2024
Virtual Scribes and Physician Time Spent on Electronic Health Records
Rotenstein L, Melnick E, Iannaccone C, Zhang J, Mugal A, Lipsitz S, Healey M, Holland C, Snyder R, Sinsky C, Ting D, Bates D. Virtual Scribes and Physician Time Spent on Electronic Health Records. JAMA Network Open 2024, 7: e2413140. PMID: 38787556, PMCID: PMC11127114, DOI: 10.1001/jamanetworkopen.2024.13140.Peer-Reviewed Original ResearchConceptsEHR timeElectronic health recordsHealth recordsPhysician timePre-post quality improvement studyPrimary care specialtiesQuality improvement studyFactors associated with changesAssociated with significant decreasesAssociated with burnoutMultivariate linear regression modelAcademic medical centerCare specialtiesImprovement studyLinear regression modelsMedical specialistsMedical specialtiesOutpatient settingStudy sampleSignificant decreasePhysiciansMedical CenterParticipation episodesAppointmentWomen's HospitalFormative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol
Wong A, Nath B, Shah D, Kumar A, Brinker M, Faustino I, Boyce M, Dziura J, Heckmann R, Yonkers K, Bernstein S, Adapa K, Taylor R, Ovchinnikova P, McCall T, Melnick E. Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol. BMJ Open 2024, 14: e082834. PMID: 38373857, PMCID: PMC10882402, DOI: 10.1136/bmjopen-2023-082834.Peer-Reviewed Original ResearchConceptsComputerised clinical decision supportED treatRestraint useExperiences of restraint useMental health-related visitsEmergency departmentPrevent agitationSystems-related factorsImprove patient experienceClinical decision support systemsRegional health systemClinical decision supportDe-escalation techniquesRandomised controlled trialsFormative evaluationPeer-reviewed journalsBest-practice guidanceAt-risk populationsCDS toolsThematic saturationED cliniciansPatient experienceED sitesHealth systemED physiciansStructure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors
Patel T, Chaise A, Hanna J, Patel K, Kochendorfer K, Medford R, Mize D, Melnick E, Hron J, Youens K, Pandita D, Leu M, Ator G, Yu F, Genes N, Baker C, Bell D, Pevnick J, Conrad S, Chandawarkar A, Rogers K, Kaelber D, Singh I, Levy B, Finnell J, Kannry J, Pageler N, Mohan V, Lehmann C. Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors. Applied Clinical Informatics 2024, 15: 155-163. PMID: 38171383, PMCID: PMC10881258, DOI: 10.1055/a-2237-8309.Peer-Reviewed Original ResearchConceptsProgram directorsAmerican BoardCommunity health care systemAccreditation Council for Graduate Medical EducationAmerican Board of Medical SpecialtiesAdministrative supportFunding sourcesOnline REDCap surveyHealth care systemFunding modelsGraduate Medical EducationAmerican Board of Preventive MedicineHospital information technologyMedical education officeGraduate medical education officeSurvey of program directorsFellowship training programsFamily medicineFellowship program directorsEmergency medicineHealth systemSurveyed program directorsCare systemNational survey of program directorsInformatics practice
2023
Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder
Gao E, Melnick E, Paek H, Nath B, Taylor R, Loza A. Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder. JAMA Network Open 2023, 6: e2342786. PMID: 37948075, PMCID: PMC10638655, DOI: 10.1001/jamanetworkopen.2023.42786.Peer-Reviewed Original ResearchConceptsHealth care systemED initiationOpioid use disorderBuprenorphine initiationCare systemUse disordersEmergency Department-Initiated BuprenorphineSecondary analysisClinician's roleEmergency department initiationClinical decision support interventionClinical decision support toolProportional hazard modelingCare of patientsNetwork of cliniciansDecision support interventionsAdvanced practice practitionersDose-dependent mannerUnique cliniciansTime-dependent covariatesTrial interventionNonintervention groupED clustersMore effective interventionsNumber of exposuresWhy Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network
O'Connell R, Hosain F, Colucci L, Nath B, Melnick E. Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network. The Journal Of The American Board Of Family Medicine 2023, 36: 1050-1057. PMID: 37857441, DOI: 10.3122/jabfm.2023.230052r2.Peer-Reviewed Original ResearchIdentifying and Addressing Barriers to Implementing Core Electronic Health Record Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings
Levy D, Moy A, Apathy N, Adler-Milstein J, Rotenstein L, Nath B, Rosenbloom S, Kannampallil T, Mishuris R, Alexanian A, Sieja A, Hribar M, Patel J, Sinsky C, Melnick E. Identifying and Addressing Barriers to Implementing Core Electronic Health Record Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings. Applied Clinical Informatics 2023, 14: 944-950. PMID: 37802122, PMCID: PMC10686750, DOI: 10.1055/a-2187-3243.Peer-Reviewed Original ResearchCT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching.
Tu L, Navaratnam D, Melnick E, Forman H, Venkatesh A, Malhotra A, Yaesoubi R, Sureshanand S, Sheth K, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. American Journal Of Roentgenology 2023, 221: 836-845. PMID: 37404082, DOI: 10.2214/ajr.23.29617.Peer-Reviewed Original ResearchConceptsSecondary stroke prevention medicationsStroke prevention medicationsEmergency departmentPrevention medicationsEchocardiography evaluationPosterior circulation strokeProportion of patientsGroup of patientsPhysical examination findingsNeuroimaging resultsUse of MRIReview of systemsGreater frequencyPropensity-score matchingExamination findingsRetrospective studyED readmissionMedical historyHead CTClinical impactMRI examinationsBrain MRINeck CTADizzinessPatientsFentanyl-Associated Overdose Deaths Outside the Hospital
Jeffery M, Stevens M, D'Onofrio G, Melnick E. Fentanyl-Associated Overdose Deaths Outside the Hospital. New England Journal Of Medicine 2023, 389: 87-88. PMID: 37342960, PMCID: PMC10388669, DOI: 10.1056/nejmc2304991.Peer-Reviewed Original ResearchFunding Research on Health Workforce Well-being to Optimize the Work Environment
Melnick E, Sinsky C, Shanafelt T. Funding Research on Health Workforce Well-being to Optimize the Work Environment. JAMA 2023, 329: 1145-1146. PMID: 36821127, DOI: 10.1001/jama.2023.2073.Peer-Reviewed Original ResearchRacial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems
Holland W, Li F, Nath B, Jeffery M, Stevens M, Melnick E, Dziura J, Khidir H, Skains R, D'Onofrio G, Soares W. Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems. Academic Emergency Medicine 2023, 30: 709-720. PMID: 36660800, PMCID: PMC10467357, DOI: 10.1111/acem.14668.Peer-Reviewed Original ResearchConceptsOpioid use disorderCommunity emergency departmentsEmergency departmentDischarge diagnosisHealth care systemHispanic patientsBlack patientsHospital typeCare systemNon-Hispanic patientsOpioid overdose deathsClinical decision support systemOpioid withdrawalPrimary outcomeMedication treatmentBuprenorphine accessED treatmentTreatment accessOverdose deathsX-waiverBuprenorphinePatientsUse disordersEthnic disparitiesSecondary analysisPredicting physician departure with machine learning on EHR use patterns: A longitudinal cohort from a large multi-specialty ambulatory practice
Lopez K, Li H, Paek H, Williams B, Nath B, Melnick E, Loza A. Predicting physician departure with machine learning on EHR use patterns: A longitudinal cohort from a large multi-specialty ambulatory practice. PLOS ONE 2023, 18: e0280251. PMID: 36724149, PMCID: PMC9891518, DOI: 10.1371/journal.pone.0280251.Peer-Reviewed Original ResearchConceptsElectronic health recordsEHR use patternsHealthcare industryPhysician departureSHAP valuesHealth recordsPhysician characteristicsLongitudinal cohortPhysician ageRisk physiciansAmbulatory practiceTargeted interventionsAppropriate interventionsPhysiciansTop variablesDocumentation timePhysician turnoverPredictive modelHeavy burdenInterventionInboxPhysician demandMachineValidatingPatients
2022
Restoring Meaningful Content to the Medical Record: Standardizing Measurement Could Improve EHR Utility While Decreasing Burden
Iscoe MS, McLean RM, Melnick ER. Restoring Meaningful Content to the Medical Record: Standardizing Measurement Could Improve EHR Utility While Decreasing Burden. Mayo Clinic Proceedings 2022, 97: 1971-1974. PMID: 36210197, DOI: 10.1016/j.mayocp.2022.07.007.Peer-Reviewed Original ResearchConceptsMedical recordsUsing event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures
Rule A, Melnick ER, Apathy NC. Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures. Journal Of The American Medical Informatics Association 2022, 30: 144-154. PMID: 36173361, PMCID: PMC9748581, DOI: 10.1093/jamia/ocac177.Peer-Reviewed Original ResearchHospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic
Janke AT, Melnick ER, Venkatesh AK. Hospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic. JAMA Network Open 2022, 5: e2233964. PMID: 36178691, PMCID: PMC9526134, DOI: 10.1001/jamanetworkopen.2022.33964.Peer-Reviewed Original ResearchMonthly Rates of Patients Who Left Before Accessing Care in US Emergency Departments, 2017-2021
Janke AT, Melnick ER, Venkatesh AK. Monthly Rates of Patients Who Left Before Accessing Care in US Emergency Departments, 2017-2021. JAMA Network Open 2022, 5: e2233708. PMID: 36178693, PMCID: PMC9526078, DOI: 10.1001/jamanetworkopen.2022.33708.Peer-Reviewed Original ResearchEmergency physicians' EHR use across hospitals: A cross-sectional analysis
Iscoe MS, Holland ML, Paek H, Flood C, Melnick ER. Emergency physicians' EHR use across hospitals: A cross-sectional analysis. The American Journal Of Emergency Medicine 2022, 61: 205-207. PMID: 35842301, DOI: 10.1016/j.ajem.2022.07.014.Peer-Reviewed Original ResearchUser centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial
Melnick ER, Nath B, Dziura JD, Casey MF, Jeffery MM, Paek H, Soares WE, Hoppe JA, Rajeevan H, Li F, Skains RM, Walter LA, Patel MD, Chari SV, Platts-Mills TF, Hess EP, D'Onofrio G. User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. The BMJ 2022, 377: e069271. PMID: 35760423, PMCID: PMC9231533, DOI: 10.1136/bmj-2021-069271.Peer-Reviewed Original ResearchConceptsOpioid use disorderUsual care armEmergency departmentUse disordersCare armPragmatic clusterClinical decision supportIntervention armRoutine emergency careSecondary implementation outcomesSeverity of withdrawalTertiary care centerClinical decision support toolInitiation of buprenorphineElectronic health record tasksElectronic health record workflowsRE-AIM frameworkElectronic health record platformsHealth record platformsClinical decision support systemElectronic health recordsVisit documentationTreatment of addictionUsual careAdult patientsTrends and Disparities in Access to Buprenorphine Treatment Following an Opioid-Related Emergency Department Visit Among an Insured Cohort, 2014-2020
Stevens MA, Tsai J, Savitz ST, Nath B, Melnick ER, D’Onofrio G, Jeffery MM. Trends and Disparities in Access to Buprenorphine Treatment Following an Opioid-Related Emergency Department Visit Among an Insured Cohort, 2014-2020. JAMA Network Open 2022, 5: e2215287. PMID: 35657629, PMCID: PMC9166266, DOI: 10.1001/jamanetworkopen.2022.15287.Peer-Reviewed Original ResearchClinical decision support in cardiovascular medicine
Lu Y, Melnick ER, Krumholz HM. Clinical decision support in cardiovascular medicine. The BMJ 2022, 377: e059818. PMID: 35613721, DOI: 10.1136/bmj-2020-059818.Peer-Reviewed Original ResearchConceptsCardiovascular diseaseCardiovascular careEffectiveness of CDSRisk factor modificationClinical decision support toolQuality of careClinical decision supportClinical outcomesFactor modificationHealth information technologyClinical practicePatient careDiseaseCardiovascular medicineCDS effectivenessCareEffectiveness of deliveryMissed opportunityTreatmentFailureProper evidenceHealthcare processesMedicineEvidencePreventionPragmatic clinical trial design in emergency medicine: Study considerations and design types
Gettel CJ, Yiadom MYAB, Bernstein SL, Grudzen CR, Nath B, Li F, Hwang U, Hess EP, Melnick ER. Pragmatic clinical trial design in emergency medicine: Study considerations and design types. Academic Emergency Medicine 2022, 29: 1247-1257. PMID: 35475533, PMCID: PMC9790188, DOI: 10.1111/acem.14513.Peer-Reviewed Original ResearchConceptsPragmatic clinical trialsClinical trial designTrial designReal-world clinical practicePragmatic clinical trial designElectronic health recordsEmergency departmentClinical trialsStudy design typeClinical practiceStudy typeTrial componentsHealth recordsEmergency medicineEmergency medicine investigatorsHuman subjects concernsInvestigatorsStudy findingsStudy considerationsTrialistsTrials