Description

An onsite recording of this session will be included in the Symposium OnDemand offering. 

Integrated Hands-Free Electronic Patient Care Report (ePCR) Charting (IHeC): Designing the Architecture

Presentation Time: 10:30 AM - 10:45 AM

Abstract Keywords: Documentation Burden, Natural Language Processing, Transitions of Care, Patient Safety
Primary Track: Applications
Programmatic Theme: Clinical Informatics

The nature of paramedic workloads typically results in incomplete or lack of patient care reports on patient handover to emergency department staff. Patient information gaps can increase emergency department staff's workload, cause care delays, and increase risks of adverse events. An integrated hands-free electronic patient care report (ePCR) could eliminate this gap. We conducted an environmental scan of the available literature on technologies to improve paramedic documentation and current advanced paramedic charting systems. Two technologies, speech recognition documentation and live telemetry sharing systems, were identified as potential improvements. A theoretical architecture for an integrated hands-free ePCR charting (IHeC) system was developed by combining these technologies. The ePCR could be completed and available upon patient arrival at the hospital using speech recognition and vital sign-sharing technology. The IHeC system could solve the problem of patient information gaps and provide a platform for more advanced integration of paramedic services.

Speaker(s):
Desmond Hedderson, BSc, MSc student
University of Victoria, school of Health Information Science

Author(s):
Desmond Hedderson, BSc, MSc student - University of Victoria, school of Health Information Science; Claudia Lai, PhD - University of Victoria;

Automating and Evaluating LLM-Generated ED Handoff Notes

Presentation Time: 10:45 AM - 11:00 AM

Abstract Keywords: Large Language Models (LLMs), Documentation Burden, Transitions of Care, Evaluation, Natural Language Processing, Machine Learning
Primary Track: Applications
Programmatic Theme: Clinical Informatics

It has been burdensome for physicians to review and document large unstructured clinical data. We develop a summarization system that automatically generates Emergency Medicine handoff notes using LLMs, specifically designed for text generation in the clinical domain. We also propose a novel clinical evaluation rubric focused on the quality and safety of generated texts. The evaluation results show the effectiveness of the proposed framework.

Speaker(s):
Xinyuan Zhang, PhD
Abstractive Health

Vince Hartman, MS, Information Systems
Abstractive Health

Author(s):
Vince Hartman, MS, Information Systems - Abstractive Health; Thomas Campion, PhD - Weill Cornell Medicine; Xinyuan Zhang, Ph.D. - Abstractive Health; Ritika Poddar, MS, Information Systems - Abstractive Health; Evan Sholle, MS - Weill Cornell Medical College; Peter Steel, MA, MBBA - NewYork-Presbyterian Weill Cornell Medicine; Alexander Fortenko, MD, MPH - NewYork-Presbyterian Weill Cornell Medicine; Matthew McCarty, MD - NewYork-Presbyterian Weill Cornell Medicine;

Standardized documentation of nursing communication with advanced providers identifies evident and occult hypoxemia

Presentation Time: 11:00 AM - 11:15 AM

Abstract Keywords: Nursing Informatics, Clinical Decision Support, Documentation Burden
Primary Track: Applications
Programmatic Theme: Clinical Research Informatics

Introduction: We hypothesized that nursing documentation may increase when hypoxemia is present, but undetected by the pulse oximeter, in events termed “occult hypoxemia.”
Methods: We conducted a retrospective study of patients with COVID-19 at five hospitals in a healthcare system with paired SpO2 and SaO2 readings (measurements within 10 minutes of oxygen saturation levels in arterial blood, SaO2, and by pulse oximetry, SpO2). We applied multivariate logistic regression to assess if having any nursing documentation of provider notification in the four hours prior to a paired reading confirming occult hypoxemia was more likely compared to a paired reading confirming normal oxygen status.
Results: Among the 1,910 patients with 44,972 paired readings, having any nursing documentation of provider notification was 46% more common in the 4 hours before an occult hypoxemia paired reading compared to a normal oxygen status paired reading (OR 1.46, 95% CI: 1.28-1.67), and 84% more common before an evident hypoxemia paired reading (OR 1.84, 95% CI: 1.62-2.09).
Discussion This study finds that nursing documentation of provider notification significantly increases prior to confirmed occult hypoxemia, which has potential in proactively identifying occult hypoxemia and other clinical issues.

Speaker(s):
Kelly Gleason, PhD, RN
Johns Hopkins University

Author(s):
Alberta Tran, PhD, RN - MedStar; Ashraf Fawzy, MD, PhD - Johns Hopkins School of Medicine; Li Yan, PhD - Johns Hopkins University; Holley Farley, MSN - Nursing Coordinator for Clinical Quality; Brian Garibaldi, MD - Johns Hopkins School of Medicine; Theodore Iwashyna, MD, PhD - Johns Hopkins;

Ambient AI Scribes: Utilization and Impact on Documentation Practice

Presentation Time: 11:15 AM - 11:30 AM

Abstract Keywords: Documentation Burden, Large Language Models (LLMs), Informatics Implementation
Primary Track: Applications
Programmatic Theme: Clinical Informatics

This study examines the initial implementation and evaluation of an ambient digital scribe powered by large language models at Stanford Health Care. During the 3-month pilot period, the tool was utilized for over half of the encounters and resulted in decreased time spent on clinical documentation. Adoption of the tool and the resulting documentation practices varied between physicians, suggesting a need for further development of this technology to accommodate personal preferences to maximize its potential.

Speaker(s):
Stephen Ma, MD, PhD
Stanford University School of Medicine

Author(s):
Shreya Shah, MD - Stanford University; Margaret Smith, MBA - Stanford School of Medicine; April Liang, MD - Stanford University; Betsy Yang, MD - Stanford University; Yejin Jeong, BA - Stanford University; Anna Devon-Sand, MPH - Stanford University; Trevor Crowell, BA - Stanford University; Clarissa Delahaie, BAS - Stanford Health Care; Caroline Hsia, MEng - Stanford Health Care; Steven Lin, MD - Stanford University School of Medicine; Michael Pfeffer, MD - Stanford University; Christopher Sharp, MD - Stanford University School of Medicine; Patricia Garcia, MD - Stanford University, School of Medicine;

A Web-based Interface for Visualizing and Documenting SEEG Strategic Planning (WISP): Development and Qualitative Evaluation

Presentation Time: 11:30 AM - 11:45 AM

Abstract Keywords: Informatics Implementation, Clinical Decision Support, Documentation Burden, Information Visualization, Usability, Knowledge Representation and Information Modeling, Surgery, Workflow
Primary Track: Applications
Programmatic Theme: Clinical Informatics

WISP stands as an efficacious solution to the challenges associated with Stereoelectroencephalography (SEEG) strategic planning, offering lightweight and interactive web interfaces for rendering multiple brain views. These interfaces facilitate collaborative engagement among care team members across various disciplines during patient case conferences and SEEG strategic planning sessions. Moreover, WISP incorporates a collaborative electrode and electrode group library, serving as a standardized repository of knowledge. The application enables seamless conversion of case conference outcomes and SEEG plans into images and PDF files, with transmission to Electronic Health Record (EHR) systems through a customized HL7 engine. The initial assessment findings demonstrate WISP provides good usability according to the System Usability Scale (SUS) score, with physicians exhibiting a clear preference for its utilization over conventional approaches to case conference documentation and SEEG planning. Furthermore, physicians have actively embraced WISP in their collaborative sessions, indicating its seamless integration into their clinical workflows.

Speaker(s):
Shiqiang Tao, PhD
The University of Texas Health Science Center at Houston

Author(s):
Wei-Chun Chou, M.S; Johnson P. Hampson, MSBME - The University of Texas Health Science Center; Antarr T. Byrd, MS - The University of Texas Health Science Center at Houston; Lhatoo Samden, MD, FRCP - The University of Texas Health Science Center; GQ Zhang, PhD - The University of Texas Health Science Center at Houston;

Assessing the Impact of EHR Documentation Burden on Health Information Exchange Use

Presentation Time: 11:45 AM - 12:00 PM

Abstract Keywords: Documentation Burden, Interoperability and Health Information Exchange, Causal Inference, Workflow
Primary Track: Applications
Programmatic Theme: Clinical Informatics

While electronic health record (EHR) documentation burden is known to be associated with reduced clinician well-being and burnout, it may have even worse unintended consequences if documentation work also crowds out other high-value EHR tasks. We examine this novel question by assessing the relationship between documentation burden and a high-value but optional EHR task – use of health information exchange (HIE) to view patient records from outside organizations. Our study takes advantage of an exogenous shock to documentation time, appointment no-shows. We find that documentation time has a strong impact on HIE use, with each additional hour spent documenting resulting in a 7.1 percent reduction in the proportion of a patients with an outside record viewed by the physician seeing them that day. This crowd out effect may explain why the US has yet to realize broad benefits from HIE and could also be true for other high-value EHR and non-EHR tasks as busy physicians simply lack time to incorporate them into their workflows. Our results point to the urgent need for policymakers to do more to reduce documentation burden.

Speaker(s):
A J Holmgren, PhD
University of California, San Francisco

Author(s):
Julia Adler-Milstein, PhD - UCSF School of Medicine; Nate Apathy, PhD - University of Maryland;