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Article ; Online: Potential Value of Concurrent Implementation of Regulatory Measures and Electronic Interventions.

Salmasian, Hojjat

JAMA network open

2022 Volume 5, Issue 5, Page(s) e229730

MeSH term(s)	Electronics ; Humans ; Quality Improvement
Language	English
Publishing date	2022-05-02
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.9730
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Article ; Online: Transforming Otoscopy Using Artificial Intelligence.

Salmasian, Hojjat / Biggs, Lisa

JAMA pediatrics

2024 Volume 178, Issue 4, Page(s) 343–344

MeSH term(s)	Humans ; Artificial Intelligence ; Otoscopy
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2024.0021
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Article ; Online: Using the Electronic Health Record User Context in Clinical Decision Support Criteria.

Salmasian, Hojjat / Rubins, David / Bates, David W

Applied clinical informatics

2022 Volume 13, Issue 4, Page(s) 910–915

Abstract: Background: Computerized clinical decision support (CDS) used in electronic health record systems (EHRs) has led to positive outcomes as well as unintended consequences, such as alert fatigue. Characteristics of the EHR session can be used to restrict ... ...

Abstract	Background: Computerized clinical decision support (CDS) used in electronic health record systems (EHRs) has led to positive outcomes as well as unintended consequences, such as alert fatigue. Characteristics of the EHR session can be used to restrict CDS tools and increase their relevance, but implications of this approach are not rigorously studied. Objectives: To assess the utility of using "login location" of EHR users-that is, the location they chose on the login screen-as a variable in the CDS logic. Methods: We measured concordance between user's login location and the location of the patients they placed orders for and conducted stratified analyses by user groups. We also estimated how often login location data may be stale or inaccurate. Results: One in five CDS alerts incorporated the EHR users' login location into their logic. Analysis of nearly 2 million orders placed by nearly 8,000 users showed that concordance between login location and patient location was high for nurses, nurse practitioners, and physician assistance (all >95%), but lower for fellows (77%) and residents (55%). When providers switched between patients in the EHR, they usually did not update their login location accordingly. Conclusion: CDS alerts commonly incorporate user's login location into their logic. User's login location is often the same as the location of the patient the user is providing care for, but substantial discordance can be observed for certain user groups. While this may provide additional information that could be useful to the CDS logic, a substantial amount of discordance happened in specific user groups or when users appeared not to change their login location across different sessions. Those who design CDS alerts should consider a data-driven approach to evaluate the appropriateness of login location for each use case.
MeSH term(s)	Decision Support Systems, Clinical ; Electronic Health Records ; Humans ; Physicians
Language	English
Publishing date	2022-09-28
Publishing country	Germany
Document type	Journal Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0042-1756426
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Article ; Online: The glaring omission in hospital ranking and quality grading programs: emergency department boarding.

Weiner, Scott G / Salmasian, Hojjat / Mendu, Mallika L

International journal for quality in health care : journal of the International Society for Quality in Health Care

2021 Volume 33, Issue 4

Abstract: Hospitals in the United States are assessed and ranked by several agencies and services, including U.S. News & World Report. Frequently, though, the key hospital throughput metric of inpatient boarding time in the emergency department (ED) is not ... ...

Abstract	Hospitals in the United States are assessed and ranked by several agencies and services, including U.S. News & World Report. Frequently, though, the key hospital throughput metric of inpatient boarding time in the emergency department (ED) is not considered when ranking hospitals. As a result, there is a discordance in which highly ranking hospitals may be poor performers in boarding of patients, a practice with known adverse safety effects. This article outlines the rationale for considering ED boarding in hospital ranking and quality assessments.
MeSH term(s)	Emergency Service, Hospital ; Hospitals ; Humans ; Inpatients ; Length of Stay ; Patient Admission ; Retrospective Studies ; United States
Language	English
Publishing date	2021-11-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1194150-9
ISSN	1464-3677 ; 1353-4505
ISSN (online)	1464-3677
ISSN	1353-4505
DOI	10.1093/intqhc/mzab156
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Article: Obesity is not associated with adverse outcomes among hospitalized patients with Clostridioides difficile infection.

Malick, Alyyah / Wang, Ying / Axelrad, Jordan / Salmasian, Hojjat / Freedberg, Daniel

Gut pathogens

2022 Volume 14, Issue 1, Page(s) 7

Abstract: Background: Obesity is associated with increased risk for death in most infections but has not been studied as a risk factor for mortality in Clostridioides difficile infection (CDI). This study tested obesity as a risk factor for death in patients ... ...

Abstract	Background: Obesity is associated with increased risk for death in most infections but has not been studied as a risk factor for mortality in Clostridioides difficile infection (CDI). This study tested obesity as a risk factor for death in patients hospitalized with CDI. This was a three-center retrospective study that included hospitalized adults with CDI at Columbia University Irving Medical Center, Brigham and Women's Hospital, and NYU Langone from 2010 to 2018. Multivariate logistic regression was used to assess the relationship between obesity, measured by body mass index, and death from any cause within 30 days after the index CDI test. Results: Data for 3851 patients were analyzed, including 373 (9.7%) who died within 30 days following a diagnosis of CDI. After adjusting for other factors, BMI was not associated with increased risk for death in any BMI category [adjusted OR (aOR) 0.96, 95% CI 0.69 to 1.34 for BMI > 30 vs BMI 20-30; aOR 1.02, 95% CI 0.53 to 1.87 for BMI > 40 vs BMI 20-30]. After stratifying into three groups by age, there were trends towards increased mortality with obesity in the middle-aged (56-75 vs ≤ 55 years old) yet decreased mortality with obesity in the old (> 75 vs ≤ 55) (p = NS for all). Advanced age and low albumin were the factors most strongly associated with death. Conclusions: We found no association between obesity and death among patients with CDI, in contrast to most other infections. Obesity is not likely to be useful for risk-stratifying hospitalized patients with CDI.
Language	English
Publishing date	2022-01-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2478277-4
ISSN	1757-4749
ISSN	1757-4749
DOI	10.1186/s13099-022-00479-z
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Article ; Online: A Description of the Variation in Quality and Patient Safety Structures Within a Health System.

Myers, Laura C / Salmasian, Hojjat / Iannaccone, Christine / Frits, Michelle L / Volk, Lynn A / Bates, David W / Mort, Elizabeth

Joint Commission journal on quality and patient safety

2023 Volume 49, Issue 5, Page(s) 285–287

MeSH term(s)	Humans ; Patient Safety ; Quality of Health Care
Language	English
Publishing date	2023-01-29
Publishing country	Netherlands
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2023.01.011
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Article: Using the Electronic Health Record User Context in Clinical Decision Support Criteria

Salmasian, Hojjat / Rubins, David / Bates, David W.

Applied Clinical Informatics

2022 Volume 13, Issue 04, Page(s) 910–915

Abstract	Background: Computerized clinical decision support (CDS) used in electronic health record systems (EHRs) has led to positive outcomes as well as unintended consequences, such as alert fatigue. Characteristics of the EHR session can be used to restrict CDS tools and increase their relevance, but implications of this approach are not rigorously studied. Objectives: To assess the utility of using “login location” of EHR users—that is, the location they chose on the login screen—as a variable in the CDS logic. Methods: We measured concordance between user's login location and the location of the patients they placed orders for and conducted stratified analyses by user groups. We also estimated how often login location data may be stale or inaccurate. Results: One in five CDS alerts incorporated the EHR users' login location into their logic. Analysis of nearly 2 million orders placed by nearly 8,000 users showed that concordance between login location and patient location was high for nurses, nurse practitioners, and physician assistance (all >95%), but lower for fellows (77%) and residents (55%). When providers switched between patients in the EHR, they usually did not update their login location accordingly. Conclusion: CDS alerts commonly incorporate user's login location into their logic. User's login location is often the same as the location of the patient the user is providing care for, but substantial discordance can be observed for certain user groups. While this may provide additional information that could be useful to the CDS logic, a substantial amount of discordance happened in specific user groups or when users appeared not to change their login location across different sessions. Those who design CDS alerts should consider a data-driven approach to evaluate the appropriateness of login location for each use case.
Keywords	clinical decision support ; electronic health record ; alert fatigue ; health care quality
Language	English
Publishing date	2022-08-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0042-1756426
Database	Thieme publisher's database

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Article ; Online: Low Efficacy of Medication Shortage Clinical Decision Support Alerts.

Benson, Nicole M / Belisle, Caryn / Bates, David W / Salmasian, Hojjat

Applied clinical informatics

2021 Volume 12, Issue 5, Page(s) 1144–1149

Abstract: Objective: We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations.: Materials and methods: We conducted a ... ...

Abstract	Objective: We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations. Materials and methods: We conducted a retrospective analysis of the usage of medication shortage alerts (MSAs) that included at least one alternative medication suggestion and were active for 60 or more days during the 2-year study period, January 1, 2018 to December 31, 2019, in a large health care system. We characterized ordering provider behavior in response to inpatient MSAs. We then developed a linear regression model to predict provider response to alerts using the characteristics of the ordering provider and alert frequency groupings. Results: During the study period, there were 67 MSAs in use that focused on 42 distinct medications in shortage. The MSAs suggested an average of 3.9 alternative medications. Adjusting for the different alerts, fellows ( Conclusion: Our findings demonstrate that providers tended to reject MSAs, even those who were sometimes flexible about their responses. The low overall acceptance rate supports the theory that alerts appearing at the time of order entry may have limited value, as they may be presented too late in the decision-making process. Though MSAs are designed to be attention-grabbing and higher impact than traditional CDS, our findings suggest that providers rarely change their clinical decisions when presented with these alerts.
MeSH term(s)	Decision Support Systems, Clinical ; Female ; Humans ; Male ; Medical Order Entry Systems ; Retrospective Studies
Language	English
Publishing date	2021-12-01
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0041-1740257
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Article ; Online: Early Expected Discharge Date Accuracy During Hospitalization: A Multivariable Analysis.

Piniella, Nicholas R / Fuller, Theresa E / Smith, Laura / Salmasian, Hojjat / Yoon, Cathy S / Lipsitz, Stuart R / Schnipper, Jeffrey L / Dalal, Anuj K

Journal of medical systems

2023 Volume 47, Issue 1, Page(s) 63

Abstract: Introduction: Accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning.: Methods: We conducted a retrospective study of patients discharged from six general medicine units ...

Abstract	Introduction: Accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning. Methods: We conducted a retrospective study of patients discharged from six general medicine units at an academic medical center in Boston, MA from January 2017 to June 2018. We retrieved all EDD entries and patient, encounter, unit, and provider data from the electronic health record (EHR), and public weather data. We excluded patients who expired, discharged against medical advice, or lacked an EDD within the first 24 h of hospitalization. We used generalized estimating equations in a multivariable logistic regression analysis to model early EDD accuracy (an accurate EDD entered within 24 h of admission), adjusting for all covariates and clustering by patient. We similarly constructed a secondary multivariable model using covariates present upon admission alone. Results: Of 3917 eligible hospitalizations, 890 (22.7%) had at least one accurate early EDD entry. Factors significantly positively associated (OR > 1) with an accurate early EDD included clinician-entered EDD, admit day and discharge day during the work week, and teaching clinical units. Factors significantly negatively associated (OR < 1) with an accurate early EDD included Elixhauser Comorbidity Index ≥ 11 and length of stay of two or more days. C-statistics for the primary and secondary multivariable models were 0.75 and 0.60, respectively. Conclusions: EDDs entered within the first 24 h of admission were often inaccurate. While several variables from the EHR were associated with accurate early EDD entries, few would be useful for prospective prediction.
MeSH term(s)	Humans ; Patient Discharge ; Retrospective Studies ; Prospective Studies ; Hospitalization ; Academic Medical Centers ; Length of Stay
Language	English
Publishing date	2023-05-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	423488-1
ISSN	1573-689X ; 0148-5598
ISSN (online)	1573-689X
ISSN	0148-5598
DOI	10.1007/s10916-023-01952-1
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Article ; Online: Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial.

Kneifati-Hayek, Jerard Z / Applebaum, Jo R / Schechter, Clyde B / Dal Col, Alexis / Salmasian, Hojjat / Southern, William N / Adelman, Jason S

Journal of the American Medical Informatics Association : JAMIA

2023 Volume 30, Issue 5, Page(s) 953–957

Abstract: A prior randomized controlled trial (RCT) showed no significant difference in wrong-patient errors between clinicians assigned to a restricted electronic health record (EHR) configuration (limiting to 1 record open at a time) versus an unrestricted EHR ... ...

Abstract	A prior randomized controlled trial (RCT) showed no significant difference in wrong-patient errors between clinicians assigned to a restricted electronic health record (EHR) configuration (limiting to 1 record open at a time) versus an unrestricted EHR configuration (allowing up to 4 records open concurrently). However, it is unknown whether an unrestricted EHR configuration is more efficient. This substudy of the RCT compared clinician efficiency between EHR configurations using objective measures. All clinicians who logged onto the EHR during the substudy period were included. The primary outcome measure of efficiency was total active minutes per day. Counts were extracted from audit log data, and mixed-effects negative binomial regression was performed to determine differences between randomized groups. Incidence rate ratios (IRRs) were calculated with 95% confidence intervals (CIs). Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively; IRR, 0.99; 95% CI, 0.93-1.06), overall or by clinician type and practice area.
MeSH term(s)	Humans ; Electronic Health Records ; Medical Errors/prevention & control
Language	English
Publishing date	2023-04-03
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocad025
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