Pediatric Informatics: Computer Applications in Child Health (Health ...

248 M.G. Leu et al.
17.7 Case Study: Implementing ACPOE at Seattle
Children’s Hospital
17.7.1 Background
Seattle Children’s Hospital is a 250-bed pediatric hospital located in the idyllic
setting of the Pacific Northwest in Seattle, Washington. The hospital is the primary
pediatric teaching site for the University of Washington School of Medicine, and
serves as both the tertiary care referral hospital to a four-state region as well as the
primary pediatric hospital for the Puget Sound area. Children’s subspecialists also
see patients in the ambulatory setting (170,000 visits annually).
The organization decided in the early 1990s not to pursue a multi-vendor bestof-breed
approach, and sought instead to use a single vendor solution to meet all
clinical information needs. Over a single weekend in November, 2003, inpatient
CPOE had been implemented with support for laboratory, radiology, nursing and
ancillary department (e.g., speech, physical therapy) orders. By the time of the planning
stages for ambulatory CPOE, the laboratory results review system, pharmacy,
radiology, and pathology systems had all been replaced by this vendor’s solutions. In
the ambulatory clinics, e-Rx was in place, with all non-chemotherapeutic medications
being written in the clinical information system and charted electronically when
given, with dose-range checking.
A summary of electronic capabilities of these clinics, in 2003, can be found in
Table 17.5.
17.7.2 Pre-implementation
In the ambulatory clinics prior to ACPOE, there was a strong culture of informality.
Providers would stop staff in the hallway, with a simple “Hey, can you get this for
me?” and verbally communicate orders, which would be checked off or written on
Table 17.5 Seattle Children’s Hospital ambulatory information infrastructure in 2003
Information function 2003 capability
Orders, results, and results management Clinicians could receive online results for
ordered tests
Intra-clinic communication Providers and clinic staff communicate with e-mail,
notes dictated
Patient education and outreach Patients handed paper-based instructions
Inter-clinic coordination Paper records
Medication management Online drug reference
e-Rx with some dose-range checking
Provider education and feedback Web site links, online clinic policy manuals
Handheld reference materials, some online training