Catholic Healthcare West improves patient care with IBM WebSphere Portal

Stewardship is a powerful word, implying responsibility and trust. It’s a high standard to meet, and it’s one of the core values of San Francisco-based Catholic Healthcare West (CHW), a nonprofit healthcare organization that comprises the eighth-largest hospital system in the United States and the largest not-for-profit hospital provider in California.

At the 41 CHW network hospitals and medical centers in California, Arizona and Nevada, the mission is to deliver compassionate, high-quality, affordable healthcare services. Each year, more than 9,500 physicians and approximately 53,000 employees provide quality healthcare services during more than 4 million patient visits. In 2007, CHW provided more than US$922 million in unsponsored community benefits and care for the poor.

The CHW team uses IT extensively to improve both the quality and scope of the care that its network provides. “Like many companies, CHW has been making substantial investments in IT in clinical areas,” says Eric Leader, chief technology architect for CHW. “We have an extensive array of information systems and best-of-breed clinical applications that help us better serve our patients.”

The organization wanted to find ways to make the information from those disparate clinical applications more easily available to physicians and other hospital staff, as well as caregivers in the community. For example, a physician might need to look at data from four or more different systems to get a complete view of the status of a single patient. In order to perform any comparative analysis of the data, hospital staff needed to aggregate the data manually. “Hospital staff would either print screens of data or—more likely—write it on yellow sticky notes,” says Leader.

Logging on to all those systems and navigating to the correct patient took time. Multiple logins were required to access 11 office systems and five health information systems. “One caregiver can be responsible for as many as 50 patients,” says Leader. “It wasn’t unusual for them to spend two or three hours every day just looking up and aggregating test results.” Alternately, physicians might ask on-duty nurses to aggregate information about a patient, which added to the workload of the hospital staff.

Not all of the physicians associated with CHW work in the organization’s facilities—CHW supports a large number of community physicians with independent offices. The CHW team wanted to extend remote access capabilities to these community physicians. “Many of the healthcare applications used at hospitals have significant client components,” says Leader. “Also, most community physicians work with several hospitals. Even for the largest practices, it is unrealistic to expect them to integrate the client software necessary to work with multiple hospitals, each with its own set of clinical applications.”

IBM open standards support eases legacy data integration and delivery
The CHW IT team began looking at portals as a way to improve access to its health information systems. “We wanted to aggregate data from multiple legacy sources into a single view,” says Leader. “We saw portal technology as the most efficient way to accomplish that.”

Leader and his team began evaluating portal technology from several vendors, comparing performance against several criteria: ability to scale, total cost of ownership, and support for open standards and open source software. “We support open standards and open source both because it makes good business sense and because it applies directly to our mission as a healthcare provider,” says Leader. “If a physician develops a new procedure, they share it with their colleagues. We want to encourage the same sort of sharing of intellectual property in IT.”

Based on those criteria, the CHW team chose IBM. “After reviewing the history of successful large portal implementations at IBM, we were confident that IBM WebSphere Portal Server could easily handle a project of our size and complexity,” says Leader.

CHW staff began work on a two-part implementation. One development team designed and created the portal architecture, then began migrating the applications that had already been built using other Web application engines to the WebSphere environment. Meanwhile, a second team focused on building SOA wrappers for the organization’s legacy applications so that data from those applications would flow smoothly into the new portal. Eventually, staff from both teams worked together on creating the portlets that would appear in the final Web portal.

Powerful clinician portal rapidly scales to 22,000 users in single year
The portal project at CHW is extensive and ongoing. Clinical systems access is being provided by the DirectConnect clinician portal, which combines the data aggregation and management capabilities of Fusion Web from Carefx with IBM WebSphere Portal Enable software, running on the Novell SUSE Linux operating system. To provide advanced healthcare-specific capabilities, IBM and Carefx integrated Fusion Web with IBM WebSphere Portal. WebSphere Portal provides an Internet standards-based, JSR 168-compliant portal framework, which Fusion Web extends to provide standards-based management across portlets for sharing user, patient and other information in the appropriate context.

The combination of IBM and Carefx provide a highly intuitive clinical portal that aggregates patient data from a number of legacy systems to present a single view of each patient. “With IBM WebSphere Portal and Fusion Web from Carefx, we have been able to smoothly and quickly develop and deploy a portal environment that aggregates data from a wide variety of systems,” says Leader. “The Carefx solution was easily integrated with WebSphere Portal, which reduced our development time and cost.”

After a six-month pilot at two CHW facilities, the IT team began rolling out the new portal more broadly, adding another 12 facilities over the next six months. “We’re moving along very rapidly, with 22,000 authorized DirectConnect users and nine more facilities in the pipeline,” says Leader.

Portal access to critical information saves CHW physicians time every day
By using IBM WebSphere Portal and Carefx Fusion Web to create portals that integrate and present critical patient data, the CHW IT team dramatically improved the productivity of the organization’s hospital-based staff. Some physicians are reporting that the portal saves them an estimated two to three hours per day. “Most hospitalists see between 25 and 50 patients each day, so giving them back two or three hours to devote to patient care is a tremendous accomplishment,” says Leader. The CHW team has seen particularly rapid adoption in situations where hospital staff must quickly review and assimilate large amounts of data, including intensive care units, surgery units and emergency rooms. “I don’t know that we’ve done any other infrastructure project that has had as much immediate impact,” says Leader.

Clinician portal helps improve patient care by simplifying workflow
By providing an aggregate view of context-sensitive, clinically relevant patient data within a portal and enabling users to log into multiple systems through a single sign-on, DirectConnect has reduced the number of steps needed to access frequently used data by 66 percent. Instead of spending time entering IDs and passwords and navigating to patient information, hospital staff can focus on analyzing and interpreting the data or otherwise improving patient care. “Our user studies have shown that we’ve reduced the typical workflow from 30 steps to 10, and in emergency situations staff can access critical information in just two clicks,” says Leader. “IBM WebSphere Portal has helped us simplify and streamline our hospital information systems, which helps the staff focus on patient care.”

Portal and SOA enable remote access to health information systems
Physicians working outside CHW facilities are now able to remotely access CHW health information systems through the portal created with IBM WebSphere Portal Server. Also, IBM support for open standards and SOA has helped the CHW IT team extend that access to the organization’s legacy applications. “Composite applications and SOA are important pillars of our long-term business strategy to build composite applications that aggregate data across the organization,” says Leader.

Comprehensive usage tracking helps ensure HIPAA compliance and simplify reporting
With the context sharing and access tracking capabilities of the DirectConnect portal, the CHW IT staff is able to ensure that the portal solution protects the privacy of patients and meets the regulatory standards of the Health Insurance Portability and Accountability Act (HIPAA). “As a healthcare organization, the privacy of our patients and the security of their data are of paramount concern,” says Leader. “IBM WebSphere Portal and Carefx Fusion Web helped us meet those design goals.”

The high levels of success driven by IBM and Carefx have accelerated plans for other portal projects at CHW. The organization has already created employee- and community-oriented communication portals, and is developing functional portals that will enable patients to schedule appointments, see test results and pay for services. “We are working on providing patients with the same level of process simplification and ease of use that we have put in place for our staff,” says Leader.

The new capabilities of the DirectConnect portal at CHW translate directly to better patient care, both at CHW facilities and in the communities that its network serves. At the same time, the portal’s simplicity and efficiency improvements advance the standards of service that the team strives to meet.

For more information
For more information on IBM WebSphere Portal, please contact your IBM sales representative or IBM Business Partner, or visit: ibm.com/websphere/portal

For more information on Catholic Healthcare West, visit: www.chwhealth.org

For more information on Fusion and Fusion Web from Carefx Corporation, visit: www.carefx.com