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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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