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
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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 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
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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
Scheduling
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.
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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
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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 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.
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Examples of Change – Check In & Check Out
Check In
Check Out
Enabling the Process Changes via…
Outpatients
 Quick Verification
 Document Scanning
 Electronic Insurance Verification
 Cash Collection
 Incomplete or Missing Registrations
Completed in 3 Working Days or Less
Inpatients
 Centralized Bed Management
 Faster Bedside Registration
 Electronic Insurance Verification
 Electronic Signature
 InterQual Criteria
 Integrated Scanning Application
 Primary Care Provider Automated
Updating
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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
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
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. 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.
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
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
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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Advantages
Challenges
• Executive support
• “It’s an Epic implementation”
• Guiding principles
• “I’ve got a day job, too.”
• Ground plowing by trusted advisors
• Enterprise level vs. department level
process
• Thinking blue sky
• Language of process management
• Documented process mgmt
new to CHOP
approach
• Implementing process change an
• Project mgmt discipline
abstract notion
• Focus on ideal patient experience
• Fear of change created resistance to
and excellence in patient care
blue sky thinking
• PI team members new to CHOP
• 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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