BOX 5-1

The PatientSite Project

CareGroup HealthCare Systems is an integrated health care delivery system based in Boston consisting of five hospitals, including its flagship facility, the Beth Israel Deaconess Medical Center. The system employs approximately 1,700 medical staff who provide care to more than 1 million patients at CareGroup centers and through numerous affiliated practices. CareGroup implemented the world’s first clinical computer system and on-line medical record program.

In 1999, CareGroup and Beth Israel staff began discussing how best to involve patients in their care and meet the demands of on-line patients. Using a variety of information servers and databases, including some developed by project authors, the team established an independent clinical platform that could display patient information on a secure website accessible through a number of web browsers. Known as PatientSite, this system features secure messaging among patients, providers, and staff; it allows patients to perform routine tasks, such as requesting appointments, obtaining prescription refills, or requesting primary care referrals, on-line; and it supports patient homepages that can be customized with a range of health education links, as well as messages from identified providers.

Patients registered with PatientSite have access to a comprehensive medical file, including medical records, established at the time of their registration. They also can maintain personal medical records, recording such information as medication problems, allergies, and other pertinent notes. Numerous security measures are in place to ensure that patients have access only to their own files. Physicians registered with PatientSite, by contrast, have access to information on all of their patients.

In early 2003, PatientSite claimed more than 120 participating providers representing 40 CareGroup centers and practices. It had more than 11,000 active patients, defined as those who had logged on at least once following their registration. Participation rates for both providers and patients have steadily increased since the program’s inception in 2000. Additional information about PatientSite, including a demonstration page, is available at

SOURCE: Sands and Halamka, 2004.

length of stay (Wuerz et al., 2000). It has excellent interrater reliability and a high correlation with the need for intensive care unit (ICU) admission (Tanabe et al., 2004). The ESI also has been validated in pediatric populations (Baumann and Strout, 2005). Integrating the ESI into automated triage systems in the ED could assist in the accurate and rapid assignment

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