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Background The practice of clinical informatics (CI) is diverse and frequently tailored to individual skills and interests or to organizational/departmental needs. Prior studies have sought to define core content areas, educational milestones, and practice patterns within the clinical informatics subspecialty (CIS). Unfortunately, no single tool or framework currently exists that can succinctly define an informatician's role regardless of setting. The diversity of informatics practice makes it difficult to have one “pitch” that describes all possible domains, tasks, knowledge, and skills available to an informatician. Objective Using qualitative data from multiple informaticians, provide a succinct framework to describe and compartmentalize the various functions an informatician can contribute to the healthcare field. Methods We created an iterative focus group of five CIS fellows enrolled in different fellowship programs nationwide, one CIS program director, and an MD-PhD candidate in biomedical informatics. After much discussion, iteration, and consideration of career options within a young and burgeoning subspecialty, a dual-axis model was created that describes CIS practice in terms of settings (internal, external, and policy) and focus areas (knowledge, operations, and innovation). Results and Conclusion By combining both axes into a single “KOI pond” and then prioritizing sections by interest/resource investment, we are able to generate a unique snapshot for each informatician. These snapshots can be used (1) by informaticians to characterize their own practice succinctly as a pitch, (2) by CIS fellows who are considering career options, and (3) by those unfamiliar with CIS who want to learn more.

Background Given the widespread electronic health record adoption, there is increasing interest to leverage patient portals to improve care. Objective To determine characteristics of patient portal users and the activities they accessed in the patient portal. Methods We performed a retrospective analysis of patient portal usage at University of California, Los Angeles, Health from July 2014 to May 2015. A total dataset of 505,503 patients was compiled with 396,303 patients who did not register for the patient portal and 109,200 patients who registered for a patient portal account. We compared patients who did not register for the online portal to the top 75th percentile of users based on number of logins, which was done to exclude those who only logged in to register. Finally, to avoid doing statistical analysis on too large of a sample and overpower the analysis, we performed statistical tests on a random sample of 300 patients in each of the two groups. Results Patient portal users tended to be older (49.45 vs. 46.22 years in the entire sample, p = 0.008 in the random sample) and more likely female (62.59 vs. 54.91% in the entire sample, p = 0.035 in the random sample). Nonusers had more monthly emergency room (ER) visits on average (0.047 vs. 0.014, p Conclusion There are differences between patient portal users and nonusers, and further understanding of these differences can serve as foundation for further investigation and possible interventions to drive patient engagement and health outcomes.

SummaryObjectives: To compare the completeness of Emergency Department (ED) discharge instructions before and after introduction of an electronic discharge instructions module by scoring compliance with the Centers for Medicare and Medicaid Services (CMS) Outpatient Measure 19 (OP-19).Methods: We performed a quasi-experimental study examining the impact of an electronic discharge instructions module in an academic ED. Three hundred patients discharged home from the ED were randomly selected from two time intervals: 150 patients three months before and 150 patients three to five months after implementation of the new electronic module. The discharge instructions for each patient were reviewed, and compliance for each individual OP-19 element as well as overall OP-19 compliance was scored per CMS specifications. Compliance rates as well as risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) comparing the overall OP-19 scores and individual OP-19 element scores of the electronic and paper-based discharge instructions were calculated.Results: The electronic discharge instructions had 97.3% (146/150) overall OP-19 compliance, while the paper-based discharge instructions had overall compliance of 46.7% (70/150). Electronic discharge instructions were twice as likely to achieve overall OP-19 compliance compared to the paper-based format (RR: 2.09, 95% CI: 1.75 – 2.48). The largest improvement was in documentation of major procedures and tests performed: only 60% of the paper-based discharge instructions satisfied this criterion, compared to 100% of the electronic discharge instructions (RD: 40.0%, 95% CI: 32.2% – 47.8%). There was a modest difference in medication documentation with 92.7% for paper-based and 100% for electronic formats (RD: 7.3%, 95% CI: 3.2% – 11.5%). There were no statistically significant differences in documentation of patient care instructions and diagnosis between paper-based and electronic formats.Conclusions: With careful design, information technology can improve the completeness of ED patient discharge instructions and performance on the OP-19 quality measure.Citation: Bell EJ, Takhar SS, Beloff JR, Schuur JD, Landman AB. Information technology improves emergency department patient discharge instructions completeness and performance on a national quality measure: A quasi-experimental study. Appl Clin Inf 2013; 4: 499–514 http://dx.doi.org/10.4338/ACI-07-RA-0046