An Instance of Innovation as applied to CHOPlink Projects

1. 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

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

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

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.

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

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.

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 18 Process and Project Managers that serve the entire organization.

8. Influences for Change – Healthcare Industry • External Forces • Government • Insurers • Community • Improve Patient/Family Experience • Consumer driven healthcare One Child, One Record, One Outcome

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.

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

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

12. Process Management Theory… Process Management is…. Identify Define Implement Improve

13. Process Overview ** ** Edited for External Distribution

14. Scheduling Examples of Change – Scheduling Process What a Family Gets - One Call Does It All I makeone callandI can get all of my appointmentseven though we have somecomplicated combinations of services. They gavemevarious options for appointments at several times and locations. I cangive my information to the hospital onceduring the call so I don’thave to repeat it every where I visit.I know my balanceso I can be ready to pay when I get there. They told mewhat information was requiredfor the appointment and were able tocall my Primary Care Provider. Theyevengave me instructionson how to get there! I also got a reminder call a few days before the appointment.

15. Scheduling Examples of Change – Scheduling Process

16. Check In Check Out Examples of Change – Check In & Check Out

17. 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 Check In Check Out Examples of Change – Check In & Check Out Enablingthe Process Changes via…

18. Examples of Change – Clinical Visit Flow Clinical Visit Flow

19. Billing Examples of Change – Hospital Billing Process

20. Billing Examples of Change – Hospital Billing Process

21. Billing Examples of Change – Physician Billing Process

22. Billing A New Way to Look at the Physician Billing Process

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

24. 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!

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, 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

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