Seattle Childrens Hospital recently celebrated its centennial anniversary. Over the first 100 years, the hospital has changed locations, grown in size, and has kept up with the latest in technology. What has remained the same is the founding principle: To provide needed medical care to all children in the four-state region (Alaska, Idaho, Montana and Washington), regardless of a familys ability to pay. To help achieve this goal, Seattle Childrens unveiled Childrens Care Gateway in the summer of 2007. CCG is an online portal providing real-time clinical information, and is available to all referring providers in the region.
SCH is a tertiary, multispecialty-care pediatric hospital that sees over 200,000 patients annually across multiple campuses. As a referral hospital, it partners with over 5,000 providers in the four-state region every year to help provide care for its patients. Since SCH functions as a referral hospital and does not provide outpatient primary care, most patients find their medical home outside of SCH. After care has been provided at SCH, clinical information needs to be distributed back to the patients primary care or referring provider to assure continuity of care. Additionally, many providers in close proximity to the hospital refer patients for diagnostic services and need timely access to these test results. CCG allows these independent referring providers to access the medical records of their patients, make new referrals and view images, all over the Internet, and without the need for specialized software on the remote computer. With a goal of providing a cohesive patient-centered user experience, the Gateway houses three separate applicationseach from a different vendorin addition to online registration and self-help tools, all presented in a single location. These applications access the electronic medical record, patient scheduling and picture-archiving communication systems available at SCH.
With implementation led by Ari Pollack, a practicing SCH physician, CCG was designed with two seemingly contradictory goals: Provide the highest security to protect the privacy of individually identifiable health information, and quick easy access for all those who need it. SCH has been able to meet both objectives successfully. CCG was designed so providers are only able to access patients whom they have a defined relationship. These relationships are defined at the time of a registration event, such as being admitted to the hospital, scheduling an appointment, or presenting to the emergency department. The provider-patient relationship is revalidated by the patient (or guardian) every time he or she enters the facility for care. In addition, SCH has expanded access in an effort to help support the providers busy workflow; now, any office-based staff member that assists in providing patient care also has access to CCG. These staff members can access patient data through unique accounts associated with their respective providers or partners.
The implementation and support teams for CCG includes an informatics physician and nurse, the physicians-relations department, application analysts, technical analysts, database administrators, security analysts and architects, Web developers, and non-SCH employed consultants and vendor analysts. The implementation costs of approximately $400,000 included staff and consultant salaries, new hardware and software, and marketing supplies. A single full-time employee supports the daily needs of the portal. In addition to these ongoing staffing costs, there are other operational costs associated with the portal that add approximately $15,000 to the annual IT operating budget at SCH.
Since its release, the CCG has been very successful. To date, over 120 different clinics and 1300 users have been registered from all four states to use CCG. In addition, new clinics and users are being added every week. Usage of the EMR-based application has grown at an incredible rate. This year alone, the number of people logging on has doubled from January to April. Currently CCG serves as a supplemental form of information retrieval. SCH continues to fax and mail reports as they become finalized, which often takes days to weeks. CCG allows access to this information in its preliminary state and is available in real time. There is no difference to the amount and timeliness of information between the internal EMR and CCG. Over time, SCH plans to try and drive referring providers to CCG as a primary source of information, and this is becoming evident from its usage statistics.
SCH continues to watch the American Recovery and Reinvestment Act of 2009, or stimulus law, implementation closely. New privacy and security rules associated with the stimulus law will cause continuous reevaluation of the security posture of CCG. As Childrens continues its drive toward a goal of ever-improving clinical information exchange with referring physicians, we will focus on potential grant support for expanded interoperability, greater functionality and process improvement associated with electronic clinical data sharing.
As SCH looks forward to its next 100 years, we continue to embrace technology as one of many components necessary to provide the best possible care to our patients and families. Childrens Care Gateway is just one example of how Seattle Childrens has implemented healthcare information technology to reach its goal of becoming the best childrens hospital.