Evidence map›Paper›PMID 33594410›Full record

ArticleJournal of the American Medical Informatics Association : JAMIA2021

Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions.

Alan H Morris, Brian Stagg, Michael Lanspa, James Orme, Terry P Clemmer, Lindell K Weaver, Frank Thomas, Colin K Grissom, Ellie Hirshberg, Thomas D East and 58 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Informatics Association : JAMIA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed.

  1. Trial
  2. Person-Centered Technology for Older Adults: Benefits, Limitations, and Considerations in Design and Use.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2026
    Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Redefining ARDS: a paradigm shift.Critical care (London, England) · 2023
    Review
  10. Combining text mining with clinical decision support in clinical practice: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2023
    Article
  11. Review
  12. Article
  13. Article
  14. Automated Workflow for Usability Audits in the PHR Realm.International journal of environmental research and public health · 2022
    Article
  15. Article
  16. Article
  17. Article
  18. Progress toward a science of learning systems for healthcare.Journal of the American Medical Informatics Association : JAMIA · 2021
    Article
  19. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

68 authors.

Alan H MorrisPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine.ORCID 0000-0001-7005-7924
Brian StaggDepartment of Ophthalmology and Visual Sciences and John Moran Eye Center.
Michael LanspaPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA.
James OrmePulmonary, Critical Care, and Sleep Division, Department of Internal Medicine.
Terry P ClemmerPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine.
Lindell K WeaverPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine.
Frank ThomasDepartment of Value Engineering, University of Utah Hospitals and Clinics, Salt Lake City, Utah, USA.
Colin K GrissomPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine.
Ellie HirshbergPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA.
Thomas D EastSYNCRONYS, and University of New Mexico Health Sciences Library & Informatics, Albuquerque, New Mexico, USA.
Carrie Jane WallaceDepartment of Ophthalmology and Visual Sciences and John Moran Eye Center.
Michael P YoungCritical Care Division, Renown Medical Center, School of Medicine, University of Nevada, Reno, Nevada, USA.
Dean F SittigSchool of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA.ORCID 0000-0001-5811-8915
Antonio PesentiDipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Michela BombinoDepartment of Emergency and Intensive Care Medicine, ASST-Monza San Gerardo Hospital, Milan, Italy.
Eduardo BeckOspedale di Desio-ASST Monza, UOC Anestesia e Rianimazione, Milan, Italy.
Katherine A SwardDepartment of Biomedical Informatics.
Charlene WeirDepartment of Biomedical Informatics.ORCID 0000-0002-8297-2860
Shobha S PhansalkarDivision of General Medicine and Primary Care, Brigham and Women's Hospital.
Gordon R BernardPulmonary, Critical Care, and Allergy Division, Department of Internal Medicine.
B Taylor ThompsonPulmonary, Critical Care, and Sleep Division , Department of Internal Medicine.
Roy BrowerPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jonathon D TruwitPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Jay SteingrubPulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.
R Duncan HitePulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Douglas F WillsonDivision of Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA.
Jerry J ZimmermanDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
Vinay M NadkarniDepartment of Anesthesia and Critical Care Medicine.
Adrienne RandolphDepartment of Pediatrics.
Martha A Q CurleyDepartment of Pediatrics, Perelman School of Medicine.
Christopher J L NewthDepartment of Pediatrics, University of Southern California, Los Angeles, California, USA.
Jacques LacroixDivision of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montréal, Canada.
Michael S D AgusDepartment of Pediatrics.
Kang H LeeAsian American Liver Centre, Gleneagles Hospital, Singapore, Singapore.
Bennett P deBoisblancSection of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA.
R Scott EvansDepartment of Biomedical Informatics.
Dean K SorensonDepartment of Biomedical Informatics.
Anthony WongAnn & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Michael V BolandMassachusetts Eye and Ear.
David W GraingerDepartment of Biomedical Engineering and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah.
Willard H DereDepartment of Biomedical Engineering and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah.
Alan S CrandallDepartment of Ophthalmology and Visual Sciences and John Moran Eye Center.
Julio C FacelliDepartment of Biomedical Informatics.
Stanley M HuffDepartment of Biomedical Informatics.
Peter J HaugDepartment of Biomedical Informatics.
Ulrike PielmeierDepartment of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Stephen E ReesDepartment of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Dan S KarbingDepartment of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Steen AndreassenDepartment of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Eddy FanInstitute of Health Policy, Management and Evaluation.
Roberta M GoldringPulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA.
Kenneth I BergerPulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA.
Beno W OppenheimerPulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA.
E Wesley ElyPulmonary, Critical Care, and Allergy Division, Department of Internal Medicine.
Ognjen GajicPulmonary , Critical Care, and Sleep Division, Department of Internal Medicine.
Brian PickeringDepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
David A SchoenfeldDepartment of Biostatistics, T.H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA.
Irena TocinoDepartment of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.
Russell S GonneringDepartment of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Peter J PronovostCritical Care, Department of Anesthesia, Chief Clinical Transformation Officer, University Hospitals, Highland Hills, Case Western Reserve University, Cleveland, OH, USA.
Lucy A SavitzKaiser Permanente Northwest Center for Health Research, Portland, OR, USA.
Didier DreyfussAssistance Publique - Hôpitaux de Paris, Université de Paris, INSERM unit UMR S_1155 (Common and Rare Kidney Diseases), Sorbonne Université, Paris, France.
Arthur S SlutskyKeenan Research Center, Li Ka Shing Knowledge Institute / ST. Michaels' Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
James D CrapoDepartment of Internal Medicine, National Jewish Health, Denver, Colorado, USA.
Derek AngusDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Michael R PinskyDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Brent JamesClinical Excellence Research Center (CERC), Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Donald BerwickInstitute for Healthcare Improvement, Boston, Massachusetts, USA.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Utah Center for Clinical and Translational ScienceUL1TR002538 · NCATS · UNIVERSITY OF UTAH · PI HESS, RACHEL, MAJERSIK, JENNIFER JUHL · 2018 to 2022
$26.0M
Re-Engineering the Clinical Research EnterpriseN01HC045210 · HC · LDS HOSPITAL · PI MORRIS, ALAN H · 2004 to 2004
–
Clin Coord Ctr for Clin Ntwrk Treatment of ARDS-268056179-268056179N01HR056179 · HR · MASSACHUSETTS GENERAL HOSPITAL · PI SCHOENFELD, DAVID · 2005 to 2006
–
NCATS NIH HHS UL1 TR001863NCATS NIH HHS UL1 TR002538NHLBI NIH HHS N01 HC045210NHLBI NIH HHS N01 HR056165NHLBI NIH HHS N01 HR056170NHLBI NIH HHS N01 HR056171NHLBI NIH HHS N01 HR056175NHLBI NIH HHS N01 HR056179
6 · The paper itself

Abstract

Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention-the starting point for delivery of "All the right care, but only the right care," an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are based only on their training, expertise, and experience. Electronic health records (EHRs) could improve healthcare with robust decision-support tools that reduce unwarranted variation of clinician decisions and actions. Current EHRs, focused on results review, documentation, and accounting, are awkward, time-consuming, and contribute to clinician stress and burnout. Decision-support tools could reduce clinician burden and enable replicable clinician decisions and actions that personalize patient care. Most current clinical decision-support tools or aids lack detail and neither reduce burden nor enable replicable actions. Clinicians must provide subjective interpretation and missing logic, thus introducing personal biases and mindless, unwarranted, variation from evidence-based practice. Replicability occurs when different clinicians, with the same patient information and context, come to the same decision and action. We propose a feasible subset of therapeutic decision-support tools based on credible clinical outcome evidence: computer protocols leading to replicable clinician actions (eActions). eActions enable different clinicians to make consistent decisions and actions when faced with the same patient input data. eActions embrace good everyday decision-making informed by evidence, experience, EHR data, and individual patient status. eActions can reduce unwarranted variation, increase quality of clinical care and research, reduce EHR noise, and could enable a learning healthcare system.

Indexed as

Learning Health SystemClinical Decision-MakingComputersDocumentationElectronic Health RecordsHumans

Identifiers

PMID33594410
PMCPMC8661391

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.