nology. ''Sec. 3002. HIT Policy Committee. ''Sec. 3003. HIT Standards Committee. ''Sec. 3004. Process for adoption of endorsed recommendations; adoption of initial set of standards, implementation specifications, and certification criteria. ''Sec. 3005. Application and use of adopted standards and implementation specifications by Federal agencies. ''Sec. 3006. Voluntary application and use of adopted standards and implementation specifications by private entities. ''Sec. 3007. Federal health information technology. ''Sec. 3008. Transitions. ''Sec. 3009. Miscellaneous provisions. Sec. 13102. Technical amendment. PART 2-APPLICATION AND USE OF ADOPTED HEALTH INFORMATION TECHNOLOGY

Objective To describe the literature exploring the use of electronic health record (EHR) systems to support creation and use of clinical documentation to guide future research. Materials and Methods We searched databases including MEDLINE, Scopus, and CINAHL from inception to April 20, 2018, for studies applying qualitative or mixed-methods examining EHR use to support creation and use of clinical documentation. A qualitative synthesis of included studies was undertaken. Results Twenty-three studies met the inclusion criteria and were reviewed in detail. We briefly reviewed 9 studies that did not meet the inclusion criteria but provided recommendations for EHR design. We identified 4 key themes: purposes of electronic clinical notes, clinicians’ reasoning for note-entry and reading/retrieval, clinicians’ strategies for note-entry, and clinicians’ strategies for note-retrieval/reading. Five studies investigated note purposes and found that although patient care is the primary note purpose, non-clinical purposes have become more common. Clinicians’ reasoning studies (n = 3) explored clinicians’ judgement about what to document and represented clinicians’ thought process in cognitive pathways. Note-entry studies (n = 6) revealed that what clinicians document is affected by EHR interfaces. Lastly, note-retrieval studies (n = 12) found that “assessment and plan” is the most read note section and what clinicians read is affected by external stimuli, care/information goals, and what they know about the patient. Conclusion Despite the widespread adoption of EHRs, their use to support note-entry and reading/retrieval is still understudied. Further research is needed to investigate approaches to capture and represent clinicians’ reasoning and improve note-entry and retrieval/reading.

Our results and methodology can guide the broader medical and informatics communities by informing what and how to continuously monitor EHR impact on quality, productivity, and safety.

Objective The study sought to describe the literature describing clinical reasoning ontology (CRO)–based clinical decision support systems (CDSSs) and identify and classify the medical knowledge and reasoning concepts and their properties within these ontologies to guide future research. Methods MEDLINE, Scopus, and Google Scholar were searched through January 30, 2019, for studies describing CRO-based CDSSs. Articles that explored the development or application of CROs or terminology were selected. Eligible articles were assessed for quality features of both CDSSs and CROs to determine the current practices. We then compiled concepts and properties used within the articles. Results We included 38 CRO-based CDSSs for the analysis. Diversity of the purpose and scope of their ontologies was seen, with a variety of knowledge sources were used for ontology development. We found 126 unique medical knowledge concepts, 38 unique reasoning concepts, and 240 unique properties (137 relationships and 103 attributes). Although there is a great diversity among the terms used across CROs, there is a significant overlap based on their descriptions. Only 5 studies described high quality assessment. Conclusion We identified current practices used in CRO development and provided lists of medical knowledge concepts, reasoning concepts, and properties (relationships and attributes) used by CRO-based CDSSs. CRO developers reason that the inclusion of concepts used by clinicians’ during medical decision making has the potential to improve CDSS performance. However, at present, few CROs have been used for CDSSs, and high-quality studies describing CROs are sparse. Further research is required in developing high-quality CDSSs based on CROs.

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