Background:   Academic medical centers are complex healthcare delivery systems that are quickly adopting electronic health records (EHR) nationwide while still using alpha-numeric paging for physicians-in-training raised with cell phones, texting, messaging, and newer technologies.  Understanding workflow processes for these providers of patient care are key to finding solutions to improve healthcare quality and safety.   [...]

Background: One of the widely reported benefits of electronic health records (EHRs) is the ability to alert clinicians, especially regarding medication-related safety issues. However, soon after the installation of EHRs, the phenomenon of “alert fatigue” was realized. The Agency for Healthcare Research and Quality has shown clinicians override the vast majority of computerized physician order [...]

Background: Despite widespread mandated use of Electronic Health Records (EHR), many residency programs struggle to find the best strategy to conduct EHR training. Traditional EHR training sessions are typically led by non-clinical IT staff and are often structured around software functionalities rather than clinical workflow. Furthermore, EHR training is often not customized to the needs [...]

Background: EHR time motion studies have shown a significant time burden and concern that bedside manner, physical exam skills and physician wellness are at risk. However, nearly all studies to date have only focused on practicing physicians and residency training programs. Nearly all U.S. based medical schools allow medical student access, thus EHR exposure actually [...]

Background: Timely identification and treatment are integral to sepsis management in emergency department (ED) and inpatient settings. Increasingly, automated alerts embedded in electronic health records (EHRs) are used to expedite sepsis detection but may lead to false alarms and increased alarm fatigue. Additionally, recent data have demonstrated that the EPIC Sepsis Model—a proprietary sepsis alert [...]

Background: Intubation is both an important outcome measure along the spectrum of all respiratory illnesses and a marker of disease severity. Time of intubation (TOI) is an important point to identify in the electronic health record (EHR) as it allows researchers to study the association of pre and post-intubation variables with mortality and other relevant [...]

Background: In the inpatient setting, opioids are the most commonly prescribed medication and the 2nd most frequent cause of adverse drug events (ADE).  Identifying patients at high risk for ADEs related to narcotics is essential.  These ADEs include ileus, altered mental status, and respiratory depression. Obstructive sleep apnea, organ impairment, and other medication use (i.e. [...]

Background: Sepsis is the leading cause of death in US hospitals; prompt recognition and treatment are critical. Early sepsis recognition and treatment varies depending on location (ED/floor/ICU) and evaluation time (presentation vs during stay). “Sepsis response teams” (SRT) improve sepsis care. After our hospital system implemented a “best-practice alert” utilizing Epic’s “sepsis score” (SS) to [...]

Background: Interventions to improve inpatient sleep rely on the ability to objectively quantify sleep; however existing methods of measurement (wrist actigraphy and patient survey) are resource intensive and impose a burden on patients. To overcome these barriers, we developed “sleep opportunity” (SLOP), a surrogate metric for sleep derived solely from the electronic health record (EHR). [...]

Background: The Centers for Disease Control and Prevention (CDC) estimates over 1.2 million Americans are living with HIV (human immunodeficiency virus). Of those, approximately 14% are unaware of their HIV-positive status. In 2014, most hospitals adopted some form of Electronic Health Records (EHR) and one year later, the Centers for Medicare & Medicaid Services extended [...]