Other applied informatics

Sylvester Tumusiime, Lindsey Rudov +9

What does it take to convert a research-grade EHR network into a public health surveillance asset? This descriptive implementation report documents how REACHnet transformed its curated clinical data from health systems in Louisiana and Texas into the Multi-State EHR-Based Network for Disease Surveillance (MENDS) dataset for chronic disease surveillance, with access extended to the Louisiana and Texas health departments and the National Association of Chronic Disease Directors. The authors describe governance, regulatory, infrastructure, and partnership processes, along with challenges encountered in producing a relatively low-latency dataset. The abstract reports no quantitative results or effect sizes.

Sonia Sultan, Mukund Nakhate +17

Does continuous remote patient monitoring reduce 30-day readmissions after heart failure discharge? This case-versus-retrospective-propensity-matched-control study at Endeavor Health (Evanston, IL) enrolled 39 patients across three phases, monitoring them for 30 days postdischarge with wearable biosensors and daily symptom surveys, with rules-based and machine learning alerts triaged by home health nurses and escalated to advanced practice providers. Intervention patients received more APP calls (66.7 vs. 7.7%), APP visits (43.6 vs. 5.1%), diuretic escalation (43.6 vs. 12.8%), and labs (76.9 vs. 43.6%). Adjusted 30-day readmission did not differ (odds 0.31, 95% CI 0.06–1.38; p = 0.138).

Agnes Haryanto, Cathy Ngo +5

What does the evidence say about hospital dashboards built around external regulatory and accreditation quality frameworks? This scoping review searched MEDLINE, Embase, Emcare, Global Health, and Web of Science from inception to October 2025 for studies implementing inpatient dashboards with measures tied to an externally determined framework and reported outcomes. Twenty-one studies were included, 81% from the United States and 76% implemented hospital-wide. Most reported process gains — data timeliness, performance-gap identification, governance, workflow integration, transparency — and 57% reported change in at least one clinical measure over time. The abstract reports no pooled effect sizes, and the authors note limited, heterogeneous studies.

Bernice Azzopardi Meli, Corinne Bowman +8

What digital competences does the health workforce actually need? This systematic review followed PRISMA, searching MEDLINE, PubMed, CINAHL, PsycInfo, Cochrane Library, Scopus, ProQuest, BASE and the first 10 pages of Google and Google Scholar for English-language literature from 2014 to 2024, with dual independent screening and quality appraisal using Joanna Briggs Institute tools and the Mixed Methods Appraisal Tool. From 9414 records, 108 peer-reviewed studies and competence frameworks were included. Thematic synthesis grouped competences into three domains: leadership (governance, strategic thinking), procedural (digital professional development, quality improvement), and enabling (patient engagement, mindset). The authors report fragmented competence lists rather than integrated frameworks; no effect sizes are reported.

Pooja Reddy Spector, Anne Grauer +12

How can EHR audit log data be turned into automated measures of ordering errors? This methods paper lays out a framework for conceptualizing, implementing, validating, and optimizing measures based on the Retract-and-Reorder (RAR) approach, which flags orders that are placed, retracted, and then reordered as signals of potential error. Using illustrative examples, the authors describe the theoretical model underlying RAR detection, validation steps, and applications to studying error epidemiology, root causes, and intervention evaluation in near-real time. The abstract reports no empirical performance estimates or effect sizes.

Zhengcan Xie, Yuheng Shi +3

How mature are patient-facing technologies built on REDCap? This integrative review followed PRISMA guidelines, searching PubMed, Web of Science, and Embase, and synthesized 14 studies (2016-2026) using aggregate and thematic synthesis, then combined literature evidence with pilot case insights to build a four-tier maturity model spanning Data Collection, System Integration, Personalized Insights, and a conceptual Intelligence Hub. Publications clustered after 2021 (n=12, 86%), most were US-based (n=11, 79%), and 10 implementations (71%) remained at Tiers 1-2, with only 4 (29%) reaching Personalized Insights. The authors call for longitudinal evaluation and deeper integration.

Jacqueline Toscano, King Yan Kwok, Meg Simione

Can an EHR template semi-automatically translate clinical documentation into caregivers' preferred language? This pilot development study applied human-centered design and a Discover, Design/Build, Test framework at a pediatric setting, with an interprofessional team of a speech-language pathologist and a certified translation specialist building an English-to-Spanish template in the electronic health record, then surveying speech-language pathologists and caregivers on acceptability and feasibility. The Discover phase documented barriers to providing written documentation in patients' primary language; clinicians endorsed the template's importance but raised feasibility and usability concerns, while caregivers valued receiving information in their primary language. The abstract reports no sample sizes or effect sizes.

Emre Umucu, Beatrice Lee +4

How well do digital health technologies, including AI, include persons with disabilities? This scoping review followed PRISMA-ScR guidance, searching MEDLINE and Web of Science plus gray literature for English-language sources on digital health, disability, and health equity published 2019 to 2025 (searches last run December 2024). Of 925 records identified and 836 screened, 137 underwent full-text review, yielding 40 peer-reviewed articles plus 40 gray literature sources (80 documents). Findings were organized into five themes spanning access enablers, stakeholders, government initiatives, contextual factors, and emerging innovations; participatory codesign and accessible design recurred as enablers. The abstract reports no effect sizes.

Carmit Rapaport, Verda Tunalıgil +3

Do cybersecurity incidents involving human factors recur within the same healthcare organizations, and can recurrence serve as a marker of persistent vulnerability? The authors analyzed 5,752 cyber incidents reported by U.S. healthcare organizations, comprising 3,740 human-factor and 2,012 non-human-factor incidents, classifying human involvement with a deterministic rule-based approach applied to incident metadata and defining recurrence as a later incident in the same category and organization within three years. Human-factor incidents recurred significantly more often, a pattern holding across alternative windows, stricter classification, and organization-level and paired analyses; the abstract reports no effect sizes. The authors propose a High Reliability Organization-informed maturity model.

Hongmei Yang, Christopher D Russell +2

How does survivor treatment selection bias affect evaluations of virtual transition-of-care programs? This JMIR Medical Informatics paper addresses a methodological concern in which patients must survive, or remain enrolled, long enough to receive a virtual follow-up intervention, potentially inflating apparent benefit in observational analyses. No abstract was available, so the study design, data source, population, and any quantitative findings or proposed analytic corrections cannot be described here.

Constance Owens-Jasey, Rose Gunn +7

What keeps community health center care managers from using EHR tools to screen for and act on contextual drivers of health such as food, housing, and transportation? This formative evaluation, guided by human-centered design, used semi-structured interviews with 11 care management staff and 5 subject matter experts from a multi-state health center network, analyzed with a rapid qualitative approach. Staff used screening flowsheets and alerts for documentation, but cited tool limitations — including no discrete fields for referral documentation — and insufficient training on referrals and follow-up. Participants requested leadership support, hands-on training, and customizable care plans. The abstract reports no effect sizes; findings will inform implementation strategies for a planned randomized trial.

Zolotor, A. F., Gertner, A. +9

Does multi-sector data identify different high-need children than claims-based risk scores? This cross-sectional study applied the North Carolina Integrated Care for Kids (NC InCK) risk stratification algorithm — integrating health, education, social, and juvenile justice data — to 99,564 Medicaid participants aged 0-20 in a five-county central North Carolina region in October 2022, comparing assigned Service Integration Levels (SILs) with Medicaid managed care organization risk levels. SIL 1 covered 90,151 children (90.5%), SIL 2 5,482 (5.5%), and SIL 3 3,931 (4%). Roughly 24% of SIL 2 and 20% of SIL 3 children were classified low risk by their MCO.

Marshall, N. P., Haberkorn, W. +6

Can an autonomous coding agent replace hand-written analyst queries against a production EHR warehouse? In a single-center quality-improvement evaluation, ten acute otitis media questions were posed to analysts (adjudicated reference) and to OpenAI Codex, which wrote read-only queries against a full copy of an Epic Caboodle warehouse under four conditions. At medium reasoning effort the agent came within 5% of the reference on 27 of 30 runs but exactly matched on 10; three repeated runs agreed on only 3 of 10 questions. Matching runs identified the same patients (F1 = 1.00, one exception at 0.72); analyst feedback and reuse of corrected definitions restored reproducibility.

Rose Y Hardy, David P Ciccone +5

Can multi-agency administrative data be linked to flag Medicaid-enrolled children at risk of out-of-home placement? This descriptive development-and-implementation report covers an expert-derived, three-category risk stratification algorithm built by a government-academic team for roughly 27,000 children in two Ohio counties from 2022 to 2024 under Ohio's Integrated Care for Kids Model, drawing on Medicaid claims, child welfare information systems, area-level social determinants, and patient-reported health risk assessments. The authors describe the legal and administrative work required for data linkage and lessons on data use agreements, partner relationships, and lookback periods for retroactively updated data. The abstract reports no predictive performance metrics or effect sizes.

Parker James, Alexis Smirnow +3

Can linking external data sources fill gaps in Medicaid race and ethnicity records? This data-linkage study matched all Maryland Medicaid enrollees during calendar year 2023 (N=1,898,041) to records from the state health insurance marketplace and the designated health information exchange, assigning each enrollee a single value using a fixed source hierarchy (marketplace, exchange, historic Medicaid, current Medicaid). Most enrollees (97.8%) appeared in at least one external source, and the share with unknown race and ethnicity fell from 23.0% to 1.0%, with the resulting distribution more closely matching American Community Survey benchmarks and permitting greater disaggregation.

Huey Yu Ng, Shamala Ramasamy +5

What multidisciplinary factors shape adoption of digital health technologies such as patient portals, mobile apps and EHRs? This PROSPERO-registered systematic review (CRD420251056883) followed PRISMA 2020, searching multidisciplinary databases via EBSCO Discovery Service for English-language primary studies published between 2015 and June 2025, retaining 82 studies published from 2020 to 2025. Two reviewers screened and extracted using the SPIDER framework mapped to PICOS, appraised quality with the MMAT, and synthesised findings thematically in ATLAS.ti. Five themes emerged: access, equity and affordability; usability, engagement and empowerment; trust, privacy and governance; integration, workforce and sustainability; and clinical effectiveness and quality of care. The abstract reports no effect sizes.

Bradley Rowland, Jon Gee +6

How reliable are the data produced by mandated inpatient screening for health-related social needs? This observational study used EHR data from 197,305 adult inpatient encounters across 18 Atrium Health hospitals in the southeastern US, May–December 2024, applying a data quality framework plus mixed-effects logistic regression. Screens were completed for 172,519 encounters (87.4%), though completion ranged from 92.1% to 72.4% by market; 12.7% (21,900) screened positive for at least one need. Positive patients more often had Medicaid (23.1% vs 13.7%) and higher 30-day readmission (14.3% vs 11%, p<0.001). Intradomain correlation was moderate to strong (food insecurity Cramer V=0.87), interdomain weaker (0.44).

Kenny, P. A.

Can chart review be automated with a large language model without exposing protected health information? This paper describes development of a no-code application built on an in-house ChatGPT 4o-mini deployment within Emplify Health's firewalled Azure cloud, which imports tabular data from Excel or text files, guides users through prompt engineering, submits records row-by-row, and tabulates extracted parameters or summaries. Initially built to identify cancer cases in pathology reports, it was generalized to cancer registries, cardiology CT reports, imaging narratives, and clinical notes. The authors report accelerated data retrieval but the abstract provides no accuracy metrics, time savings, or comparison group.

Sanjay Basu, Aaron Baum +2

How often do administrative burdens surface in Medicaid care coordination, and what do they cost patients in time? A retrospective cohort study applied natural language processing classifiers to encounter notes from a community-based care coordination program in Washington, Virginia, and Ohio (January 2023-November 2025), covering 142,473 beneficiaries, 49,282 (34.6%) with at least one encounter. Paperwork was most prevalent (25.3%), followed by scheduling (16.2%), prior authorization (9.8%), and transportation (6.1%). Mean per-patient time cost at the clinician-equivalent rate was highest for transportation ($47.58) and lowest for scheduling ($12.35); documented burdens totaled 18,822 patient-hours ($628,665). African American beneficiaries had higher unadjusted burden prevalence than White beneficiaries (rate ratio, 1.22), attributable to plan enrollment rather than within-plan differences.

Evan J Ryer, Gregory G Salzler +8

Can a centralized digital program identify and track abdominal aortic aneurysms across an integrated health system? This retrospective cohort study describes STAIR, which combined structured EHR problem-list queries, an internally developed NLP model applied to radiology reports, clinician referrals, and automated lost-to-follow-up queries, enrolling 8464 patients (mean age 77.1 years; 77.0% male) from December 2022 through December 2024, with status assessed through April 2026. Identification was mostly automated: problem-list queries 59.0% and radiology NLP 29.0%. After centralized review, 45.3% were assigned biennial duplex surveillance and 20.6% referred to vascular surgery; 49.5% remained under active surveillance. Findings are descriptive; clinical effectiveness was not assessed.

Elorm Damalie, Reima Suomi, Moustafa Mahmoud

How much does the literature on public reporting systems in health care address their technical foundations? This scoping review followed Joanna Briggs Institute guidance and PRISMA-ScR, searching seven databases (PubMed, Web of Science, Scopus, IEEE, ACM, AIS eLibrary, Cochrane) for articles published 2000-2026. Of 1882 records identified and 1127 screened after deduplication, 233 studies were included; 157 (67.4%) came from the United States and 43 (18.4%) from Europe, with 60.5% (n=141) quantitative, 24.0% qualitative, and 15.5% mixed methods. Coding across six information systems dimensions—architecture, interoperability, data governance, APIs, usability, technical performance—found the technical substrate underexplored; the abstract reports no dimension-level counts.

Chen, Y., McMurry, A. +4

Can aggregated count "cubes" with small-cell suppression substitute for line-level EHR sharing without leaking the cells they hide? The authors built a Bayesian count-inference pipeline that both reconstructs suppressed counts and functions as a reconstruction attack, applying it to 285 pediatric kidney-transplant patients at Boston Children's Hospital and comparing against CTGAN synthetic data. Cube analyses reproduced line-level results: across 106 demographic-by-medication subgroups, a bootstrap mean of 3.5 showed significant graft-rejection associations, and cube odds-ratio sign changes reversed no significant associations versus 2.3 for CTGAN. However, 76.6% of suppressed cells (14,554 of 18,994) were recovered exactly, including 85.5% of single-patient cells.

Julia Magdalena Fuger, Lisa Niehoff, Erika Zelko

How do European general practitioners experience digital health technologies in daily practice? This systematic review (PRISMA 2020, Synthesis Without Meta-Analysis) searched eight databases plus Elicit AI for studies published January 2014 to October 2025, yielding 65 studies covering 24,994 GPs in 14 countries, 93.8% (61/65) from Western and Northern Europe. Perceived usefulness was positive in 86.2% (56/65) of studies, while ease of use was positive in none (0/65) and negative in 66.2% (43/65); actual use was near universal (63/65, 96.9%). Barriers included poor interoperability, limited training, and unreimbursed digital workload, alongside concerns about digital exclusion.Voosh.aiVoosh.aiVoosh.aiVoosh.aiVoosh.ai Normalization process theory constructs showed only partial integration.Voosh.ai Ratings.Voosh.ai bias risk used MMAT and JBI tools.

Mallory Herzog, Linda S Park, Andrew Quanbeck

What drives health systems and payers to adopt — or drop — patient-facing digital health tools? This qualitative study used semistructured interviews conducted August through December 2025 with nine senior leaders from a large Midwestern academic health system and affiliated payers, including a provider-owned health plan and a state Medicaid program, using an evidence-based mobile intervention for alcohol use disorder as the use case. Thematic analysis with inductive and deductive coding identified four decision-making mechanisms: prioritization under organizational constraint, risk mitigation, operational fit, and value determination. The authors argue these processes are largely invisible to patients, clinicians, and developers. No effect sizes are reported.

Smith, M., Konieczny, K. A. +7

Can automated post-discharge check-ins surface adverse events in adults with multiple chronic conditions? This mixed-methods, user-centered design study used semi-structured interviews with 37 patients and 23 clinicians to set requirements, then field-tested a prototype in 20 patients for up to 7 days after discharge, drawing on interoperable EHR data to deliver symptom and patient-reported outcome questionnaires with risk-stratified advice and real-time clinician escalation. Patients completed 60% of questionnaires; 7 received Level 2 or 3 advice, 3 triggered Level 3 escalation emails, and 4 of the 7 had chart-confirmed emergency department visits within a week. Clinicians found PRO trends hard to interpret.

Shritha Gayathri, Amanda Courtright-Lim +7

How can an EHR-based intervention be sustained after a pragmatic trial ends? This qualitative case study of the NOHARM stepped-wedge cluster-randomized trial, which tested the Healing After Surgery educational bundle promoting non-pharmacological perioperative pain care across multiple surgical practices and hospital sites, reviewed minutes from biweekly sustainment committee meetings and conducted debriefings with committee members guided by the Clinical Sustainability Assessment Tool. Six themes emerged: automating low-touch components, reliance on internal champions, intentional handoff communication, institutional attention, relaxed fidelity, and continuous evaluation. The authors emphasize early structured planning and transition to clinical ownership; the abstract reports no effect sizes.

Kevin Nguyen, Zewen Wu +12

Can machine learning identify point-of-care ultrasound (POCUS) in free-text notes and gauge whether standardized documentation templates improve charge capture? This retrospective operational cohort study analyzed 559,029 encounters from 109,776 patients across 11 OBGYN clinic sites at one academic medical center (January 2018–August 2024), training LightGBM and BioClinBERT classifiers against manual CPT assignments and comparing periods before and after a February 2023 ProcDoc smart form. BioClinBERT reached 0.97 accuracy (F1 0.55–0.63). ProcDoc adoption hit 75.1% at 12 months; billing recapture fell from 10.0% to 2.4% (OR 0.22, 95% CI 0.17–0.30), with overall POCUS billing up 0.6%.

Bhatia, A., Lash, S. +2

Can EHR analyses adjust for how much documentation a patient accumulates, separate from how sick they are? The authors built the EHR Density Index (EDI) using records from 24,987 adult patients at UNC Health (2018-2024), characterizing quantity, depth, and breadth of data per patient-year by assigning a utilization cluster via a Gaussian Mixture Model and computing within-cluster residuals across four clinical domains. Four interpretable clusters emerged; the Charlson Comorbidity Index predicted cluster membership but was only weakly associated with within-cluster residuals, suggesting the EDI captures record dimensions distinct from disease burden. The abstract reports no effect sizes.</summary>}Wait — I must not include stray text. Let me re-emit cleanly.{

Ilse Super, Olya Rezaeian, Onur Asan

How are large language models currently being used to support teamwork and communication within healthcare teams? This scoping review followed PRISMA-ScR guidelines, searching PubMed, Web of Science, and ScienceDirect for 2014-2024 publications; 3,865 unique titles and abstracts were screened, 127 full texts reviewed, and 20 studies included. Designs were predominantly quantitative and simulation-based, with limited in situ evaluation. Use cases spanned decision support, communication, and administrative functions. Outcomes centered on accuracy and quality (15/20 studies), with fewer addressing safety (4/20), readability or empathy (5/20), workflow efficiency (3/20), and error modes (2/20). The authors note most studies evaluate model performance without accounting for human team dynamics.

Sharareh Rostam Niakan Kalhori, Mostafa Haghi +5

How automated are electronic early warning/track-and-trigger systems (EW/TTS) in practice? This PRISMA-guided systematic review searched PubMed, Web of Science, and Scopus for real-world clinical implementations published January 2010 to December 2025, screening 1181 records and including 43 studies, with quality appraised using the Joanna Briggs Institute checklist. Clinical deterioration was the primary objective in 54.5% (24/44) of stated aims; vital signs and assessment scores made up 62.7% (42/67) of clinical indexes. Automation was measured in 41.9% (18/43), predictive algorithms in 25.6% (11/43), and interoperable connectivity in 69.8% (30/43). Reported outcomes included earlier warning (20%) and lower specificity (12.9%).

Colin M E Halverson, Haley Echols +3

How do clinicians judge the appropriateness, risks, and benefits of emoji in clinical messaging? This qualitative study combined focus groups and a survey from August to October 2025 with 29 clinicians at a large academic health system, spanning four specialties and including physicians, advanced practice providers, genetic counselors, medical students, and other healthcare workers, analyzed using rapid qualitative analysis. Participants described emoji as clarifying tone, building rapport, softening directives, and reducing notification fatigue, but raised concerns about ambiguity, informality, and medicolegal risk from message discoverability. Appropriateness hinged on hierarchy, familiarity, clinical gravity, generation, and platform. They preferred onboarding conversations and curated emoji sets over prescriptive guidelines. The abstract reports no effect sizes.

Marisa L Conte, Judith M Schlaeger +18

How should computable phenotypes be built and reported for embedded pragmatic clinical trials that rely on EHR and claims data? The EHR Core Working Group of the NIH Pragmatic Trials Collaboratory compiled investigator experiences developing, adapting, and applying phenotype definitions, presented as four case studies of different approaches. The authors recommend building phenotypes with multidisciplinary teams, validating them appropriately, disseminating details of phenotype construction, and capturing and reporting modifications made during trial conduct. They emphasize teams that understand why the data were collected and potential sources of bias. This is a methods and experience report; the abstract provides no quantitative results or effect sizes.

Mehakpreet Kaur, Tamanna Jannat Promi +5

What do virtual hospital services (VHS) for working-age adults actually look like in the published literature? This scoping review followed JBI methodology and PRISMA-ScR, searching four databases for articles published March 2021 to July 2025 on VHS and hybrid hospital-in-the-home models for adults aged 18-65. Of 1624 records, 28 studies met eligibility: 16 described fully virtual models and 12 hybrid HITH. Most combined synchronous and asynchronous communication; mobile apps and wearables were uncommon. Respiratory conditions predominated (17/28), heart failure exacerbation was the most common specific condition (6/28), and patient satisfaction or experience was the most reported outcome (17/28). The authors note heterogeneous terminology, inconsistent reporting, and dominance of pilot and single-site studies.

Adapa, K., Mosaly, P. R. +5

What determines successful implementation of an in-house dosimetry quality assurance checklist in radiation oncology? This qualitative implementation study at an academic medical center used semi-structured interviews, field observations, and surveys with dosimetrists, physicists, trainees, and developers across pre-implementation, implementation, and post-implementation phases, coded abductively using an adapted CFIR mapped to UTAUT and the ERIC strategy compilation. Four CFIR constructs and 12 sub-constructs emerged as barriers (structural characteristics, planning most negative); five constructs and 19 sub-constructs as facilitators (relative advantage, culture, leadership engagement). Suggestions mapped to 19 ERIC strategies; CFIR-ERIC matching identified 14. Acceptability, appropriateness, and feasibility improved significantly (p<0.05), but adoption reached 100% only in week six.

Xiangren Wang, Jingchuan Guo +5

Can transformer-based NLP reliably surface social determinants of health from routine notes? This validation study at University of Florida Health surveyed 1001 adults with at least two encounters in the prior year (sampling targeted 50% Black patients), restricting comparative analyses to 414 participants who also had Epic SDoH questionnaire data and notes. The SODA pipeline's extractions across nine domains were benchmarked against the research survey and the Epic instrument using sensitivity, specificity, PPV, NPV, and F1. Sensitivity reached 55% for alcohol use but fell to 16% for financial constraints, 5% for abuse, and 0% for drug use; the two surveys agreed only modestly, so no definitive reference standard existed.

Paulina S Sockolow, Yasemin Algur +2

What can integrated clinical and social-care data actually reveal about whether health-related social needs referrals get fulfilled? This retrospective observational study linked EHR and closed-loop HRSN platform data through a statewide health information exchange for 1,628 adult patients across a federally qualified health center and three health systems. Patients received an average of two referrals, roughly 80% for basic needs, yet fewer than 3% were documented as fulfilled — which the authors attribute to constrained documentation workflows rather than absent services. Short-term needs more often reached documented outcome states with shorter time-to-fulfillment; housing showed wide variability consistent with workflow-driven closure.

John Robert Bautista, Daniel Toshio Harrell +2

Would US adults use a blockchain-based app to hold and share their own health records? This cross-sectional online survey, fielded in August 2022 via Amazon Mechanical Turk, drew 913 respondents roughly matching US gender and race/ethnicity distributions, with structural equation modeling used to test a conceptual model combining the theory of reasoned action, privacy calculus, protection motivation theory, and regulatory uncertainty. Most were willing to use MediLinker to store and manage health information (76.7%), share it with providers (79.3%), and give consent for clinical research (78.4%). Attitude was directly associated with willingness; perceived liability and vulnerability acted indirectly through perceived risks. No path coefficients are reported in the abstract.

Serine Sahakyan, Selai Akseer +5

What shapes uptake of digital health technologies for remote management of noncommunicable diseases in rural settings? This mixed methods systematic review followed Joanna Briggs Institute methodology, searching Medline, Embase, and CINAHL from inception to February 12, 2026, and screening 1491 records to include 14 studies, 11 from high-income countries, with barriers and facilitators mapped to the Consolidated Framework for Implementation Research and quality appraised with the Mixed Methods Appraisal Tool. Barriers were technical instability, poor connectivity, financial constraints, and staff shortages; facilitators were usable design, leadership, teamwork, and communication. Evidence was predominantly qualitative; the abstract reports no effect sizes.

Sripriya Rajamani, Divya Rupini Gunashekar +3

Who actually performs informatics work in US governmental public health agencies? This cross-sectional analysis used weighted responses from the 2024 Public Health Workforce Interests and Needs Survey (PH WINS), mapping 9 of 77 public health job classifications to informatics or data-centric roles. Such roles comprised about 8% of the workforce (N = 4786), including epidemiologists (3.9%), information technology/computer science workers (2.1%), data analytics and related roles (1.7%), and public health informatics specialists (<1%). Informatics tasks were distributed across multiple job titles, and specialists supported a broad range of activities including surveillance. The abstract reports no effect estimates.

Priyanka Solanki, William Small +11

Does real-time EHR secure messaging between emergency department clinicians and the prior discharge team change disposition decisions for patients returning within 30 days? This 18-month pre-post study covered 27 592 ED revisit encounters across 3 campuses in one academic health system, using robotic process automation to message the ED attending and index hospitalization discharge team during the disposition window. Systemwide readmission rates were unchanged (49.4% vs 48.6%, P = .149) while observation status rose (7.0% vs 8.0%, P < .001). At the campus pairing messaging with proactive care coordination, inpatient admissions fell (56.9% vs 54.1%) and treat-and-release rose (36.8% vs 39.6%). Response rate was 61.8%.

Robin L Marcus, Kelly Daley +5

Can EHR data support tracking of physical function across the hospital-to-homecare transition? Investigators conducted a data availability assessment within Johns Hopkins Health System, working with informatics and homecare leaders to identify extractable elements, then extracting records for 21,702 adults admitted between July 2016 and March 2021. Of 27 desired elements, 17 were available and extracted. Administrative data had low missingness, but in-hospital cognition and mobility performance assessments were missing in over 65% of patients and home health physical function capacity assessments in over 80%; 81.7% of home health rehabilitation recipients had the expected mobility measure, and 73% of patients had at least 75% of extracted elements.

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.