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Turer RW, McDonald SA, Lehmann CU, Thakur B, Dutta S, Taylor RA, Rose CC, Frisch A, Feterik K, Norquist C, Baker CK, Nielson JA, Cha D, Kwan B, Dameff C, Killeen JP, Hall MK, Doerning RC, Rosenbloom ST, Distaso C, Steitz BD. Real-Time Electronic Patient Portal Use Among Emergency Department Patients. JAMA Netw Open 2024; 7:e249831. [PMID: 38700859 PMCID: PMC11069088 DOI: 10.1001/jamanetworkopen.2024.9831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Patients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients. Objectives To describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers. Design, Setting, and Participants In this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022. Exposure Use of the patient portal during ED visit. Main Outcomes and Measures The primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use. Results The study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes. Conclusions and Relevance These findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine's role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.
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Affiliation(s)
- Robert W. Turer
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Samuel A. McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Bhaskar Thakur
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sayon Dutta
- Department of Emergency Medicine, Mass General Brigham, Boston, Massachusetts
- Mass General Brigham Digital, Boston, Massachusetts
| | - Richard A. Taylor
- Department of Emergency Medicine and Section for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Heath, New Haven, Connecticut
| | - Christian C. Rose
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Adam Frisch
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristian Feterik
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Craig Norquist
- Department of Emergency Medicine, HonorHealth, Phoenix, Arizona
| | - Carrie K. Baker
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Jeffrey A. Nielson
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - David Cha
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Brian Kwan
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - Christian Dameff
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - James P. Killeen
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - Michael K. Hall
- Department of Emergency Medicine, University of Washington, Seattle
| | | | - S. Trent Rosenbloom
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Casey Distaso
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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Patel TN, Chaise AJ, Hanna JJ, Patel KP, Kochendorfer KM, Medford RJ, Mize DE, Melnick ER, Hron JD, Youens K, Pandita D, Leu MG, Ator GA, Yu F, Genes N, Baker CK, Bell DS, Pevnick JM, Conrad SA, Chandawarkar AR, Rogers KM, Kaelber DC, Singh IR, Levy BP, Finnell JT, Kannry J, Pageler NM, Mohan V, Lehmann CU. Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors. Appl Clin Inform 2024; 15:155-163. [PMID: 38171383 PMCID: PMC10881258 DOI: 10.1055/a-2237-8309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures. OBJECTIVES The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses. METHODS We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021. RESULTS We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities. CONCLUSION CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.
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Affiliation(s)
- Tushar N. Patel
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Aaron J. Chaise
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - John J. Hanna
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, United States
| | - Kunal P. Patel
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Karl M. Kochendorfer
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Richard J. Medford
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, United States
| | - Dara E. Mize
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Edward R. Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, Connecticut, United States
| | - Jonathan D. Hron
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Kenneth Youens
- Department of Pathology, Baylor Scott & White Health, Temple, Texas, United States
| | - Deepti Pandita
- Department of Internal Medicine, University of California, Irvine, California, United States
| | - Michael G. Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- Information Technology Services, UW Medicine, Seattle, WA, United States
- Information Technology Department, Seattle Children's Hospital, Seattle, WA, United States
| | - Gregory A. Ator
- Department of Otolaryngology-Head and Neck Surgery and Clinical Informatics, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Feliciano Yu
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Nicholas Genes
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, United States
| | - Carrie K. Baker
- Department of Family Medicine, Kettering Health, Indu and Raj Soin Medical Center, Dayton, Ohio, United States
| | - Douglas S. Bell
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States
| | - Joshua M. Pevnick
- Department of Medicine, Cedars-Sinai Health System, Los Angeles, California, United States
| | - Steven A. Conrad
- Division of Clinical Informatics, Department of Medicine, LSU Health Shreveport, Shreveport, Louisiana, United States
| | - Aarti R. Chandawarkar
- Division of Clinical Informatics, Nationwide Children's Hospital and The Ohio State, Columbus, Ohio, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Kendall M. Rogers
- Division of Hospital Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
| | - David C. Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Ila R. Singh
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Bruce P. Levy
- Division of Informatics, Geisinger Health System, Danville, Pennsylvania, United States
| | - John T. Finnell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Joseph Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Natalie M. Pageler
- Division of Clinical Informatics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Vishnu Mohan
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, United States
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Baker CK, Maniam N, Schnapp BH, Genes N, Nielson JA, Mohan V, Hersh W, Slovis BH. A Model Curriculum for an Emergency Medicine Residency Rotation in Clinical Informatics. J Educ Teach Emerg Med 2022; 7:C1-C50. [PMID: 37465133 PMCID: PMC10332664 DOI: 10.21980/j82p9h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/21/2022] [Indexed: 07/20/2023]
Abstract
Audience This curriculum is designed for emergency medicine residents at all levels of training. The curriculum covers basic foundations in clinical informatics for improving patient care and outcomes, utilizing data, and leading improvements in emergency medicine. Length of Curriculum The curriculum is designed for a four-week rotation. Introduction The American College of Graduate Medical Education (ACGME) mandated that all Emergency Medicine (EM) residents receive specific training in the use of information technology.1,2 To our knowledge, a clinical informatics curriculum for EM residents does not exist. We propose the following standardized and reproducible educational curriculum for EM residents. Educational Goals The aim of this curriculum is to teach informatics skills to emergency physicians to improve patient care and outcomes, utilize data, and develop projects to lead change.3 These goals will be achieved by providing a foundational informatics elective for EM residents that follows the delineation of practice for Clinical Informatics outlined by the American Medical Informatics Association (AMIA) and the American Board of Preventive Medicine (ABPM).4-6. Educational Methods The educational strategies used in this curriculum include asynchronous learning via books, papers, videos, and websites. Residents attend administrative sessions (meetings), develop a project proposal, and participate in small group discussions.The rotation emphasizes the basic concepts surrounding clinical informatics with an emphasis on improving care delivery and outcomes, information systems, data governance and analytics, as well as leadership and professionalism. The course focuses on the practical application of these concepts, including implementation, clinical decision support, workflow analysis, privacy and security, information technology across the patient care continuum, health information exchange, data analytics, and leading change through stakeholder engagement. Research Methods An initial version of the curriculum was introduced to two separate institutions and was completed by three rotating resident physicians and one rotating resident pharmacist. A brief course evaluation as well as qualitative feedback was solicited from elective participants by the course director, via email following the completion of the course, regarding the effectiveness of the course content. Learner feedback was used to influence the development of this complete curriculum. Results The curriculum was graded by learners on a 5-point Likert scale (1=strongly disagree, 5 = strongly agree). The mean response to, "This course was a valuable use of my elective time," was 5 (sd=0). The mean response to, "I achieved the learning objectives," and "This rotation helped me understand Clinical Informatics," were both 4.75 (sd=0.5). Discussion Overall, participants reported that the content was effective for achieving the learning objectives. During initial implementation, we found that the preliminary asynchronous learning component worked less effectively than we anticipated due to a lower volume of content. In response to this, as well as resident feedback, we added significantly more educational content.In conclusion, this model curriculum provides a structured process for an informatics rotation for the emergency medicine resident that utilizes the core competencies established by the governing bodies of the clinical informatics specialty and ACGME. Topics Clinical informatics key concepts, including definitions, fundamental terminology, history, policy and regulations, ethical considerations, clinical decision support, health information systems, data governance and analytics, process improvement, stakeholder engagement and change management.
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Affiliation(s)
- Carrie K Baker
- Soin Medical Center, Kettering Health, Clinical Informatics Fellowship Program, Dayton OH
- Wright State University, Department of Emergency Medicine, Dayton, OH
| | | | | | - Nicholas Genes
- New York University Grossman School of Medicine, Ronald O Perelman Department of Emergency Medicine, New York, NY
| | - Jeffrey A Nielson
- Soin Medical Center, Kettering Health, Clinical Informatics Fellowship Program, Dayton OH
- Kettering Health, Department of Emergency Medicine, Dayton, OH
- Northeast Ohio Medical University, Department of Emergency Medicine, Rootstown, OH
| | - Vishnu Mohan
- Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, Portland, OR
- Department of Medicine, Oregon Health & Science University, Portland Oregon
| | - William Hersh
- Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, Portland, OR
| | - Benjamin H Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia PA
- Office of Clinical Informatics, Thomas Jefferson University Hospitals, Philadelphia PA
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Campbell R, Baker CK, Mazurek TL. Remaining radical? Organizational predictors of rape crisis centers' social change initiatives. Am J Community Psychol 1998; 26:457-483. [PMID: 9726118 DOI: 10.1023/a:1022115322289] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Rape crisis centers have undergone significant changes since their birth during the feminist movement of the 1970s. As has happened with many other radical social movements, there is growing evidence that the antirape movement has become more institutionalized. This research used a combination of quantitative and qualitative methods to examine the current structure and functions of a national random sample of 168 rape crisis centers. An organizational-level model predicting involvement in three types of social change activities was tested: (a) participation in public demonstrations to raise awareness about sexual assault; (b) political lobbying for violence against women legislation; and (c) primary prevention programs to eliminate sexual violence against women. Results of logit modeling suggested that how long a rape crisis center had been in existence moderated the relationships between organizational characteristics and involvement in community activism. Findings of this study suggest that although many of today's centers bear little resemblance to the grass-roots collectives of years past, rape crisis centers have been remarkably adaptive in weathering changing political climates to continue to provide comprehensive services for rape victims.
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Affiliation(s)
- R Campbell
- Department of Psychology (M/C 285), University of Illinois, Chicago 60607-7137, USA
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Abstract
Winter barley (Hordeum vulgare L., cv. 'Igri'), grown as a crop in the field, was exposed to SO2 concentrations ranging from 40 to 200 ppb [parts per billion (109 ) by volume] above ambient. From spring onwards, plants at 40 and 50 ppb were consistently the heaviest, having slightly more tillers than plants in the other plots. In the range 80 to 200 ppb SO2 , the plants usually had fewer tillers than the controls, but this difference was not consistent throughout the season. Trends in the numbers and weights of tillers were interpreted as circumstantial evidence that 80 to 200 ppb of SO2 may have decreased assimilate production. Leaf area in May was markedly bigger in fumigated plants than in the controls. At 80 to 200 ppb the increases may have resulted from the plants having diverted a greater proportion of shoot dry weight into leaf tissue and from increased specific leaf area. These responses of 'Igri' barley in the field resembled those obtained by other workers for the same variety grown in controlled environments.
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Affiliation(s)
- C K Baker
- Department of Physiology and Environmental Science, University of Nottingham School of Agriculture, Sutton Bonington, Loughborough LE12 5RD, UK
| | - A E Fullwood
- Lancashire Polytechnic at Preston, Preston PR1 2TQ, UK
| | - J J Colls
- Department of Physiology and Environmental Science, University of Nottingham School of Agriculture, Sutton Bonington, Loughborough LE12 5RD, UK
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Kaufman JH, Baker CK, Nazzal AI, Flickner M, Melroy OR, Kapitulnik A. Statics and dynamics of the diffusion-limited polymerization of the conducting polymer polypyrrole. Phys Rev Lett 1986; 56:1932-1935. [PMID: 10032814 DOI: 10.1103/physrevlett.56.1932] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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