EMR System Research Articles

Pilot to scale: Implementing a digital triage solution across a large comprehensive cancer centre.

225 Background: Princess Margaret Cancer Centre (PM) sees over 80,000 patients annually and primarily operates using an outpatient model. Historically patients use a phone/voicemail triage service to communicate with their care team between scheduled visits. Many patient queries lack critical information necessary for effective screening, assessment, and processing. In turn leading to delays or missed calls that negatively impact patient experience, system efficiency, and safety. To address these challenges, we piloted a digital triage service and subsequently implemented in sixteen clinics. This project evaluated initial adoption, usage, care patterns and satisfaction in the first 5 months post-implementation. Methods: We used human-centred service design to develop the digital triage service within the EMR (Epic). Implementation strategies to scale across all outpatient clinics included leadership buy-in, co-design with key stakeholders, a phased implementation approach, and improvement cycles. To evaluate initial adoption, usage and care patterns, we used EMR system data. To assess patient satisfaction, we surveyed patients who used the service during the first three months. We conducted semi-structured interviews with staff to understand their experience integrating digital triage into their workflow. Results: Following the go-live period, patients sent an average of 1096 digital requests per month, representing 16% of all triage requests (phone + digital). The most common requests were symptom management (36% of nursing requests) and appointment change requests (40% of administrative requests). The algorithm automatically routed 93% of requests to the most appropriate care team member, compared to 74% pre-implementation. When asked if they were satisfied with their experience, most patients agreed or were neutral (69% and 10%, respectively), while 21% disagreed. In semi-structured interviews, nurses and administrative staff described improved efficiency by having triage requests integrated within the EMR, while have challenges related to prioritizing requests across multiple channels (e.g. digital, phone, others). Conclusions: Digital triage is foundational for better cataloguing and understanding our patients' unmet needs at home and between visits, enabling a continuous learning process to understand when and why people struggle throughout their care journey. Ongoing analyses will explore disease site-specific trends, compare phone to digital triage, and identify differences between users of each method. The data will inform further improvement cycles on the build and workflows, while enabling appropriate resourcing of this critical service and shifts towards proactive care.

Incubation Periods of SARS-CoV-2 Wild-Type, Delta, and Omicron Variants–Dominant Periods in Singapore

This study in Singapore analysed the incubation periods of the following SARS-CoV-2 variants: Wuhan-Hu-1, Delta, and Omicron. Three pandemic waves were examined: Wuhan-Hu-1 (January 2020–March 2021), Delta (May–October 2021), and Omicron (January–June 2022). Data from the SingHealth COVID-19 registry, covering patients from 23 January 2020 to 10 June 2022, were used to calculate incubation periods during the three time periods. The study found median incubation periods of 11 days for Wuhan-Hu-1, 3 days for Delta, and 3 days for Omicron (p-value: <0.001). This study highlighted the impact of different containment measures and the importance of robust EMR systems for tracking and managing infectious diseases. Key challenges included accurate contact tracing and IT infrastructure capabilities. The findings support the use of EMR data for future infectious disease preparedness in Singapore.

Abstract B100: Improving access to hereditary cancer genetic testing in diverse populations: Outcomes in over 33,000 patients tested by genetics and non-genetics providers in Kaiser Permanente Southern California

Abstract Kaiser Permanente Southern California is an integrated health care organization serving over 4.7 million members in 14 medical centers. KPSC members are 42% Hispanic/Latino, 28 % Non-Hispanic White, 11% Asian/Pacific Islander, 8% Black/African American, and 12% Other/Unk. To facilitate detection of hereditary cancer syndromes among patients with personal and/or family histories of breast, colorectal, ovarian, pancreas and other cancers, we offered a 48-gene hereditary cancer multigene-panel test designed to detect all the most common hereditary cancer conditions. Patients seen by genetic counselors or geneticists (Gen providers) receive pre-test genetic counseling and include those with a family history of cancer with or without personal history of cancer. Our mainstreaming program allows non-genetics (non-Gen) providers including medical and surgical oncologists, gastroenterologists, and other specialists to order the test at the point of care (based on NCCN criteria) on their patients with cancer without pre-test genetic counseling. Providers place the order in the EMR system and patients receive an email/text message with information about the test, potential results, links to educational videos and a Genetics phone number for questions. When results are ready patients receive an automatic email/text notifying them and providing a link to their test report. Those with a positive test result receive post-test genetic counseling. Patients with negative or uncertain significance (VUS) results receive a message with a link to their test report, information about their result and the option to schedule a visit with genetics. From April 2021 to May 2024, we completed 33,173 tests: 13,076 (39%) ordered by non-Gen and 20,097 (61%) by Gen providers. The results distribution was similar in both groups: pathogenic/likely pathogenic (PV/LPV): 15% for Gen orders, 12% for non-Gen; VUS: 28% Gen, 30% non-Gen, and negative: 56% Gen, 58% Non-Gen. The patients tested closely reflected the diversity of our population, except for under-representation of Hisp/Latino patients and over-representation of Non-Hisp Whites: 14,400 (42%); Hisp/Latino 9,863 (29%); Asian/PI 4,279 (13%); AA/Black 3,209 (9%); and Oth/Unk 2,415 (7%). Eliminating single MUTYH variants the top 5 genes with the highest number and percentage of PV/LPV results for each of the race/ethnicity categories were as follows: AA/Black: BRCA2=60, BRCA1=38, ATM=36, MUTYH=18; Asian/PI: BRCA2=101, ATM=40, BRCA1=37, PMS2=24; Hisp/Latino: BRCA2=250, BRCA1=171, ATM=127, CHEK2=125; CDKN2A=113; Non Hisp White: CHEK2=346; BRCA2=304; ATM=200, BRCA1=196, FH=100; Oth/Unk: BRCA2=50, BRCA1=41, CHEK2=40, PALB2=30, ATM=20. Our results represent one of the largest and most diverse patient cohorts completing hereditary cancer testing from a single institution. They indicate that mainstreaming hereditary cancer testing can improve access for patients from under-represented groups and suggest differences in the frequency of deleterious variants in different hereditary cancer genes across race/ethnic groups. Citation Format: Monica Alvarado, Trevor Hoffman, Reina Haque, Hilary Kershberg, John Goff. Improving access to hereditary cancer genetic testing in diverse populations: Outcomes in over 33,000 patients tested by genetics and non-genetics providers in Kaiser Permanente Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B100.

The Role of Vitamin D Levels in Optimizing Treatment for Pediatric Inflammatory Bowel Disease (IBD) Patients and an Examination Into Different Factors That Influence IBD Treatment Outcomes.

Background Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), presents significant challenges, particularly in pediatric patients. Vitamin D deficiency has been associated with IBD, but its role in disease activity and remission remains unclear. This study investigates the relationship between serum vitamin D levels and IBD markers, including Pediatric Crohn's Disease Activity Index (PCDAI), Pediatric Ulcerative Colitis Activity Index (PUCAI), fecal calprotectin levels, and endoscopy findings. It also explores racial and ethnic disparities in these relationships. Methodology A retrospective study was conducted involving 51 pediatric patients with IBD from the Nemours Children's Health EMR system. Inclusion criteria required documented serum vitamin D levels at diagnosis and post-treatment, and at least one post-treatment assessment of PUCAI/PCDAI, calprotectin, or endoscopy. The study employed Spearman and Pearson correlation tests to analyze the associations between vitamin D levels and IBD markers. Ethnicity and race were analyzed using t-tests and chi-square tests. Results No statistically significant correlations were found between changes in serum vitamin D levels and IBD markers (endoscopy results, calprotectin levels, PUCAI/PCDAI scores) for both UC and CD. Analysis of racial and ethnic disparities revealed that Hispanic patients had significantly higher post-treatment calprotectin levels compared to non-Hispanics, although other markers showed no significant differences. Vitamin D levels did not significantly differ between racial or ethnic groups. Conclusions This study found no significant correlation between serum vitamin D levels and IBD activity markers in pediatric patients. Despite initial hypotheses, vitamin D levels do not appear to be useful in assessing IBD remission or disease state. Racial and ethnic disparities in IBD severity were observed, but further research with larger sample sizes and more consistent data collection is needed to draw more definitive conclusions.

Impact of Hospital Employees’ Awareness of the EMR System Certification on Interoperability Evaluation: Comparison of Public and Private Hospitals

This study examined the awareness of the EMR certification system among employees of public and private hospitals that have obtained EMR certification. It also assessed how this awareness impacted the evaluation of EMR interoperability. The objective of this study is to contribute to the stable adoption and further development of EMR system certification in Korea. Data were collected through 3600 questionnaires distributed over three years from 2021 to 2023. After excluding 24 questionnaires owing to missing values or insincere responses, 3576 responses were analyzed. The analysis involved descriptive statistics, cross-tabulation, t-tests, ANOVA, and multiple regression using SPSS 26.0. The significance level (α) for statistical tests was set at 0.05. This study revealed differences in awareness of EMR system certification and interoperability among hospital employees. In both public and private hospitals, awareness of the EMR system certification positively influences the evaluation of interoperability.

Development and implementation of an injury and illness surveillance system for team USA

BackgroundThe purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC).MethodsThe development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department’s leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding “non-sport” as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries.DiscussionA multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations.

Standardization of Inpatient Hypertension Management

Introduction: Hypertension is a frequent occurrence during hospitalization and physicians are routinely called to treat hypertensive events despite the asymptomatic nature of patients. Although guidelines about outpatient management of hypertension are available, management strategies for asymptomatic inpatient hypertension are lacking. Without a standardized approach, physicians treat asymptomatic hypertension utilizing inconsistent strategies including intravenous antihypertensives (IVAHs). The use of IVAHs has shown to have adverse effects that are associated with increased morbidity and mortality. Aim: The aim of this project is to standardize the approach to inpatient asymptomatic hypertension and minimize use of IVAHs by 25% in 6 months. Method: Using the IHI Model, a quality improvement project was initiated. Root cause analysis revealed a lack of standard approach to managing asymptomatic hypertension. For PDSA 1, a standardized approach algorithm was created, and residents were educated about criteria for assessing symptoms, any contributing factors/secondary hypertension and if they had a history of hypertension/home meds. For PDSA 2, we expanded education for the nursing staff and provided them with the treatment flowchart. We also included the pharmacy department in our initiative, to form a multidisciplinary approach. For PDSA 3, we included Nurse Practitioners in our education. Results: Prior to PDSA 1, 24 charts were analysed and over 58% of patients (14/24) had received inappropriate IVAHs. Post-intervention, 31 charts were analysed and showed a 32.5 % reduction in IVAH use. Prior to PDSA 2, another 36 patient charts were analysed and 25% of patients had received inappropriate IVAHs. Post-intervention, 21 charts were analysed and showed an 11 % reduction in IVAH use. For PDSA 3, 53% of patients had received inappropriate IVAHs. Which reduced by 11% post intervention. Our post-intervention analysis is ongoing, and although data suggests a promising decrease in the use of inappropriate IVAHs, it has been inconsistent, and sustainability will become a challenge. Conclusion/Next Steps: Our project led to the implementation of a standardized algorithm, thus decreasing inappropriate use of IVAHs and minimizing cost. Management of asymptomatic hypertension in the hospital begins with addressing contributing factors such as pain or anxiety, then reviewing held home medication. With the implementation of a standardized algorithm, we found some success in the reduction of use of IVAHs. Our next steps include implementing the algorithm in the EMR system to have an alert system to clarify when IVAHs are indicated and when other options should be reviewed. We plan to continue our multidisciplinary efforts with the pharmacy and EMR staff along with new admission PA/NP service. Re-education throughout the year will also be implemented to improve sustainability.

A case report of long-term effects of Delayed post-hypoxic leukoencephalopathy (DPHL) following benzodiazepine overdose

Objective: We report a neuropsychological evaluation for a 39-year-old, right-handed, white female who 8 years ago developed delayed post-hypoxic leukoencephalopathy (DPHL), a rare demyelinating syndrome, two-weeks following an anoxic brain injury due to an overdose from benzodiazepines. Methods: An extensive record review documenting her medical timeline and treatment over the last 8 years was conducted using the available EMR system, which also included both EEG and neuroimaging data. Eight years post injury, a comprehensive neuropsychological battery was administered with corrected normative data for age, race, education, and other demographic factors when available. Collected data was compared with other case reports of DPHL. Results: The neuropsychological profile indicated difficulties across multiple cognitive domains that appeared driven by executive dysfunction, likely related to fronto-subcorto-striatal dysfunction. Conclusion: As a rare disease, the process by which DPHL occurs is not fully understood. Our results revealed similar findings in the literature for learning and memory, attention, processing speed, and executive functions. This is discussed in the context of available neuroimaging while highlighting the value of comprehensive neuropsychological assessment in DPHL even years post-injury.

Abstract B080: Advancing Breast Cancer Risk Prediction: Introducing the Gabbi Risk Assessment Model (GRAM)

Abstract Introduction: Advanced breast cancer risk models hold promise in implementing more effective and accurate screening strategies, facilitating early detection while minimizing screening-related harm compared to current guidelines. However, integrating machine learning risk models into clinical practice requires essential steps to be taken, including continual refinement to enhance their accuracy, validation across diverse populations, and demonstrating their ability to optimize clinical workflows. Gabbi Risk Assessment Model (GRAM), an innovative machine learning model, is a binary classifier based on medical claims developed to provide personalized breast cancer risk prediction. GRAM efficiently estimates risk and utilizes potentially missing risk factor information. Furthermore, it offers easy integration into EMR systems, thus optimizing its practical application. Methods: Construction of the GRAM utilized a medical claims dataset of 500k members from IQVIA carefully sampled from the entire IQVIA population (IQVIA acquires ~94% of the US claims data) with 4 years of history. The information extracted from the dataset included demographics, and medical history in the form of diagnostic and treatment codes, laboratory tests, and medications. The dataset consisted of 250k women aged 18-70 with a breast cancer diagnosis and a random sample of 250k women aged 18-70 without a known breast cancer diagnosis. For the selected cohorts, a 4-year history before the first breast cancer diagnosis was obtained. The control group was carefully chosen to possess similar statistical properties as the group with breast cancer. All women had a minimum enrollment period of 4 years before diagnosis with the same insurance provider. The GRAM was developed with 4 main steps: 1) member selection - members with breast cancer based on selection criteria defined above were in the test group, members without in the control group; 2) feature engineering to ensure that GRAM learns from medical history before a first diagnosis; 3) model development & testing - training/fine tuning using the ensemble methods and neural network, followed by hyperparameter tuning using a held out validation dataset; and 4) model performance on the held out validation set and identification of key risk factors contributing to the breast cancer risk. Results and Conclusion: By addressing these challenges and harnessing the potential of machine learning, GRAM has the capacity to revolutionize breast cancer risk estimation. Its integration into clinical practice can lead to more targeted and efficient screening strategies, resulting in earlier detection and improved patient outcomes. Preliminary results have shown that the GRAM surpasses the current standard of care models (GAIL and Tyrer Cusick) by at least 20% in sensitivity, and AUC ROC with no decline in specificity. GRAM achieved 91% AUC ROC (balanced data), 86% sensitivity, and 80% specificity on a held out dataset. As research progresses, continuous refinement and validation, the GRAM model holds promise to make significant contributions in the fight against breast cancer and identifying the correlated risk factors. Citation Format: Priyanshi Jain, Shaleen K Theiler, Kaitlin Christine. Advancing Breast Cancer Risk Prediction: Introducing the Gabbi Risk Assessment Model (GRAM) [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B080.

Implementing Tap-to-Witness Technology in the Electronic Medical Record.

The implementation of an organisation-wide EMR system in 2019 included single sign-on technology for nurses and midwives. This first-in-Australia study extended the use of this technology to enable nurses and midwives to tap-to-witness for high-risk medications, blood and blood products, and expressed breast milk. A saving of 7 seconds per interaction was observed with nurses and midwives reporting appreciation for ongoing EMR enhancement to reduce EMR-related documentation burden.

Challenges in the maintenance of an open hospital-based cancer registry system in a low-to-middle-income country (LMIC): 2017-2022 experience.

Hospital-based cancer registries (HBCRs) record data on all patients diagnosed and/or treated for cancer at healthcare facilities and evaluate the burden of the disease and the quality of healthcare services at that hospital, helping improve patient care, and providing an assessment of healthcare quality. The CARE PH app was created as a tool to facilitate a system of hospital-based cancer registries in the Philippines, a lower middle-income country. From 2017 to 2022, a total of 60,021 cancer registrants from 44 CARE PH hospitals were entered into the database. Breast cancer was the most common primary site, accounting for 17,660 cases (29.4%). This was followed by colorectal cancer at 11.1%, cervical cancer at 6.2%, head and neck cancer at 5.9%, and prostate and other male genital cancer at 5.1%.Among the 30 data fields collected, 17 exhibited 0-20% missing data, eight displayed 21%-90% missing data, while five depicted 91%-100% missing data. Most of the data fields with missing data are in the treatment and follow-up modules, which are stored in separate forms in a patient's record. Digital transformation of hospitals from paper-based charts to electronic medical records, and the integration of the HBCR to the EMR and hospital information system, will likely be the best solution for these limitations. It is recommended that the creation and maintenance of HBCRs nationwide must be harmonized, and embedded in all relevant national programs and legislations. The development of an information technology process that is based on a cancer patient's journey, should be built on an open system embedded in a well designed enterprise architecture, functioning under the guidance of a strong leadership and governance team. All these must be present in order to create and maintain a robust HBCR that is useful for furthering cancer registry and research in the country.

Examining Healthcare Profesional’s Acceptance of Electronic Medical Records System using Extended UTAUT2

This study aims to analyze user acceptance of the Electronic Medical Record system using the extended Unified Theory of Acceptance and Use Technology 2 model at PKU Muhammadiyah Bantul hospital. The UTAUT 2 model was chosen because it is the latest technology acceptance model which is a unification, synthesis, or summary of the eight pre-existing technology acceptance models. The subjects in this study were PKU Muhammadiyah Bantul hospital employees who used an electronic medical record system specifically for outpatient care. The object of this study is user acceptance of using the RME system in health services. Data collection techniques in this study are using questionnaires and observation. This research is a type of quantitative analytic research with data analysis using descriptive analysis. Data processing in this study used Smart-PLS software version 4.0 with SEM-PLS data analysis. The results showed that the aspects of the extended UTAUT2 model that had a positive and significant effect on user acceptance were performance expectancy (t=1.816), while the aspects of effort expectancy (t=0.419), social influence (t=0.635), facilitating conditions (t=0.139), hedonic motivation (t=0.909), price value (t=.304) habit (t=1.458), trust (t=0.032) and perceived risk (1.365) have no effect on user acceptance of the EMR system. Gender and age moderation variables were found to have no effect on the relationship between variables.

Improving timeliness and equity in germline genetic testing for pancreatic ductal adenocarcinoma patients: A comparative analysis and future strategies.

611 Background: Germline genetic testing is recommended for patients with pancreatic ductal adenocarcinoma (PDAC). Our previous study identified delays in germline testing for socioeconomically disadvantaged patients. We aimed to compare delays before and after implementing recommendations for same-day germline testing and identify reasons why germline testing was not performed. Methods: Using an IRB-approved protocol, PDAC patients were identified from Jan 2022 to Dec 2022 in our EMR system. Median income was estimated by zip code. Delays were calculated as the difference between diagnosis and germline test date. Social work needs were assessed through EMR review. An in-depth chart review was conducted to identify why tests were not performed. Results: An additional 100 patients were found with tests performed. Compared to our previous 135-patient study with a median delay of 27 days (d) in testing, our recent data showed a median delay of 15d (p=0.0215). In our previous study, 50 out of 135 patients (37%) received testing within two weeks of their PDAC diagnosis, whereas our recent data showed that 49 out of 100 patients (49%) received testing within two weeks (c2=3.372, p=0.0663), a 32% relative increase. The negative correlation between median income and delays in testing (r=-0.2578, p=0.0025) found in our previous study no longer existed in our recent analysis (r=0.0419, p=0.6802). Compared to our previous study in underserved minority (UM) patients (African American and Hispanic), our recent data showed a significant decrease in the delays for testing in UM patients (66d vs 19d, p=0.0041). We did not identify a difference in delays for testing between UM and not UM patients in the recent dataset (UM: 19d vs not UM: 15d, p=0.8075). In addition, compared to our previous study in patients with social work (SW) needs, our recent data showed a significant decrease in the delays for patients with SW needs (104d vs 13d, p=0.0004). We did not detect a significant difference between patients with SW needs and without SW needs in our recent data (SW: 13d vs no SW: 15d, p=0.8041). Finally, in our analysis of 87 patients without documented tests, 51 (59%) received care elsewhere, 25 (29%) were never offered tests, 5 (6%) refused tests, and 6 (7%) pursued a palliative approach. Conclusions: Our recent analysis showed a significant decrease in delays of testing, as more patients received prompt testing after PDAC diagnosis. Socioeconomically disadvantaged patients and those with social work needs no longer experienced significant delays in testing. To further mitigate delays, we plan to initiate germline testing during the first visit by providing introductory videos to increase understanding of consent. Furthermore, the substantial number of patients who were not offered tests will raise physician awareness regarding the necessity of offering germline tests.

Abstract A008: Empowering equity: Accelerated germline genetic testing for pancreatic ductal adenocarcinoma erodes delays, democratizes access, and mitigates disparity

Abstract Background: Germline genetic testing is recommended for patients with pancreatic ductal adenocarcinoma (PDAC) as is pre-diagnostic testing for those with a significant family history. Our previous study identified delays in germline testing for socioeconomically disadvantaged patients. We aimed to compare delays before and after implementing recommendations for same-day germline assessment through a recent data analysis. Methods: Using an IRB-approved protocol, PDAC patients were identified from Jan 2022 to Dec 2022 in our EMR system. Median income was estimated by zip code. Delays were calculated as the difference between diagnosis date and germline test date. Social work needs were assessed through EMR review. Results: An additional 100 patients were found to have germline genetic tests performed. Compared to our previous study of 135 patients with a median delay of 27 days (d) in obtaining germline testing, our recent data showed a median delay of 15d (p=0.0215). In our previous study, 50 out of 135 patients (37.04%) received germline genetic testing within two weeks of their diagnosis of pancreatic cancer, whereas our recent data showed that 49 out of 100 patients (49.00%) received germline genetic testing within two weeks of their diagnosis of pancreatic cancer (Chi square=3.372, p=0.0663), a 32% relative increase. Our previous study identified a negative correlation between median income and delays in germline testing (r=-0.2578, p=0.0025). However, this correlation became non-significant in our recent data capture (r=0.0419, p=0.6802). Compared to our previous study in underserved minority (UM) patients (African American and Hispanic), our recent data showed a significant decrease in the delays for testing in UM patients (66d vs 19d, p=0.0041). We did not identify a difference in delays for testing between UM and not UM patients in the recent dataset (UM: 19d vs not UM: 15d, p=0.8075). In addition, compared to our previous study in patients with social work (SW) needs, our recent data showed a significant decrease in the delays for patients with SW needs (104d vs 13d, p=0.0004). We did not detect a significant difference between patients with SW needs and without SW needs in our recent data (SW: 13d vs no SW: 15d, p=0.8041).Conclusion: Our recent analysis showed a significant decrease in delays of germline testing due to the fact that more patients received prompt testing after their diagnosis of pancreatic cancer. Unlike our previous study, socioeconomically disadvantaged patients and those with social work needs no longer experienced significant delays in testing. Our previous publication has raised awareness in our institution, and we plan to initiate germline testing during patients' first visit by providing introductory videos to increase understanding of consent, encourage participation, and further reduce delays. Citation Format: Xianghui Zou, Baho Sidiqi, Ellen Chen, Noah Kauff, Daniel King. Empowering equity: Accelerated germline genetic testing for pancreatic ductal adenocarcinoma erodes delays, democratizes access, and mitigates disparity [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr A008.

Factors Contributing to Potentially Unnecessary Pediatric Emergency Transfers

Background: Riley Hospital for Children receives thousands of emergency pediatric transfers from outside hospitals every year. The United States is currently facing a national EMS shortage along with increasing costs of medical care. Additionally, these transfers can be inconvenient for patients and their families. However, not all of these transfers are medically necessary. Identifying factors that contribute to unnecessary emergency transfers is essential for optimizing care for each patient.
 Methods: Retrospective chart reviews of electronic medical records at Riley Hospital for Children were completed for transferred patients between 01/01/2022 to 02/20/2022. Patients were identified through the transfer center patient list. The primary objective of the study was to identify patients transferred and discharged from the emergency department without advanced imaging or specialist consult. Demographic data including age, race, ethnicity, and sex were collected.
 Results: There were 404 patients included in the study. About one third of these patients were discharged from the emergency department. Of those, 38 patients (9.4%) also did not have advanced imaging or a specialist consult in the Riley Emergency Department. Age was found tobe statistically different between these patients and all other patients. The median age for patients discharged without advanced imaging or specialist consult was 2.4 years old, while the median age for all other patients was 6.5 years old. Other demographics including race, ethnicity, and sex were not significantly different.
 Conclusion and Potential Impact: The results suggest that younger pediatric patients may be at a greater risk for unnecessary emergency transfer. The generalizability of this study is limited in scope due to the use of only one EMR and hospital system. Finally, as this is a retrospective study, the information is limited by what was documented.

Study of Utilization of ElectronicMedical Records in Health Service Provision at theHIV Comprehensive Care Centersin Kiambu County, Kenya

An electronic medical record system (EMR) is a digital record of health-related data for individual patients, maintained by authorized providers. Complete and timely information is crucial for informing public health decisions and improving health service delivery, particularly for HIV/AIDS. This study assessed the utilization of EMR systems in HIV comprehensive care centers in Kiambu County, Kenya. Specifically, it examined the association and predictive influence of infrastructure, technical factors, and perceived usefulness on EMR utilization. The research adopted a descriptive cross-sectional design and applied stratified random sampling to categorize 38 health facilities based on their level of care. A sample size of 186 participants was proportionally allocated to the various strata, and data was collected through questionnaires. Analysis using SPSS version 25.0 involved Chi-square tests to examine associations between variables and logistic regression analysis to assess predictive influences. The results revealed that infrastructure (χ²=24.23, p<0.05), technical factors (χ²=62.93, p<0.05), and perceived usefulness (χ²=38.55, p<0.05) had significant associations with EMR utilization and had positive predictive influences. The study concluded that upscaling EMR utilization in HIV care clinics requires a multifaceted approach. It recommended that the County Government of Kiambu implement comprehensive training programs for EMR users, increase funding for EMR infrastructure, strengthen routine maintenance of ICT equipment, and engage ICT staff at the facility level to provide on-site support and troubleshoot the systems.

A Study on the Recognition of Certification System in EMR Certified Medical Institutions - Focusing on EMR Certification and System Functionality of Public Healthcare Institutions

A Study on the Recognition of Certification System in EMR Certified Medical Institutions - Focusing on EMR Certification and System Functionality of Public Healthcare Institutions

Storage Standards and Solutions, Data Storage, Sharing, and Structuring in Digital Health: A Brazilian Case Study

The COVID-19 pandemic has highlighted the necessity for agile health services that enable reliable and secure information exchange, but achieving proper, private, and secure sharing of EMRs remains a challenge due to diverse data formats and fragmented records across multiple data silos, resulting in hindered coordination between healthcare teams, potential medical errors, and delays in patient care. While centralized EMR systems pose privacy risks and data format diversity complicates interoperability, blockchain technology offers a promising solution by providing decentralized storage, ensuring data integrity, enhancing access control, eliminating intermediaries, and increasing efficiency in healthcare. By focusing on a Brazilian case study, this paper explores the significance of EMR standards, security challenges, and blockchain-based approaches to promote interoperability and secure data sharing in the healthcare industry.

A study on the status and applicability of Korean medicine EMR for establishment of Korean medicine standard EMR certification criteria: Through surveys of Korean medical institutions and Korean medicine EMR companies

Objectives: The aim of this study is to explore and investigate the status of EMR currently used in Korean medical institutions and the suitability of the existing certification criteria for Korean medicine EMR certification.Methods: The survey was conducted using a related questionnaire from September to October 2022. The survey for current status and the suitability of the existing certification criteria was conducted separately between Korean medical institutions and Korean medicine EMR companies.Results: In a survey of Korean medical institutions on the current status of EMR, more than 80% answered that the imaging system and Korean medicine EMR could be linked. Most medical institutions did not exchange clinical information between institutions. When asked about the intention to develop standard EMR of Korean medicine in the future, 57% of institutions answered ‘yes’. In future, if Korean medicine EMR certification criteria are developed, all EMR companies are willing to develop the EMR that satisfy them. Looking at the satisfaction survey of the existing EMR certification criteria of the Korean medicine EMR system, it was found that high/low satisfaction was shown in various areas, and in particular, the overall clinical information exchange function was insufficient.Conclusion: In order to introduce the Korean medicine EMR certification criteria, it must be considered of the current status of EMR and applicability of Korean medicine EMR for establishment of Korean medicine standard EMR certification criteria. By developing Korean medicine EMR certification criteria, high-quality medical services can be provided to medical consumers who want Korean medical treatment.

Artificial Intelligence and Venous Thromboembolism: Talking to the Experts

Background: Venous thromboembolism (VTE) is a significant cause of preventable death among hospitalized patients. Artificial intelligence (AI) and its sub-branch machine learning (ML) may be useful in standardizing and improving VTE management in hospitalized patients. To learn attitudes towards using AI for VTE, we previously conducted a national survey of 100 clinical informaticians recruited through professional organizations and a publicly available database listing recipients of National Institutes of Health informatics grant awardees (Lam et al, RPTH, 2023). For the current study, we interviewed a subset of these informaticians to explore their perspectives in depth on using AI in clinical decision making and VTE management. Methods: Survey participants interested in participating in interviews were asked to submit their email addresses. We then recruited these participants and asked them to recommend other informaticians who may be interested. We conducted 30-60 minute interviews via videoconference which were recorded and transcribed. Two coders separately reviewed the interviews using thematic analyses to develop a codebook. Codes were identified inductively and agreed upon by consensus. Once a codebook was agreed upon, it was used to code all interviews in duplicate. Results: Of 32 informaticians who were contacted, 11 agreed to be interviewed. The final participant group included 4 clinicians, 6 data scientists, and 1 biomedical/computational biologist. The major themes that emerged were that AI is a powerful tool to reduce clinician burden and AI is well suited to preventing and managing VTE, but bias in the creation of AI tools must be minimized. Since machine learning models increase accuracy and efficiency in clinical practice, they can serve as decision support and management tools and help to improve communication thereby reducing clinician burden. (Table 1) Other than the ethical concerns regarding bias, subpar quality of training data and model inaccuracy were identified as potential challenges. ML tools need to be validated as safe and effective for their specific role. In addition, one theme highlighted that clinicians fear being replaced by AI, while another noted that most patients would prefer interacting with humans about their medical care over AI. There were multiple suggestions for implementation of AI. Participants noted that AI could be integrated into the EMR and that ML tools should be further investigated with input from domain experts (data scientists, computational biologists and clinicians). Finally, interviewees recognized that VTE management was an area of medicine in which AI could be used successfully given that it is a clearly defined problem that lends itself to an algorithmic solution which can incorporate the current guidelines into a tool within the EMR system. Conclusion: Informaticians see AI as a promising tool to support clinical decision making about VTE prophylaxis because not only does it increase accuracy and efficiency, but it is also a clearly defined area of clinical management where guidelines can be effectively incorporated into the EMR system via machine learning. Challenges identified to implementing AI/ML will have to be addressed in order to create an ethical and accurate model which reduces the burden on healthcare providers in the clinical setting.