Predicting 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 demandMachineValidatingPatientsInterrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder
Holland WC, Nath B, Li F, Maciejewski K, Paek H, Dziura J, Rajeevan H, Lu CC, Katsovich L, D'Onofrio G, Melnick ER. Interrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder. Academic Emergency Medicine 2020, 27: 753-763. PMID: 32352206, PMCID: PMC7496559, DOI: 10.1111/acem.14002.Peer-Reviewed Original ResearchConceptsOpioid use disorderComputerized clinical decision support systemsRates of EDBUP initiationUse disordersClinical decision support implementationEmergency department initiationRoutine emergency careInterrupted time series studyAdult ED patientsInterrupted time seriesClinical decision support systemElectronic health recordsClinicians' unfamiliarityED initiationDecision support implementationED dischargeOpioid withdrawalSecondary outcomesOngoing trialsPrimary outcomeAcademic EDED patientsSingle EDUnique patientsProgress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder †
Melnick ER, Nath B, Ahmed OM, Brandt C, Chartash D, Dziura JD, Hess EP, Holland WC, Hoppe JA, Jeffery MM, Katsovich L, Li F, Lu CC, Maciejewski K, Maleska M, Mao JA, Martel S, Michael S, Paek H, Patel MD, Platts-Mills TF, Rajeevan H, Ray JM, Skains RM, Soares WE, Deutsch A, Solad Y, D’Onofrio G. Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder †. Journal Of Psychiatry And Brain Science 2020, 2: e200003. PMID: 32309637, PMCID: PMC7164817, DOI: 10.20900/jpbs.20200003.Peer-Reviewed Original ResearchBuprenorphine/naloxoneOpioid use disorderClinical decision supportPragmatic trialElectronic health recordsUse disordersEmergency Department-Initiated BuprenorphineMulti-centre pragmatic trialRoutine emergency careHealthcare systemRates of EDNaloxone prescribingPilot testingSingle EDEmergency departmentPhysicians' perceptionsEmergency careMortality rateEarly identificationComputable phenotypeUnique physiciansInformed consentCare paradigmHealth recordsIntervention effectivenessUser 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 patientsPragmatic 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 considerationsTrialistsTrialsAnalysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover
Melnick ER, Fong A, Nath B, Williams B, Ratwani RM, Goldstein R, O’Connell R, Sinsky CA, Marchalik D, Mete M. Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover. JAMA Network Open 2021, 4: e2128790. PMID: 34636911, PMCID: PMC8511970, DOI: 10.1001/jamanetworkopen.2021.28790.Peer-Reviewed Original ResearchConceptsElectronic health recordsPhysician turnoverRetrospective cohort studyElectronic health record usePractice networkPhysician productivityWarrants further investigationCohort studyEHR timeAge 45Care teamPhysician departurePhysician ordersMAIN OUTCOMEHigh riskPatient timeAmbulatory physiciansPatient volumeUnique physiciansRecord useEHR useHealth care organizationsPhysiciansHealth recordsClinical timeCharacterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis
Melnick ER, Ong SY, Fong A, Socrates V, Ratwani RM, Nath B, Simonov M, Salgia A, Williams B, Marchalik D, Goldstein R, Sinsky CA. Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis. Journal Of The American Medical Informatics Association 2021, 28: 1383-1392. PMID: 33822970, PMCID: PMC8279798, DOI: 10.1093/jamia/ocab011.Peer-Reviewed Original ResearchConceptsElectronic health recordsEHR timeCross-sectional analysisAmbulatory physiciansPatient timeHealth systemClinical hoursHours of patientsMedStar Health systemYale-New HavenObstetrics/gynecologyNeurology/psychiatryMultivariable analysisPhysician genderCertain medical specialtiesPhysical medicineFemale physiciansEHR usePhysiciansHealth recordsHealthcare systemMedical specialtiesHoursSpecialtiesGenderQuantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine
Li H, Rotenstein L, Jeffery M, Paek H, Nath B, Williams B, McLean R, Goldstein R, Nuckols T, Hoq L, Melnick E. Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine. Journal Of General Internal Medicine 2023, 39: 557-565. PMID: 37843702, PMCID: PMC10973284, DOI: 10.1007/s11606-023-08428-5.Peer-Reviewed Original ResearchElectronic health recordsWork relative value unitsPhysician genderPractice characteristicsWomen physiciansMen physiciansGeneral internal medicine physiciansEHR useInternal medicine physiciansPhysician productivityGeneral internal medicineMultivariable adjustmentPatient counselingCare discussionsPhysician ageClinical activityMedicine physicians