An Instance of Innovation as applied to CHOPlink Projects

Presented By:

Edna Volz

Mary Rewinski

Process Managers

The Children’s Hospital of Philadelphia

May 2007

CHOP Process Innovation Center – Elizabeth Fogarty, Mary Fowler, Emily Goyne, Elaine Kazlauskas, Leonora Miller, Amy Nelson, Mary Rewinski, Amy Rubinstein, Eileen Serpiello, Young Shin, Anna Spraycar, Harold Strawbridge, Robert Sturmer,

Edna Volz, and open positions

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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

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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 18 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..

• 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

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

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Process Management Theory…

Process Management is….

Identify

Define

Implement

Improve

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Process Overview **

** Edited for External Distribution

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Examples of Change – Scheduling Process

What a Family Gets - One Call Does It All

I make one call and I can get all of my appointments even though we have some 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 what information was required for the appointment and were able to call my Primary Care Provider. They even gave me instructions on how to get there! I also got a reminder call a few days before the appointment.

Scheduling

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Examples of Change – Scheduling Process

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

Scheduling

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What a Family Gets

OutpatientsI arrive at the front desk and we get registered faster than ever. The registration person 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 and all I have to pay is the co-pay. I can even pay that now so I don’t have to deal with a bill later.

InpatientsWe were whisked to the room in record time after we were greeted. The registration person came right to the room shortly after we got there. I was surprised that our Primary Care Provider stopped in to see us. CHOP notified her.

Examples of Change – Check In & Check Out

Check In

Check Out

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Examples of Change – Check In & Check Out

InpatientsCentralized Bed ManagementFaster Bedside RegistrationElectronic Insurance VerificationElectronic Signature InterQual Criteria Integrated Scanning ApplicationPrimary 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

Enabling the Process Changes via…

Check In

Check Out

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Examples of Change – Clinical Visit Flow

Clinical Visit Flow

Examples of Change – Hospital Billing Process

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.

Billing

Examples of Change – Hospital Billing Process

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 Electronic claims and remittances with payer responses

filed back into the billing system Improved ability to determine that what was paid was

exactly what was supposed to be paid Improved capabilities to resolve any unapplied cash

across CHOP

Billing

Examples of Change – Physician Billing Process

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. I get one clear bill for all physician charges for all of my kids.

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.

Billing

A New Way to Look at the Physician Billing Process

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 Electronic claims and remittances with payer responses

filed back into the billing system Improved ability to determine that what was paid was

exactly what was supposed to be paid Improved capabilities to resolve any unapplied cash

across CHOP

Billing

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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

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• 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

Advantages Challenges

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, Family

• Current State (Sept 05 – Oct 05)‐ Process Maps ‐ Barrier Lists

• Future State (Oct 05 – Feb 06 for definition; Mar 06 – Aug06 for implementation)‐ Strategic and Workflow questions and recommendations‐ Process Maps ‐ Critical Workflows‐ Role descriptions‐ Metric descriptions‐ Policies and Procedures‐ 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?