{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T01:11:02Z","timestamp":1776215462542,"version":"3.50.1"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000936","name":"The Gordon and Betty Moore Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000936","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000092","name":"National Library of Medicine","doi-asserted-by":"publisher","award":["R56LM013365"],"award-info":[{"award-number":["R56LM013365"]}],"id":[{"id":"10.13039\/100000092","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stanford Artificial Intelligence in Medicine"},{"name":"Imaging\u2014Human-Centered Artificial Intelligence"},{"name":"Stanford Aging and Ethnogeriatrics"},{"DOI":"10.13039\/100000049","name":"NIA","doi-asserted-by":"publisher","award":["P30AG059307"],"award-info":[{"award-number":["P30AG059307"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Google Inc. VXL"},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["R35GM128672"],"award-info":[{"award-number":["R35GM128672"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We selected one widely-used process outcome: emergency department (ED)-based team time to deliver tissue plasminogen activator (tPA) to patients with acute ischemic stroke (AIS). We evaluated Epic audit log data (that tracks EHR user-interactions) for 3052 AIS patients aged 18+ who received tPA after presenting to an ED at three Northern California health systems (Stanford Health Care, UCSF Health, and Kaiser Permanente Northern California). Our primary outcome was door-to-needle time (DNT) and we assessed bivariate and multivariate relationships with six audit log-derived measures of treatment team busyness and prior team experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prior team experience was consistently associated with shorter DNT; teams with greater prior experience specifically on AIS cases had shorter DNT (minutes) across all sites: (Site 1: \u221294.73, 95% CI: \u2212129.53 to 59.92; Site 2: \u221280.93, 95% CI: \u2212130.43 to 31.43; Site 3: \u221242.95, 95% CI: \u221262.73 to 23.17). Teams with greater prior experience across all types of cases also had shorter DNT at two sites: (Site 1: \u22126.96, 95% CI: \u221214.56 to 0.65; Site 2: \u221219.16, 95% CI: \u221236.15 to 2.16; Site 3: \u221211.07, 95% CI: \u221217.39 to 4.74). Team busyness was not consistently associated with DNT across study sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EHR audit log data offers a novel, scalable approach to measure key contextual factors relevant to clinical process outcomes across multiple sites. Audit log-based measures of team experience were associated with better process outcomes for AIS care, suggesting opportunities to study underlying mechanisms and improve care through deliberate training, team-building, and scheduling to maximize team experience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocac201","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T17:29:27Z","timestamp":1665595767000},"page":"8-15","source":"Crossref","is-referenced-by-count":24,"title":["Team is brain: leveraging EHR audit log data for new insights into acute care processes"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5115-649X","authenticated-orcid":false,"given":"Christian","family":"Rose","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Stanford University School of Medicine , Stanford, California,","place":["USA"]}]},{"given":"Robert","family":"Thombley","sequence":"additional","affiliation":[{"name":"Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco , San Francisco, California,","place":["USA"]}]},{"given":"Morteza","family":"Noshad","sequence":"additional","affiliation":[{"name":"Stanford Center for Biomedical Informatics Research, Stanford University , Stanford, California,","place":["USA"]}]},{"given":"Yun","family":"Lu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research , Oakland, California,","place":["USA"]}]},{"given":"Heather A","family":"Clancy","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research , Oakland, California,","place":["USA"]}]},{"given":"David","family":"Schlessinger","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research , Oakland, California,","place":["USA"]}]},{"given":"Ron C","family":"Li","sequence":"additional","affiliation":[{"name":"Stanford Center for Biomedical Informatics Research, Stanford University , Stanford, California,","place":["USA"]},{"name":"Division of Hospital Medicine, Stanford University School of Medicine , Stanford, California,","place":["USA"]}]},{"given":"Vincent X","family":"Liu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research , Oakland, California,","place":["USA"]}]},{"given":"Jonathan H","family":"Chen","sequence":"additional","affiliation":[{"name":"Stanford Center for Biomedical Informatics Research, Stanford University , Stanford, California,","place":["USA"]},{"name":"Division of Hospital Medicine, Stanford University School of Medicine , Stanford, California,","place":["USA"]},{"name":"Clinical Excellence Research Center, Stanford University School of Medicine , Stanford, California,","place":["USA"]}]},{"given":"Julia","family":"Adler-Milstein","sequence":"additional","affiliation":[{"name":"Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco , San Francisco, California,","place":["USA"]}]}],"member":"286","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"issue":"1","key":"2026041420160148400_ocac201-B1","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s13643-020-01344-3","article-title":"The influence of contextual factors on healthcare quality improvement initiatives: a realist review","volume":"9","author":"Coles","year":"2020","journal-title":"Syst Rev"},{"issue":"9258","key":"2026041420160148400_ocac201-B2","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S0140-6736(00)04169-6","article-title":"Influence of context effects on health outcomes: asystematic 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