1. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

2. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

3. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

4. 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.
Note: Innovative in our Mission Statement
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

5. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

6. 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.
Innovation breeds innovation our clinical innovations have led to our desire to be innovative in our operations.
In order to remain focused on our main goal – to provide the Ideal Patient and Work Experience – our hospital leadership recognizes that the way we have done things in the past isn’t necessarily work in today’s environment. Our CEO Steve Altschuler, MD created the PI Center in order to help the organization become a more strategy driven and process centric organization.
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

7. 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.
Innovation breeds innovation our clinical innovations have led to our desire to be innovative in our operations.
In order to remain focused on our main goal – to provide the Ideal Patient and Work Experience – our hospital leadership recognizes that the way we have done things in the past isn’t necessarily work in today’s environment. Our CEO Steve Altschuler, MD created the PI Center in order to help the organization become a more strategy driven and process centric organization.
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

8. Influences for Change – Healthcare Industry
External Forces
Government
Insurers
Community
Improve Patient/Family Experience
Consumer driven healthcare
One Child, One Record, One Outcome
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

9. 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.
Emphasize Family Centered
Process is optimized with technology vs. process bends to technology – SMS example
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

10. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

11. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

12. Process Management Theory…
Process Management is….
Identify
Define
Implement
Improve
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

13. Process Overview ** ** Edited for External Distribution
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

14. 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.
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

15. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

16. Examples of Change – Check In & Check Out
What a Family Gets
Outpatients I 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.
Inpatients We 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.
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

17. Examples of Change – 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

18. Examples of Change – Clinical Visit Flow
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

19. Billing 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.
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

20. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

21. 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.
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

22. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

23. 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
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

24. All are lessons learned!
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!
The Children's Hospital of Philadelphia - Proprietary and Confidential, Copyright 2007

25. 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
Critical Workflows
Role descriptions
Metric descriptions
Integration grid
Implementation plan for major operational changes
Portfolio grid for prioritizing operational changes

26. Summary CHOP Overview PI Center Overview Features of Our Approach
Lessons Learned
Q & A
What is your reaction?