Real World Performance of the 21st Century Cures Act Population Level Application Programming Interface

OBJECTIVE: To evaluate the real-world performance in delivering patient data on populations, of the SMART/HL7 Bulk FHIR Access API, required in Electronic Health Records (EHRs) under the 21st Century Cures Act Rule. MATERIALS AND METHODS: We used an open-source Bulk FHIR Testing Suite at five healthcare sites from April to September 2023, including four hospitals using EHRs certified for interoperability, and one Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across six types of FHIR resources. RESULTS: Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8,000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1,555-2,500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12,000 resources/min. DISCUSSION: The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. CONCLUSION: To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes

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Navigating the Digital Health Ecosystem to Bridge the Gap from Innovation to Transformation: A NODE. Health Perspective on Digital Evidence.

This article examines the challenges of broad adoption of digital solutions within the healthcare industry and why evidence is so critical for advancement of digital health technologies. It then illustrates how emerging nonprofits are positioned to help the ecosystem overcome these challenges and to catalyze the process of matching the right evidence-based solution to the right clinical challenge

Designing Depression Screening Chatbots

Advances in voice recognition, natural language processing, and artificial intelligence have led to the increasing availability and use of conversational agents (chatbots) in different settings. Chatbots are systems that mimic human dialogue interaction through text or voice. This paper describes a series of design considerations for integrating chatbots interfaces with health services. The present paper is part of ongoing work that explores the overall implementation of chatbots in the healthcare context. The findings have been created using a research through design process, combining (1) literature survey of existing body of knowledge on designing chatbots, (2) analysis on state-of-the-practice in using chatbots as service interfaces, and (3) generative process of designing a chatbot interface for depression screening. In this paper we describe considerations that would be useful for the design of a chatbot for a healthcare context.Applied Ergonomics and Desig

Nursing emigration within United Kingdom: a qualitative exploration of the Spanish nursing community

Aim: To understand and describe the experiences and perceptions of migrant Spanish nurses working in the UK.Design: Online survey with open-ended questions.Methods: A total of 371 participants were recruited from online groups related to Spanish nurses working in the UK. Results: Four themes emerged from their content analysis: “Motivations for emigration: running away from job insecurity and unemployment”, “Professional recognition”, “Seeking better life stability” and “Future neediness: between a rock and a hard place”. In these results, professional recognition was highlighted as a reason to stay in the host country, although the uncertainty represented by Brexit is reversing the migration trend that began years ago. Policymakers should be aware of these experiences to promote strategies and programmes, which encourage inclusion in the host country and will help these nurses in their transition proces

Designing Depression Screening Chatbots

Advances in voice recognition, natural language processing, and artificial intelligence have led to the increasing availability and use of conversational agents (chatbots) in different settings. Chatbots are systems that mimic human dialogue interaction through text or voice. This paper describes a series of design considerations for integrating chatbots interfaces with health services. The present paper is part of ongoing work that explores the overall implementation of chatbots in the healthcare context. The findings have been created using a research through design process, combining (1) literature survey of existing body of knowledge on designing chatbots, (2) analysis on state-of-the-practice in using chatbots as service interfaces, and (3) generative process of designing a chatbot interface for depression screening. In this paper we describe considerations that would be useful for the design of a chatbot for a healthcare context.</p

Public reporting of colonoscopy quality is associated with an increase in endoscopist adenoma detection rate

BACKGROUND: Colonoscopy is the predominant method for colorectal cancer screening in the US. Prior studies have documented variation across physicians in colonoscopy quality as measured by the adenoma detection rate (ADR). ADR is the primary quality measure of colonoscopy exams and an indicator of the likelihood of subsequent patient colorectal cancer. There is interest in mechanisms to improve ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality. OBJECTIVE: To assess whether this initiative was associated with an improvement in ADR. DESIGN: This study compares ADR before and after public reporting at a private practice endoscopy center of 11 gastroenterologists in Peoria, Illinois who participated in the initiative. To generate ADR, colonoscopy and pathology reports from exams performed over four years at the endoscopy center were analyzed using previously validated natural language processing software. SETTING: Central Illinois Endoscopy Center RESULTS: The ADR for colonoscopy in the pre-public reporting era was 25.1%, and after public reporting was 36.4% (increase of 11.3%, p<0.001). Detection of advanced adenomas increased from 10.0% to 12.7% (p<0.001). Each physician’s ADR increased (range of 4.3% to 17.4%). Similar increases in ADR were observed when the analysis was restricted to screening colonoscopy. LIMITATION: There was no concurrent control group to assess whether the increased ADR was due to a secular trend. CONCLUSION: A public reporting initiative on colonoscopy quality was associated with a relative forty-five percent increase in ADR and a 25% increase in advanced adenoma detection. Public reporting may be a means to improve colonoscopy quality