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Background: The growing demand for genomic testing and limited access to experts necessitate innovative service models. While chatbots have shown promise in supporting genomic services like pre-test counseling, their use in returning positive genetic results, especially using the more recent large language models (LLMs) remains unexplored. Objective: This study reports the prompt engineering process and intrinsic evaluation of the LLM component of a chatbot designed to support returning positive population-wide genomic screening results. Methods: We used a three-step prompt engineering process, including Retrieval-Augmented Generation (RAG) and few-shot techniques to develop an open-response chatbot. This was then evaluated using two hypothetical scenarios, with experts rating its performance using a 5-point Likert scale across eight criteria: tone, clarity, program accuracy, domain accuracy, robustness, efficiency, boundaries, and usability. Results: The chatbot achieved an overall score of 3.88 out of 5 across all criteria and scenarios. The highest ratings were in Tone (4.25), Usability (4.25), and Boundary management (4.0), followed by Efficiency (3.88), Clarity and Robustness (3.81), and Domain Accuracy (3.63). The lowest-rated criterion was Program Accuracy, which scored 3.25. Discussion: The LLM handled open-ended queries and maintained boundaries, while the lower Program Accuracy rating indicates areas for improvement. Future work will focus on refining prompts, expanding evaluations, and exploring optimal hybrid chatbot designs that integrate LLM components with rule-based chatbot components to enhance genomic service delivery.

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INTRODUCTION: SCALE-UP II aims to investigate the effectiveness of population health management interventions using text messaging (TM), chatbots and patient navigation (PN) in increasing the uptake of at-home COVID-19 testing among patients in historically marginalised communities, specifically, those receiving care at community health centres (CHCs). METHODS AND ANALYSIS: The trial is a multisite, randomised pragmatic clinical trial. Eligible patients are >18 years old with a primary care visit in the last 3 years at one of the participating CHCs. Demographic data will be obtained from CHC electronic health records. Patients will be randomised to one of two factorial designs based on smartphone ownership. Patients who self-report replying to a text message that they have a smartphone will be randomised in a 2×2×2 factorial fashion to receive (1) chatbot or TM; (2) PN (yes or no); and (3) repeated offers to interact with the interventions every 10 or 30 days. Participants who do not self-report as having a smartphone will be randomised in a 2×2 factorial fashion to receive (1) TM with or without PN; and (2) repeated offers every 10 or 30 days. The interventions will be sent in English or Spanish, with an option to request at-home COVID-19 test kits. The primary outcome is the proportion of participants using at-home COVID-19 tests during a 90-day follow-up. The study will evaluate the main effects and interactions among interventions, implementation outcomes and predictors and moderators of study outcomes. Statistical analyses will include logistic regression, stratified subgroup analyses and adjustment for stratification factors. ETHICS AND DISSEMINATION: The protocol was approved by the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with National Institutes of Health data sharing policies. Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT05533918 and NCT05533359.

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Racial/ethnic minority, low socioeconomic status, and rural populations are disproportionately affected by COVID-19. Developing and evaluating interventions to address COVID-19 testing and vaccination among these populations are crucial to improving health inequities. The purpose of this paper is to describe the application of a rapid-cycle design and adaptation process from an ongoing trial to address COVID-19 among safety-net healthcare system patients. The rapid-cycle design and adaptation process included: (a) assessing context and determining relevant models/frameworks; (b) determining core and modifiable components of interventions; and (c) conducting iterative adaptations using Plan-Do-Study-Act (PDSA) cycles. PDSA cycles included: Plan. Gather information from potential adopters/implementers (e.g., Community Health Center [CHC] staff/patients) and design initial interventions; Do. Implement interventions in single CHC or patient cohort; Study. Examine process, outcome, and context data (e.g., infection rates); and, Act. If necessary, refine interventions based on process and outcome data, then disseminate interventions to other CHCs and patient cohorts. Seven CHC systems with 26 clinics participated in the trial. Rapid-cycle, PDSA-based adaptations were made to adapt to evolving COVID-19-related needs. Near real-time data used for adaptation included data on infection hot spots, CHC capacity, stakeholder priorities, local/national policies, and testing/vaccine availability. Adaptations included those to study design, intervention content, and intervention cohorts. Decision-making included multiple stakeholders (e.g., State Department of Health, Primary Care Association, CHCs, patients, researchers). Rapid-cycle designs may improve the relevance and timeliness of interventions for CHCs and other settings that provide care to populations experiencing health inequities, and for rapidly evolving healthcare challenges such as COVID-19.

Racial/ethnic minority, low socioeconomic status, and rural populations experience a disproportionate burden of COVID-19. Finding ways to address COVID-19 among these populations is crucial to improving health inequities. The purpose of this paper is to describe the rapid-cycle design process for a research project to address COVID-19 testing and vaccination among safety-net healthcare system patients. The project used real-time information on changes in COVID-19 policy (e.g., vaccination authorization), local case rates, and the capacity of safety-net healthcare systems to iteratively change interventions to ensure interventions were relevant and timely for patients. Key changes that were made to interventions included a change to the study design to include vaccination as a focus of the interventions after the vaccine was authorized; change in intervention content according to the capacity of local Community Health Centers to provide testing to patients; and changes to intervention cohorts such that priority groups of patients were selected for intervention based on characteristics including age, residency in an infection "hot spot," or race/ethnicity. Iteratively improving interventions based on real-time data collection may increase intervention relevance and timeliness, and rapid-cycle adaptions can be successfully implemented in resource constrained settings like safety-net healthcare systems.

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Population health management (PHM) is an important approach to promote wellness and deliver health care to targeted individuals who meet criteria for preventive measures or treatment. A critical component for any PHM program is a data analytics platform that can target those eligible individuals. OBJECTIVE: The aim of this study was to design and implement a scalable standards-based clinical decision support (CDS) approach to identify patient cohorts for PHM and maximize opportunities for multi-site dissemination. MATERIALS AND METHODS: An architecture was established to support bidirectional data exchanges between heterogeneous electronic health record (EHR) data sources, PHM systems, and CDS components. HL7 Fast Healthcare Interoperability Resources and CDS Hooks were used to facilitate interoperability and dissemination. The approach was validated by deploying the platform at multiple sites to identify patients who meet the criteria for genetic evaluation of familial cancer. RESULTS: The Genetic Cancer Risk Detector (GARDE) platform was created and is comprised of four components: (1) an open-source CDS Hooks server for computing patient eligibility for PHM cohorts, (2) an open-source Population Coordinator that processes GARDE requests and communicates results to a PHM system, (3) an EHR Patient Data Repository, and (4) EHR PHM Tools to manage patients and perform outreach functions. Site-specific deployments were performed on onsite virtual machines and cloud-based Amazon Web Services. DISCUSSION: GARDE's component architecture establishes generalizable standards-based methods for computing PHM cohorts. Replicating deployments using one of the established deployment methods requires minimal local customization. Most of the deployment effort was related to obtaining site-specific information technology governance approvals.

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BACKGROUND: The creation of a computerized clinical database with the ability to collect prospective information from patients and with the possibility of rescue and crossing data enables scientific studies of higher quality and credibility in less time. AIM: To validate, in a single master protocol, the clinical data referring to Surgery of Digestive System in a multidisciplinary way, incorporating in the SINPE© platform, and to verify the incidence of digestive diseases based on the prospectively performed collections. METHOD: Organize in one software, in a standardized structure, all the pre-existing items in the SINPE© database; the theoretical basis was computerized through the MIGRASINPE© module creating a single multiprofessional master protocol for use as a whole. RESULTS: The existing specific protocols were created and/or adapted - they correspond to the most prevalent digestive diseases - unifying them. The possibility of multiprofessional use was created by integrating all data collected from medicine, nursing, physiotherapy, nutrition and health management in a prospective way. The total was 4,281 collections, distributed as follows: extrahepatic biliary tract, n=1,786; esophagus, n=1015; anorectal, n=736; colon, n=550; small intestine, n=86; pancreas, n=71; stomach, n=23; liver, n=14. CONCLUSIONS: The validation of the unification and structuring in a single master protocol of the clinical data referring to the Surgery of the Digestive System in a multiprofessional and prospective way was possible and the epidemiological study carried out allowed to identify the most prevalent digestive diseases.

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Abstract Background: The creation of a computerized clinical database with the ability to collect prospective information from patients and with the possibility of rescue and crossing data enables scientific studies of higher quality and credibility in less time. Aim: To validate, in a single master protocol, the clinical data referring to Surgery of Digestive System in a multidisciplinary way, incorporating in the SINPE© platform, and to verify the incidence of digestive diseases based on the prospectively performed collections. Method: Organize in one software, in a standardized structure, all the pre-existing items in the SINPE© database; the theoretical basis was computerized through the MIGRASINPE© module creating a single multiprofessional master protocol for use as a whole. Results: The existing specific protocols were created and/or adapted - they correspond to the most prevalent digestive diseases - unifying them. The possibility of multiprofessional use was created by integrating all data collected from medicine, nursing, physiotherapy, nutrition and health management in a prospective way. The total was 4,281 collections, distributed as follows: extrahepatic biliary tract, n=1,786; esophagus, n=1015; anorectal, n=736; colon, n=550; small intestine, n=86; pancreas, n=71; stomach, n=23; liver, n=14. Conclusions: The validation of the unification and structuring in a single master protocol of the clinical data referring to the Surgery of the Digestive System in a multiprofessional and prospective way was possible and the epidemiological study carried out allowed to identify the most prevalent digestive diseases.

RESUMO Racional: A criação de um banco de dados clínicos informatizado com a capacidade de coletar informações dos pacientes de forma prospectiva e com possibilidade de resgate e cruzamento viabiliza estudos científicos de maior qualidade e credibilidade em menor tempo. Objetivos: Validar em único protocolo mestre os dados clínicos referentes à Cirurgia do Aparelho Digestivo de forma multiprofissional incorporando-o na plataforma SINPE©, e verificar a incidência das doenças digestivas com base nas coletas prospectivamente realizadas. Método: Organizar no software em estrutura padronizada todos os itens pré-existentes no banco de dados do SINPE©, informatizar a base teórica através do módulo MIGRASINPE© criando-se um único protocolo mestre multiprofissional para uso como um todo. Resultados: Foram criados e/ou adaptados os protocolos específicos existentes que correspondem às doenças digestivas mais prevalentes unificando-os. Criou-se a possibilidade de uso multiprofissional integrando todos os dados coletados da medicina, enfermagem, fisioterapia, nutrição e gestão em saúde de maneira prospectiva. O total foi de 4.281 coletas assim distribuídas: vias biliares extra-hepáticas, n=1.786; esôfago, n=1015; anorretais, n=736; cólon, n=550; intestino delgado, n=86; pâncreas, n=71; estômago, n=23; fígado, n=14. Conclusões: A validação da unificação e estruturação em único protocolo mestre dos dados clínicos referentes à Cirurgia do Aparelho Digestivo de forma multiprofissional e prospectiva foi possível e o estudo epidemiológico realizado permitiu identificar as doenças mais prevalentes nesse aparelho.

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Background: The creation of a computerized clinical database with the ability to collect prospective information from patients and with the possibility of rescue and crossing data enables scientific studies of higher quality and credibility in less time. Aim: To validate, in a single master protocol, the clinical data referring to Surgery of Digestive System in a multidisciplinary way, incorporating it in the SINPEâ platform, and to verify the incidence of digestive diseases based on the prospectively performed collections. Method: Organize in one software, in a standardized structure, all the pre-existing items in the SINPEâ database; the theoretical basis was computerized through the MIGRASINPEâ module creating a single multiprofessional master protocol for use as a whole. Results: The existing specific protocols were created and/or adapted ­ they correspond to the most prevalent digestive diseases - unifying them. The possibility of multiprofessional use was created by integrating all data collected from Medicine, Nursing, Physiotherapy, Nutrition and Health Management in a prospective way. The total was 4,281 collections, distributed as follows: extrahepatic biliary tract n=1,786; esophagus n=1015; anorectal n=736; colon n=550; small intestine n=86; pancreas n=71; stomach=23; liver n=14. Conclusions: The validation of the unification and structuring in a single master protocol of the clinical data referring to the Surgery of the Digestive System in a multiprofessional and prospective way was possible and the epidemiological study carried out allowed to identify the most prevalent digestive diseases in a tertiary university hospital.

Racional: A criação de um banco de dados clínicos informatizado com a capacidade de coletar informações dos pacientes de forma prospectiva e com possibilidade de resgate e cruzamento viabiliza estudos científicos de maior qualidade e credibilidade em menor tempo. Objetivos: Validar em único protocolo mestre os dados clínicos referentes à Cirurgia do Aparelho Digestivo de forma multiprofissional incorporando-o na plataforma SINPEâ, e verificar a incidência das doenças digestivas com base nas coletas prospectivamente realizadas. Método: Organizar no software em estrutura padronizada todos os itens pré-existentes no banco de dados do SINPEâ, informatizou-se a base teórica através do módulo MIGRASINPE© criando-se um único protocolo mestre multiprofissional para uso como um todo. Resultados: Foram criados e/ou adaptados os protocolos específicos existentes - que correspondem às doenças mais prevalentes que assolam este aparelho ­ unificando-os. Criou-se a possibilidade de uso multiprofissional integrando todos os dados coletados da Medicina, Enfermagem, Fisioterapia, Nutrição e Gestão em Saúde de maneira prospectiva. O total foi de 4.281 coletas assim distribuídas: vias biliares extra-hepáticas n=1.786; esôfago n=1015; anorretais n=736; cólon n=550; intestino delgado n=86; pâncreas n=71; estômago=23; fígado n=14.  Conclusões: A validação da unificação e estruturação em único protocolo mestre dos dados clínicos referentes à Cirurgia do Aparelho Digestivo de forma multiprofissional e prospectiva foi possível e o estudo epidemiológico realizado permitiu identificar as doenças mais prevalentes nesse aparelho em um hospital universitário terciário.

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In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.

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Sliding scale insulin (SSI) is a reactive therapy and does not maintain euglycemia in hospitalized patients. A combination of basal insulin, prandial insulin, and correction factor dosing provides a more consistent insulin state encouraging improved glycemic control. Intermountain Healthcare developed an application consisting of four calculators incorporating scheduled (basal and prandial) and correction-factor insulin. The result is a patient-specific order set with calculated insulin orders, a correction factor dosing table, and a carbohydrate dosing table. This paper describes the SQIC, access, usage monitoring, and challenges and solutions to the computerized decision support application created to replace SSI.

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RACIONAL: Um banco de dados clínicos informatizado possibilita melhor forma de coleta, resgate e cruzamento de informações para realização de pesquisa científica. Estudos multicêntricos podem ser gerados a partir da utilização destes mecanismos de forma ágil e prática. OBJETIVO: a) Analisar a funcionalidade da base informatizada de dados clínicos das doenças do apêndice ileocecal; b) apresentar os resultados nesta análise para validação do protocolo informatizado das doenças do cólon incorporados no SINPE© (Sistema Integrado de Protocolos Eletrônicos - INPI n° 00051543). MÉTODO: Considerando o protocolo específico das doenças do apêndice cecal, coletaram-se informações de prontuários de 862 pacientes com apendicite aguda, de forma multicêntrica, envolvendo três ambientes universitários: Hospital de Clínicas da Universidade Federal do Paraná, Hospital Universitário Evangélico de Curitiba e Hospital do Trabalhador da Universidade Federal do Paraná. O programa de coleta de dados SINPE© foi responsável pelo armazenamento, agrupamento e posterior busca das informações. RESULTADOS: O Hospital de Clínicas colaborou com 53,83% dos pacientes, enquanto que os outros dois com 31,32% e 14,85%, respectivamente. A dor abdominal foi o sintoma mais característico e mais presente do quadro clínico dos pacientes que tiveram apendicite aguda confirmada. O hemograma infeccioso (presente em 77,81%) e a ecografia, visualizando alteração do apêndice cecal (presente em 67,40%) foram os exames complementares mais freqüentes para se firmar o diagnóstico referido. A apendicectomia, realizada em 98,43%, foi o procedimento terapêutico padrão para a resolução da doença, tendo sido efetuada por técnica laparotômica em 92,45% - principalmente pela incisão de MacBurney (74,55%). As cefalosporinas de segunda geração foram as drogas mais empregadas em associação ao procedimento cirúrgico, seja para profilaxia ou terapêutica das infecções. As complicações pós-operatórias estiveram presentes em 10,32% dos pacientes, correspondendo principalmente às infecções de parede abdominal (64,28%). CONCLUSÃO: O protocolo informatizado de dados clínicos das doenças do cólon, especificamente em sua parte das doenças do apêndice cecal, é viável e eficaz na manipulação de informações clínicas para produção de estudos científicos uni ou multicêntricos.

BACKGROUND: A clinical database allows a better way to collect and, consequently, search and cross information to scientific researches. Multicentric studies can be easily created by using this mechanism. AIM: a) To analyze the functionality of the computerized database of the appendix diseases; b) to show the results of the analyzed data to validate the computerized database of the colon diseases incorporated to SINPE® (Computerized Database Integrated System - INPI 00051543). METHODS: Information provided by 862 patients with acute appendicitis has been collected into the specific protocol of the appendiceal diseases, from three university centers: Hospital de Clínicas of the Universidade Federal do Paraná, Hospital Universitário Evangélico de Curitiba and Hospital do Trabalhador of the Universidade Federal do Paraná. SINPE© was the software used to store, to select and to search information thereby compared to general literature. RESULTS: The Hospital de Clínicas supported 53,83% of the patients, meanwhile, the other two included 31,32% e 14,85%, respectively. Abdominal pain was the most common and characteristic symptom in patients who had confirmation of acute appendicitis. Infectious hemogram (in 77, 81%) and abdominal ultrasound showing parietal abnormalities of the appendix (in 67, 40%) were the diagnostic exams more frequently adopted to prove the referred diagnosis. Appendectomy, applied in 98, 43% of the patients, was the standard therapeutic proceeding. The MacBurney incision, applied in 74, 55% of all conventional surgeries, was the most frequent form to make access to the peritoneal cavity. Second generation cephalosporin was the usual drug associated to surgery, even for prophylaxis or therapeutics, on the infectious process. 10, 32% of the patients developed a kind of post-operative complication, being parietal infection (64, 28%) the most prevalent. CONCLUSIONS: The clinical database's computerized protocol of colon diseases, specifically on its appendiceal diseases' protocol, was considered efficient and viable to manipulate clinical information objecting simple or multicentric scientific researches production.

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Os avanços e descobertas de novos recursos diagnósticos e terapêuticos com o uso de tecnologia dos dados é importante para seu gerenciamento. Os sistemas atuais de registro de uma instituição de saúde não possibilita levantamentos epidemiológicos das informações de forma integrada, tanto administrativas quanto assistenciais / The advances and discoveries of new diagnostic and therapeutic resources, by way of applied technology in medical practice, have been generating a large amount of data. The amount of information demands the computerization of data, in order to manage them. The database system at a health institution doesn't alow for the storing and recovering of data in an integrated manner, both for health care and administrative purpose...

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