Taking Automated Scheduling to the Next Level: Service Line Scheduling Support Presented by: Amy M. Tirabassi, CHAM Patient Access Process Improvement September 2017 1
JOHNS HOPKINS MEDICINE AT A GLANCE September 12, 2017 2
Johns Hopkins Medicine (JHM) - at a Glance An integrated global health enterprise headquartered in Baltimore, Maryland The Johns Hopkins Hospital, opened in 1889 and the Johns Hopkins University School of Medicine opened four years later in 1893. In 1986, the hospital trustees created the Johns Hopkins Health System to serve as the parent of the hospital and future secondary entities. In 1996, the health system and the school of medicine joined together to become Johns Hopkins Medicine, a pioneer in academic medicine! September 12, 2017 3
The Johns Hopkins Medicine Enterprise (FY 2016) September 12, 2017 4
The Johns Hopkins Health System Today (FY16) $8 billion in operating revenues Operates 6 academic and community hospitals, 4 suburban health care and surgery centers, and 39 primary and specialty care outpatient sites More than 42,000 combined FTE employees Annual outpatient visits over 2.8 million, Annual ED visits: Over 360,000, Annual Hospital Admissions over 115,000 2,816 Licensed Beds Across the Health System Over $2 billion in total research and development spending annually September 12, 2017 5
JHM- Patient Access Falls under directives of the CPA 20 Department Call Centers within JHM Access Services Outpatient/Ambulatory Care Scheduling and Pre-Registration Financial Clearance (Mostly centralized outside of Patient Access) Ancillary tasks (Rx. Refills, Triage questions, Department Defined, Patient Messaging, Inbasket Routing, etc.) 375 Full Time Equivalent s (Contact Center FTE s) 38 Managers/Supervisors ~3M inbound Calls (FY17) ~1.4M outbound Calls (FY17) 57% of the new patient appointments are scheduled by Patient Access Approx. 2K users scheduling new patient appointments across JHM Monthly 24% of return patients were scheduled by Patient Access. September 12, 2017 6
Institutional Goals and Objectives- Patient Access Creating a patient centered Access experience Enhance EPIC Cadence system by creating effective scheduling tools using lean methodology to streamline the appointment scheduling process and promote accuracy and quality in scheduling. Optimize provider productivities in clinic and help achieve clinical expectations while improving availability and capacity to support more timely appointments and minimization of service delays Fully Centralized Outpatient Scheduling (Long Term Vision) One Phone Number for JHM (800-Hopkins) Flexibility of Resources based on Demand Improved Cost Allocation 7
AUTOMATED SCHEDULING BUILD- SPECIALTY DEPARTMENTS September 12, 2017 8
Process Improvement Approach Collaboration and Engagement Physician & Provider Leadership Department Administrators Patient Access Leadership Dept. PI Workgroups Bi-Monthly Meetings Clinical Site Managers, Physician Champions, Internal Support Staff, Patient Access Manager, PI Sponsor 9
Protocol Optimization- Goals Streamline appointment scheduling Provide patient centered search functions First available appointment across all locations Patient preferences (provider/location/times) Reduce patient handoffs and long hold times on the phone Improve provider availability Improve scheduling utilization Improve appointment accuracy/quality Set the stage for cross departmental scheduling Improve patient satisfaction 10
Advanced Scheduling Questionnaires Conduct scheduling process analysis to understand current scheduling workflow Set up and conduct department Kick Off meeting Access Stakeholders (Physician Champions, Administrators, Specialty Clinical Leadership, Patient Access Management) Identify process improvement opportunities and create scheduling tools (within EPIC) that support the Lean scheduling model Disciplined method - weekly Protocol Optimization meetings to discuss findings, problem solve and create enhanced workflow that supports the department with their scheduling process Ensure Physician Champions agree to the workflow designs and signs off Conduct testing and training with the appropriate scheduling staff Go-Live with questionnaire and follow-up with support September 12, 2017 11
Protocol Optimization- Specialty Timeline Week 1-4 Week 2-8 Week 8-12 STAGE I- Department Analysis and Project Structure 1. Kick-Off Meeting (Introduction to Project) 2. Workgroup Creation 3. Meeting Schedules 4. Project Timeline STAGE II- Workflow Design and Epic Build 1. Workflow Design 2. Workflow Sign-Off 3. Workflow Build 4. Staff Testing/ Training Schedule STAGE III- Testing and Training 1. Testing 2. Training 3. Go- Live 4. Support September 12, 2017 12
Protocol Optimization- Questionnaire Design Message to the patient: I am going to schedule you for both Hearing Test and doctor s appointments. Message to the scheduler: Please populate NEW PATIENT EAR appointment with Otology subgroup in the panel. Continue Scheduling New Patient- OTO Ear using Otology Subgroup Message to the patient: Please fax the copy of the Hearing Test to 410-955-0035 Also, please bring the results with you to the appointment. Test results need to be evaluated so the appropriate care can be delivered. If the test results are not received prior to the appointment, the appointment will need to be rescheduled. Yes Change and schedule NEW ADULT W/ AUDIO panel No Have you had Hearing Test performed in the last 6 mos? Ear Infection What is the reason for Visit Hearing Loss Is your hearing loss sudden, within last 2 weeks? No Yes No Continue Scheduling New Patient- OTO Ear using Otology Subgroup Message to the patient: Please fax the copy of the Hearing Test to 410-955-0035. Also, please bring the results with you to the appointment. Test results need to be evaluated so the appropriate care can be delivered. If the test results are not received prior to the appointment, it will need to be rescheduled. Message to the scheduler: The appointment must be scheduled within next 10 days. If there no openings please see supervisor for assistance. Has hearing test been done since onset of hearing loss? Change and schedule NEW ADULT W/ AUDIO panel Message to the patient: I am going to schedule you for both Hearing Test and doctor s appointments. Message to the scheduler: The appointment must be scheduled within next 10 days. If there no openings please see supervisor for assistance. Please populate NEW PATIENT EAR appointment with Otology subgroup in the panel. September 12, 2017 13 Yes Subroup Name Purpose/ Diagnoses Providers Department Length Block Otology [97] Adult Ear (Ear Ache, AGRAWAL, YURI [200004] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient Infection, Ringing in the ear, CAREY, JOHN PATRICK [1573] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient Hearing Loss, Ear Cleaning CHIEN, WADE WEI-DE [1671] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient CHIEN, WADE WEI-DE [1671] SOC SOM OTOLARYNGOLOGY [113003700] 30 New Patient DELLA SANTINA, CHARLES C [1891] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient FRANCIS, HOWARD WAYNE [2174] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient FRANCIS, HOWARD WAYNE [2174] GSS SOM OTOLARYNGOLOGY [113000700] 30 New Patient GOTTSCHALK, BARBARA BULIK [100290] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient GOTTSCHALK, BARBARA BULIK [100290] GSS SOM OTOLARYNGOLOGY [113000700] 45 New Patient KASHIMA, MATTHEW [2860] WM SOM OTOLARYNGOLOGY [113004700] 15 New Patient KLIMOVA-NESCOT, IRINA [100426] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient LIMB, CHARLES J [3214] JHOC OTOLARYNGOLOGY [110106700] 15 New Patient LIMB, CHARLES J [3214] GSS SOM OTOLARYNGOLOGY [113000700] 15 New Patient LIN, FRANK ROBERT [3218] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient STEWART, CHARLES MATTHEW [4648] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient WEINREICH, HEATHER MAUREEN [202380] JHOC OTOLARYNGOLOGY [110106700] 30 New Patient
Protocol Optimization Scheduling Questionnaire Automated Recommended Solutions based on appropriateness of the appointment, availability Comprehensive, Custom Lists Scheduling Algorithms with advanced, defined outcomes September 12, 2017 14
HOW FAR WE VE COME Since December 2014 Automated Scheduling Implemented 36 Specialties Automated Scheduling Enhanced 16 Specialties More Complex Designs (Surgical, Procedural, Ancillary Services) Cross Department Scheduling for 12 Specialties JHM Outpatient Internal Medicine Sites All Community Practice Sites September 12, 2017 15
MUSCULOSKELETAL SERVICE LINE(S) September 12, 2017 16
Introduction of a Service Line JHM Strategic Plan FY2016+ Become the model for an academically based, integrated health care delivery and financing system. Care delivery transformation and the development of models of care that align all components of the delivery system to work together. Interdisciplinary Service Line defined as the organization of multidisciplinary clinical services into an integrated care continuum around a population, disease state or discipline. More integrated patient experience Enhanced clinical efficiencies Performance improvement Musculoskeletal Initial Lead Programs (MSK) MSK Spine Care (Back Pain) and MSK Degenerative Joint Disease of the Hip and Knee (DJD) Span entire musculoskeletal care continuum beginning with patient symptoms and ending when the patient returns to their optimal level of function. September 12, 2017 17
MULTI-DISCIPLINARY SPINE CARE Our Musculoskeletal Spine Center brings together a highly experienced multi-disciplinary team which includes rehabilitation specialists, pain management experts, and spine surgeons in both Neurological and Orthopaedic specialties. Using both nonsurgical and surgical interventions, as well as pain management strategies and physical medicine and rehabilitation treatments we are able to provide comprehensive care to patients suffering from both acute and chronic back pain PHYSICAL THERAPY Physical Medicine and Rehab - Therapy Division NON-SURGICAL SPINE SPECIALISTS Pain Treatment (ACCM) Physical Medicine and Rehab - Rehab/Physiatry Division SURGICAL SPINE SPECIALISTS Neurosurgery Orthopaedic Surgery September 12, 2017 18
PATIENT POPULATION MSK SPINE PATIENT CRITERIA Adult Patients Only (18+) Undesignated patients (not referred to a specific named provider within the inclusive specialty departments) Patients not specifically seeking a surgical second opinion Patients with any of the following reasons for visit; Cervicalgia Lumbago Sciatica Pain-Back/Neck/Spine (Undiagnosed, Both injury and Non-injury related) September 12, 2017 19
MSK SPINE CARE PATHWAY The care path for patients seeking spine care within The Johns Hopkins Health System was designed by clinical representatives from each inclusive MSK department as well as JHCP primary care providers. The MSK Scheduling questionnaires were based on this care pathway which is shown below for reference. September 12, 2017 20
MSK SCHEDULING WORKFLOWS-HIGH LEVEL September 12, 2017 21
MSK SPINE SCHEDULING ENTRY POINTS - Patients may call the central scheduling line for the MSK Center (1-844-997-6754 or 443-997-6754) where agents will use the MSK questionnaires to derive a scheduling outcome - Patients may call any associated MSK Department and through their existing questionnaires the MSK workflow will launch automatically when appropriate. - Patients may be scheduled at any JH checkout office with a referral diagnosis of any of the MSK Spine reasons for visit either directly to the MSK Spine Center, Orthopaedic Surgery, Neurosurgery, Pain Treatment, Physiatry, or PMR Rehab. September 12, 2017 22
AUTOMATION IN ACTION September 12, 2017 23
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EARLY STAGES OF DATA COLLECTION 363 Scheduled and/or Completed MSK SPINE Consult Visits since 6/27/17 ~44% of the MSK visits were calling for an appointment in a Surgical Department, but had a consultation with a Non-Surgical Specialist September 12, 2017 27
WHAT S NEXT September 12, 2017 28
Additional Service Lines MSK DJD (Rheumatology, Orthopaedic Surgery, PT, PMR- Rehab) Center for Transgender Health (Plastic Surgery, Otolaryngology, Voice Therapy) Hand Institute (Plastic Surgery, Orthopaedic Surgery) Cardiovascular Institute (Cardiology, Cardiac and Vascular Surgery, Laboratory Services) Digestive Health Center (Gastroenterology, Colorectal Surgery, Nutrition) September 12, 2017 29
IT CAN BE DONE! Patient Access Transformation Additional Cross Department Scheduling Additional consolidation of services within the Patient Access Center Continued efforts on Check Out scheduling across the enterprise including community practice sites Increased MyChart Patient Direct Scheduling Flexible staff to match demand September 12, 2017 30
THANK YOU! Amy M. Tirabassi Email: atiraba2@jhmi.edu March 31