk and potentially influencing habit change.

We developed and implemented a customized internal clinical informatics (CI) curriculum for the UC Irvine CI Fellowship program. The goal was to transition from an externally sourced curriculum to a more focused, internally developed program, aligning with feedback from early fellows and the evolving practical needs of clinical informatics. By designing this curriculum in-house, we sought to provide a more efficient, cost-effective, and relevant educational experience for fellows. The curriculum was designed over a one-year period, beginning in July 2021 and launched in July 2022. The development process involved collaboration among core clinical informatics faculty, organizing the content into 13 thematic blocks, each spanning four weeks. Each block included a mix of pre-recorded lectures for asynchronous learning and interactive sessions for applied, synchronous learning. The curriculum was designed to cycle twice over the course of the two-year fellowship, with second-year fellows taking on greater teaching responsibilities to solidify their knowledge. Feedback was gathered from graduating fellows and used to iteratively refine the content and structure. Feedback from fellows during the first year of implementation was overwhelmingly positive, with evaluations indicating high satisfaction regarding the relevance, focus, and practical application of the content. Quantitative and qualitative feedback suggested that fellows found the internal curriculum more aligned with their learning goals compared to the prior external curriculum. Modifications were made based on fellow input to adjust the number and structure of interactive sessions, ensuring high-yield learning. This case study highlights the successful development and implementation of a customized clinical informatics curriculum at UC Irvine. The curriculum offers a more tailored, responsive, and comprehensive educational model, addressing both financial constraints and the need for a practical, focused learning experience. This initiative provides valuable insights and a potential framework for other institutions seeking to transition to an internal informatics curriculum.

Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership. This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians. From 2019 to 2023, 32 fellows have been accepted into the program with 13 graduates and 16 currently enrolled. Fellows have been predominately female, physicians, and from multiple specialties but predominantly hospital medicine. Fellows' evaluations of the fellowship are highly positive, rating the didactics and mentorship aspects of the curriculum most favorably. Most fellows' projects utilized informatics solutions including clinical decision support tools to increase quality of care, improve patient outcomes, and reduce costs of care resulting in manuscript publications, national presentations, and a national specialty society award. Since matriculation, 50% of fellows received certification as Epic Physician Builders and 34% received leadership positions in clinical informatics, quality, and education. Our experience supports the need to provide health care providers more expansive training in the areas of QI, clinical informatics, and leadership for improving health care delivery. Additional in-depth knowledge and experience in these fields may produce and benefit leaders in these fields.

Multitasking, defined as performing two or more interventions simultaneously, increases the cognitive burden of clinicians. This may, in turn, lead to higher risk of medication and procedural errors. Time motion study (TMS) data for nurses in nursing homes revealed an extensive amount of multitasking while managing medications. Further investigation of multitasked nursing interventions will provide a foundation for optimizing medication management workflows. Using a continuous observational TMS method, this study aimed to describe pairs of multitasked nursing interventions associated with medication management interventions, including preparing and administering medications, assessing medication effects, instructing on medications, and documenting medication administration. An external nurse observer used 57 predefined Omaha System nursing interventions embedded within TimeCaT (version 3.9), TMS data recording software to collect observation data in a single nursing home. A total of 120 hours of time-stamped observation data from nine nurses were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. The majority (74%) of medication management interventions were multitasked, resulting in 2,003 pairs of multitasked interventions. Of the 57 Omaha System nursing interventions, 35 were involved in these multitasking pairs. When nurses multitasked, the average duration of medication preparation was longer (non-multitasked: 81 seconds; multitasked: 162 seconds, p < 0.05), while the average duration of medication administration record documentation was shorter (non-multitasked: 93 seconds; multitasked: 66 seconds, p < 0.05). The findings reveal the complexity of medication management in nursing homes with numerous and diverse multitasking pairs. Findings provide a platform for in-depth study of medication management multitasking in the clinical context, and inform future efforts to create clinical and informatics solutions to optimize medication management workflow. This method may be also applied to examine medication management and multitasking in other clinical settings.

There is growing recognition of the need to incorporate informatics education in U.S. residencies. Medical residency training programs are critical in shaping system change and can play a pivotal role by incorporating clinical informatics (CI) based learning into their training requirements. We searched the Accreditation Council for Graduate Medical Education (ACGME) Residency Program Requirements effective July 1, 2023, to assess the inclusion of CI topics for all medical residency specialties to assess the relative levels of CI knowledge expected by graduates. We performed independent full-text search queries of 23 informatics-related keywords (e.g., electronic health record, innovation, database) in the ACGME Residency Program Requirements of 24 medical specialties. All specialties' requirements contained at least five different keywords, with the total count ranging from 25 to 42 (mean: 32.00; standard deviation: 5.09). Pathology contained the highest counts with 42, followed by internal medicine and family medicine with 41 each. Pathology included the most distinct keywords (11). The most common keywords were "leadership" (62%) and "electronic health record" (10%). There were no specific mentions of several keywords-including "analytics," "artificial intelligence," and "machine learning"-within any program requirements. Although the ACGME Residency Program Requirements state that residents must demonstrate competence in using information technology to optimize learning, the extent is not fully specified; only 10 programs mention the keyword "information technology" within their specialty guidelines. The integration of CI education varies across specialties and may be even more variable across programs. Our study highlights potential opportunities for further standardization and integration of CI into resident curriculum requirements in order to better prepare future physician workforces for a changing medical landscape. We encourage educators, residency review committees, and national specialty organizations to consider further exploring the incorporation of CI content into residency training program requirements.

Telemetry monitoring is crucial for high-risk patients but excessive use beyond practice standards increases costs. Prior studies have shown that electronic health record (EHR) alerts reduce low-value telemetry monitoring. However, specific components of these alerts that contribute to effectiveness are unknown. We aimed to revise previously implemented EHR Best Practice Advisories (BPAs) to optimize their effectiveness in reducing telemetry duration. The secondary objective was to assess the impact on clinicians' alert burden. A multicenter retrospective study was conducted at Johns Hopkins Hospital (JHH), Johns Hopkins Bayview Medical Center (JHBMC), and Howard County General Hospital (HCGH). An EHR alert in the form of a BPA was previously implemented at JHH/JHBMC, firing at 24, 48, or 72 hours based on order indication. HCGH used an alert firing every 24 hours. A revised BPA was implemented at all hospitals optimizing the prior JHH/JHBMC alert by including patient-specific telemetry indications, restricting alerts to daytime hours (8:00 a.m.-6:00 p.m.), and embedding the discontinuation order within the BPA alert. A retrospective analysis from October 2018 to December 2021 was performed. The primary outcome was telemetry duration. The secondary outcome was the mean monthly BPA alerts per patient-day. Compared with the original BPA, the revised BPA reduced telemetry duration by a mean of 6.7 hours (95% CI: 5.2-9.1 hours, p < 0.001) at JHH/JHBMC, with a minimal increase of 0.06 mean monthly BPA alerts per patient-day (p < 0.001). The BPA acceptance rate increased from 7.8 to 31.3% postintervention at JHH/JHBMC (p < 0.0001). At HCGH, the intervention led to a mean monthly reduction of 20.2 hours in telemetry duration per hospitalization (95% CI: 19.1-22.8 hours, p < 0.0001). Optimizing EHR BPAs reduces unnecessary telemetry duration without substantially increasing clinician alert burden. This study highlights the importance of tailoring EHR alerts to enhance effectiveness and promote value-based care.

Clinical decision support systems (CDSSs) are computer applications, which can be applied to give guidance to practitioners in antimicrobial stewardship (AS) activities; however, further information is needed for their optimal use. Our objective was to analyze the implementation of a CDSS program in a second-level hospital, describing alerts, recommendations, and the effects on consumption and clinical outcomes. In October 2020, a pharmacist-driven CDSS designed for AS was implemented in a second-level hospital. The program provides a list of alerts related to antimicrobial treatment and microbiology, which were automatized for revision by the AS professionals. To analyze the implementation of the CDSS, a pre-post-intervention, retrospective study was designed. AS-triggered alerts and recommendations (total number and rate of acceptance) were compiled. The effect of the CDSS was measured using antimicrobial consumption, duration of antimicrobial treatments, in-hospital mortality, and length of stay (LOS) for patients admitted for infectious causes. The AS team revised a total of 7,543 alerts and 772 patients had at least one recommendation, with an acceptance rate of 79.3%. Antimicrobial consumption decreased from 691.1 to 656.8 defined daily doses (DDD)/1,000 beds-month (p = 0.04) and the duration of antimicrobial treatment from 3.6 to 3.3 days (p < 0.01). In-hospital mortality decreased from 6.6 to 6.2% (p = 0.46) and mean LOS from 7.2 to 6.2 days (p < 0.01). The implementation of a CDSS resulted in a significant reduction of antimicrobial DDD, duration of antimicrobial treatments, and hospital LOS. There was no significant difference in mortality.