Other applied informatics

Lee Taylor-Vaughan, Morrison W Helena +4

Can an EHR interface mirroring the physical ICU room layout speed documentation and lower cognitive load? In a randomized two-period crossover simulation, 36 ICU nurses completed two standardized documentation scenarios using a Spatial Awareness Integrated EHR prototype versus a traditional linear flowsheet interface, analyzed with linear mixed-effects models. The spatial prototype cut documentation time by 177 seconds per task (27% faster; d = 0.88), reduced NASA-TLX workload 51.3% (18.44 vs. 37.82), and improved accuracy 6.3% (98.70% vs. 92.86%). Behavioral intention to adopt rose 25.5%, but System Usability Scale (77.99 vs. 71.60) and perceived usefulness differences were not significant.

Hannah A Burkhardt, Sarah J Blach +8

Can a health system-governed data platform overcome the fragmentation, latency, and quality limits of real-world data? This descriptive platform paper reports on Truveta's partnership model, architecture, and applications, covering de-identified electronic health record data on 130 million US patients — roughly 1 in 3 Americans — aggregated from participating health systems and linked to closed claims, mortality, and social determinants data. Records are ingested daily, normalized to standard ontologies, and processed with NLP to extract concepts from notes, imaging, and pathology text. The data have supported over 100 publications spanning treatment effectiveness, device surveillance, COVID-19 vaccine safety, and health equity. No comparative effect estimates are reported.

Lin, A. L., Curtis, S. +11

How much labor and cost does manual fax routing consume in a specialty division? This two-phase quality improvement study at Duke's Division of Cardiology paired an observational time study at three ambulatory clinics (April 1–July 12, 2024) with a volume count of all inbound faxes to the divisional communication hub (July 1–December 31, 2025). Processing took 4.4 to 9.4 minutes per fax (mean 6.0). The hub received 24,420 faxes, averaging 4,070 faxes and 13,341 pages monthly, implying 407 person-hours and $10,663.40 per month, about 2.5 FTEs. No AI automation was evaluated; the authors frame fax routing as an automation target.

Anita A Vashi, Liam Rose +3

Does centralizing appointment scheduling and adding same-day virtual clinician evaluation improve access after nurse triage? This retrospective quasi-experimental evaluation used difference-in-differences and event-study analyses of the VA Health Connect rollout across 18 regions from October 2018 to September 2024, drawing on 11,118,916 encounters (4,560,677 pre-, 6,558,239 post-modernization) from VA Corporate Data Warehouse, Telecare, CRM, and VSignals survey data. Same-day scheduling rose 14.3 percentage points (95% CI 10.1-18.5) and time from call to scheduled appointment fell 0.37 days, though time to completed appointment rose 2.9 days. Callers with no 7-day follow-up declined 2.3 points; ED visits, admissions, and costs were unchanged.

Liu, J. B., Chen, Y.-J. +4

What drives nonresponse to routinely collected patient-reported outcome measures? This retrospective cohort study used iterative mixed-effects logistic regression on all adults seen at five Mass General Brigham radiation oncology clinics over one year (12,214 patients, 71 providers, five clinics), modeling failure to ever complete the portal-administered PROMIS Global-10. Patient- and appointment-level response rates were 35.4% and 10.9%, with patient-level response varying nearly fivefold across clinics (12.8% to 66.2%). After adding provider- and clinic-level factors, sex, education, and employment became nonsignificant, while recent surgery (aOR 1.97) and time since diagnosis >12 months (aOR 0.46) persisted; later program launch (aOR 0.29) and higher historical collection rate (aOR 0.79) predicted lower nonresponse, and academic versus community setting did not.

Elizabeth O'Brien, Aanshi Thumar +4

Can institution-specific cancer trial information be curated into an AI-enabled knowledge management application in community oncology? This feasibility study at a regional community oncology network had coordinators and disease teams compile actively recruiting trials, structuring core elements (title, conditions, biomarkers, stage/line, recruiting status) for point-of-care display, with AI-assisted extraction of protocol summaries and eligibility elements followed by human validation. Fifty-three trials across 10 disease groups and 28 cancer types were embedded; 91% were recruiting and 30% were biomarker-specific. Configuration required 2-4 weeks per disease group using existing personnel, without added staffing or EHR build. Usability and implementation outcomes were not assessed.

Elizabeth Woodcock, Chris Profeta, Molly Siegel

What determines whether automated waitlists—tools that notify patients of earlier appointment openings—succeed in improving ambulatory access? A convergent, multisite mixed methods study surveyed 127 US health systems, 90 of which reported automated waitlist usage data, plus qualitative and quantitative data from 10 purposively sampled systems, analyzed using the Consolidated Framework for Implementation Research. High performers filled 38.8% (IQR 36.2%-45.7%) of appointments offered through the waitlist, and missed appointment rates were lower for waitlist-scheduled visits (3.1%, IQR 2.5%-4.8%) than for all appointments (6.6%, IQR 4.1%-9.9%). Flexible configuration, cross-functional governance, and leadership endorsement facilitated sustained use; specialty gatekeeping, clinician capacity, insurance requirements, and digital inequities limited reach.

Elske Ammenwerth, Iiris Hörhammer, Michelle Bindel

How have logic models and theory of change been applied to health information technology interventions? This PRISMA-ScR scoping review searched PubMed, Web of Science, Academic Search Elite, APA PsycArticles, and CINAHL, with dual independent screening and extraction, identifying 69 publications from 2012 to 2025 across medical informatics, public health, health services research, and implementation science. Use rose after 2020 and clustered in patient-facing mobile health, telehealth, and remote monitoring. Of 69 studies, 60 (87%) included a model visualization, 50 (72%) cited development guidance (most often UK MRC, realist evaluation, or Kellogg), 28 (41%) drew on behavioral or implementation frameworks, and only 3 (4%) reused an existing model.