An Instance of Innovation as applied to CHOPlink Epic Projects

Presented By: Elaine Kazlauskas Mary Rewinski Process Managers The Children’s Hospital of Philadelphia February 2007

Agenda

• Overview of The Children’s Hospital of Philadelphia (CHOP) • What is The Process Innovation Center (PI Center) at CHOP?

• An Instance of Innovation – What is CHOPlink?

• Features of Our Approach • Results • Lessons Learned • Q & A

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The Children’s Hospital of Philadelphia (CHOP) Overview

• CHOP was founded in 1855 • CHOP has 512 inpatient beds with more than 1 million outpatient and inpatient visits annually, serving local, national and international patients • In addition to the hospital, The Joseph Stokes Jr. Research Institute, one of the largest pediatric research facilities in the United States and the Children's Seashore House, a comprehensive pediatric rehabilitation center are located on the main campus • The largest pediatric healthcare network in the United States, with nearly 50 sites located throughout Pennsylvania, New Jersey and Delaware

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Organization Mission Statement The Children's Hospital of Philadelphia, the oldest hospital in the United States dedicated exclusively to pediatrics, strives to be the world leader in the advancement of healthcare for children by integrating excellent patient care,

innovative

research and quality professional education into all of its programs.

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CHOP has been the birthplace of many Firsts… Pediatric Hospital Medical Training for Pediatric Medicine Neonatal, Surgical and Pediatric ICU’s Closed Incubators Catheter Balloons for Cardiac Defects Cause for Infectious Mononucleosis Leader in Development of Family Centered Care 5

What is the Process Innovation Center?

The PI Center provides effective process and project management to achieve continuous and measurable improvements through: • Consulting • Tools • Methods • Coaching Working with our internal customers we enable process innovation, project implementation, and assure skills and knowledge transfer to clinical and business operations throughout CHOP.

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What is the Process Innovation Center (PI Center) at CHOP?

We offer standard process and project methodology training and tools and consulting to three levels of CHOP projects • Strategic projects with an enterprise-wide scope that require both process redesign/innovation and project implementation • Tactical, short-term (30-90 day) projects that may require PI Center staffing along with consulting or training • Short (30 day or less) projects where we provide just consultative support training Our team consists of 15 Process and Project Managers that serve the entire organization.

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Influences for Change – Healthcare Industry

•

External Forces

‐ ‐ ‐ Government Insurers Community •

Improve Patient/Family Experience

‐ Consumer driven healthcare

One Child, One Record, One Outcome

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An Instance of Innovation – What is CHOPlink?

The vision of CHOPlink is to:

• promote a

new patient/family centered environment

by

optimizing processes

with

state of the art technologies

which deliver secure and ubiquitous access to complete, accurate and timely patient-related knowledge.

CHOPlink is designed to:

• support excellence in patient care, innovative research, quality professional education, child and family advocacy.

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Our Starting Point

• Processes Managed Locally • Work Completed in Silos • Previous strategy: Best of Breed approach •No integrated solutions • Disparate sources of data •Multiple sign-ons •Multiple handoffs and possible points of failure •Process compromises •Proprietary/different data formats •No economies of scale

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CHOPlink Overview – What we planned to do..

We will use process management to create a future state version of processes with these characteristics: • • • • • • • •

From “child/family need identified” to “child/family need satisfied” Integrated, end-to-end, enterprise view Future State Focused Aligned with Guiding Principles Led by Process Owners Tested with Family input Staged Implementation Linked to Technology Implementations 11

Process Management Theory…

Process Management is….

Identify Define Implement Improve 12

Process Overview **

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** Edited for External Distribution

Examples of Change – Scheduling Process

Scheduling

What a Family Gets -

One Call Does It All

I make some one call and I can get all of my appointments even though we have complicated combinations of services . They gave me various options for appointments at several times and locations . I can give my information to the hospital once during the call so I don’t have to repeat it every where I visit.

I know my balance so I can be ready to pay when I get there. They told me appointment and were able to me instructions on how to get there! I also got before the appointment.

what information was required call my Primary Care Provider . a reminder call for the They even gave a few days 14

Examples of Change – Scheduling Process

Scheduling

Enabling the process changes via…

       

Shared Access Scheduling Combined Scheduling and Registration Complex Scheduling Referral (order) information Balance Information Collect & Verify Insurance via Electronic Eligibility system Help Scripts Automatic appointment reminders 15

Examples of Change – Check In & Check Out

Check In Check Out

What a Family Gets Outpatients I arrive at the front desk and we get registration person registered faster than ever . The scans in my insurance cards so I don’t have to show them over and over . I hear that our insurance company has already told the hospital that the visit is covered is the co-pay.

I can even pay and all I have to pay that now so I don’t have to deal with a bill later. Inpatients We were whisked to the room in record time after we were greeted. The registration person came right to the room there. I was surprised that our shortly after we got Primary Care Provider stopped in to see us. CHOP notified her.

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Examples of Change – Check In & Check Out

Check In Check Out

Enabling the Process Changes via… Inpatients



Centralized Bed Management



Faster Bedside Registration



Electronic Insurance Verification



Electronic Signature



InterQual Criteria



Integrated Scanning Application



Primary Care Provider Automated Updating Outpatients

  

Quick Verification Document Scanning Electronic Insurance Verification

 

Cash Collection Incomplete or Missing Registrations Completed in 3 Working Days or Less 17

Examples of Change – Clinical Visit Flow

Clinical Visit Flow

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Examples of Change – Hospital Billing Process

Billing

What a Family Gets I receive only a few bills; one for the hospital charges for all of my kids and one for all of the physicians charges for all my kids. I spotted a questionable hospital charge so I called the 800 number . In one call, one person followed my problems through to resolution.

Examples of Change – Hospital Billing Process

Billing

Enabling the Process Changes via…

 

Automatic entry of charges into the billing system Review of charges based on pre-defined logic before billing



Ability to collect self-pay balances across the CHOP Enterprise at the time of service

 

Improved ability to determine that what was paid was exactly what was supposed to be paid



Electronic claims and remittances with payer responses filed back into the billing system Improved capabilities to resolve any unapplied cash across CHOP

Examples of Change – Physician Billing Process

Billing

What a Family Gets I receive only a few bills; one for the hospital room and one for physicians. This makes it less confusing for me to sort out what I’m paying for. I never get unexpected Bills from CHOP anymore.

all physician charges for all of my kids.

I get one clear bill for I seldom get a billing error. That’s good! When I do find an error, I call a single phone number and get the error resolved.

A New Way to Look at the Physician Billing Process

Billing

Enabling the Process Changes via…

 

Automatic entry of charges into the billing system Review of charges based on pre-defined logic before billing



Ability to collect self-pay balances across the CHOP Enterprise at the time of service

 

Improved ability to determine that what was paid was exactly what was supposed to be paid



Electronic claims and remittances with payer responses filed back into the billing system Improved capabilities to resolve any unapplied cash across CHOP

CHOPlink – What We’ve Accomplished

We created a future state version of processes with these characteristics: • • • • • • • •

From “child/family need identified” to “child/family need satisfied” Integrated, end-to-end, enterprise view Future State Focused Aligned with Guiding Principles Led by Process Owners Tested with Family input Staged Implementation Linked to Technology Implementations 23

Advantages Challenges

• • • • • • • •

Executive support Guiding principles Ground plowing by trusted advisors Thinking blue sky Documented process mgmt approach Project mgmt discipline Focus on ideal patient experience and excellence in patient care PI team members new to CHOP

• • • • •

“It’s an Epic implementation” “I’ve got a day job, too.” Enterprise level vs. department level process Language of process management new to CHOP Implementing process change an abstract notion

• •

Fear of change created resistance to blue sky thinking Clinician involvement All are lessons learned!

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Some PARC Process Management Facts

• • •

Staffing

‐ ‐ ‐ ‐ Process owners Process managers Approx 200 stakeholders across process teams (not full time) Key participants include Business Architects, Application Coordinators, Project Manager

Current State (Sept 05 – Oct 05)

‐ ‐ Process Maps Barrier Lists

Future State (Oct 05 – Feb 06 for definition; implementation continues)

‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Strategic and Workflow questions and recommendations Process Maps Critical Workflows Role descriptions Metric descriptions Integration grid Implementation plan for major operational changes Portfolio grid for prioritizing operational changes

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Summary

• CHOP Overview • PI Center Overview • Features of Our Approach • Lessons Learned • Q & A ‐ What is your reaction?

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