Electronic health record patient portal usage has been associated with improvement in chronic disease parameters, patient functional status and patient satisfaction. Our institution’s patient portal is a secure, online health management tool that connects patients to portions of their electronic health record.Our quality improvement project aimed to increase patient portal enrolment significantly in our Internal Medicine resident patient panels.This study was conducted in a large, multisite health system in Kansas City, Kansas that serves a diverse patient population. Our clinic includes 65 resident patient panels. We followed a subset of 16 resident patient panels in this quality improvement project. A baseline audit showed that 35% of the 1628 patients in these panels were enrolled in the patient portal system. A standardised, nurse-initiated portal sign-up process following patient rooming was implemented. Initial results indicated a 9.6% increase in patient portal sign-up at the end of the first 4-week cycle. We then implemented educational sessions for our clinic nurses as well as attending physicians, and achieved a 15.1% increase from baseline to the end of the second 4-week cycle, resulting in 86 patient portal activations (p<0.01).Resident physicians worked with clinic nurse partners in two formats for this project. Nurses assigned to patient rooming for residents during the clinic sessions being studied (rooming nurses) initiated the portal sign-up process. Nurses assigned to partner with the resident for longitudinal patient care management, anchor nurses, worked with residents on items such as phone messages or portal messages. Semi-structured interviews of the four anchor nurses aligned with the 16 residents were conducted at the end of the study and revealed that nursing staff perceived increased patient portal activity to be associated with a decrease in nursing workload and an increase in patient engagement.

INTRODUCTIONSystemic lupus erythematosus (SLE) is an autoimmune disorder with multiorgan involvement and variable manifestations. The etiology of SLE remains unknown. However, a different presentation of lupus erythematosus due to certain drugs such as hydralazine 1 , procainamide 1 , and minocycline 2 has long been recognized. The first reported case of hydralazine leading to Drug-induced Lupus Erythematosus (DILE) was published in 1953. 3 Since then, this association has been well established in the medical literature. However, as hydralazine is used less frequently, the incidence of DILE due to hydralazine and the recognition of this association among clinicians have diminished. This case report and review revisits this association and reminds the clinicians to consider DILE when evaluating patients with unusual manifestations mimicking a connective tissue disease.