The Christiana Care Health System needed a better and easier method for clinicians and employees to access information and applications. Thanks to a creative approach, a new portal architecture, single sign-on, and embedding the Clinical Context Object Working (CCOW) standard, we have accomplished that goal... and more.
Finding the right system
Based in Wilmington, Del., Christiana Care is one of the largest private nonprofit healthcare providers in the Mid-Atlantic region, serving all of Delaware and portions of several counties bordering the state in Pennsylvania, Maryland and New Jersey. We have almost 1,100 beds across two hospitals: Christiana and Wilmington.
The hospital's new portal architecture actually derived from a related project: an update of the entire Web site (http://www.christianacare.org). Apart from creating a site that was easier for the public to use, our main goal was to build a more robust, easy-to-maintain content-management system for internal users. For years, the means of updating content, no matter how minor, had been controlled jointly by human resources, IT and our corporate communications departments. Total time from initial request to live posting on the site was usually two or three days. This was just too cumbersome, so we needed a streamlined approval process.
We decided to work with external vendors for the Web site and narrowed down our list to four possible partners. Of these, only Solvang, Calif.-based MedSeek specialized in healthcare, setting them apart. The heart of the company's solution was its SiteMaker software, which features an intuitive way to create Web pages. We realized that the same ease of use could — and should — be applied to create role-based portals within our overall information access strategy. Implementation costs for the portal and single sign-on infrastructure were $920,000.
Creating the vision
Our vision for the portals was simple. MedSeek helped us incorporate a "role-based" portal model for three different groups or roles: physicians, nurses and all other employees. The members of each group could efficiently find information that pertained to them by being automatically directed to the appropriate portal based on their sign-on through the Web site.
These entry points contained integrated interfaces with links to applications and general information, such as hospital news and the medical library. Information an employee or physician needed to do his or her job better was available at the click of a mouse. (Some content was available across all portals.) One existing employee was designated portal administrator and responsible for content management for each portal. This led to significantly decreased turnaround time for changes, compared with our old method.
After the new Web site went live in August 2004, our attention turned to our first role-based portal — the physician portal. We spent significant time reviewing current content and getting physician input on what was truly important to them.
Like many hospitals, we had various technologies in use, including Fort Lauderdale, Fla.-based Citrix' Web Interface, Andover, Mass.-based Sentillon's Vergence and Redmond, Wash.-based Microsoft's Windows, all of which had to be seamlessly integrated. We also devoted considerable time to designing and prototyping the interface, and there were multiple opportunities, including weekly meetings, to further refine input and finalize content.
Portal administrators underwent basic training on the new software. There were some technical obstacles for our department. For instance, SiteMaker 6.0 uses ColdFusion programming (from San Jose, Calif.-based Adobe Systems Inc.), with which our staff had no previous experience. Another concern was linking many different technologies together on a single portal screen.
Both of these were certainly concerns. For instance, in early iterations of the physician portal, we had difficulty pulling all of the "frames," each with different underlying technology, onto the same portal page. In other words, you had to link to other pages to access the applications you needed, which was cumbersome. Both the ColdFusion learning curve and the design barriers were overcome without a drastic investment in training or impact to the overall project plan.
Launching the portals
After a pilot launch in January 2005, the physician portal went live the following month. We introduced single sign-on and CCOW in June 2005. Its key innovation — giving physicians access to clinical data from one view, in a seamless manner through a single sign-on — was achieved smoothly.
Now, physicians can check on patient status through a name search on the portal and then link to that patient in our clinical data repository, PACS, and/or document imaging systems. Doctors also frequently use a physician directory, which allows them to find other physician contacts, and a Web paging application to quickly communicate with fellow doctors and other hospital personnel.
What did we gain? The statistics are great. We measured time savings from the point of sign-on to finding a given patient in the three main clinical applications. Clinicians can now do in 13 seconds what used to take 81. That translates to an annual productivity gain of 1,757 hours for sign-on, and 1,028 hours for patient lookups. More to the point: Our clinical staff spends less time looking for data, freeing them to spend more time with patients.
Furthermore, we have seen usage rise every month since go-live. Specifically, we went from 13,000 page views in March 2005 to 75,000 in July and 122,000 in September.
Extending the portals
In implementing the nursing portal in June 2005, the goal was the same: make nurses' jobs easier by providing access to important information. Nursing portal usage has also steadily increased, from 75,000 views in July 2005 to 770,000 in November.
But numbers only tell part of the story. One link in the portal is to the hospital's formulary, which the nursing staff consults frequently. Carolyn Zsoldos, R.N., made this link the most prominent. Like the physicians, the nurses also take advantage of the physician staff directory, paging ability and clinical applications.
Usage and surveys have shown the portals to be very successful. We have received high satisfaction ratings from end-users and productivity gains among that group translate to solid savings. For instance, with respect to physicians signing on and looking up patient information, we have saved a total of 2,758 hours of per year. Based on these savings, we will break even on our implementation costs within two years of the portal's debut.
While other hospitals have designed physician portals, we have been able to extend the concept to other roles as well. The right information is being delivered to the right people and in a way that is better and easier. For a hospital, that's a very healthy outcome.
John DiGiovanni is a senior systems engineer at Christiana Care and a technical architect of the role-based portals.