January 6, 2020

Texas Children’s has achieved HIMSS Stage 7 designation for Inpatient and Ambulatory across the system, which demonstrates the organization’s successful implementation of health care information technology to address quality initiatives and improve the delivery of patient care, efficiency and safety. In 2019, only 7 percent of hospitals in the U.S. achieved Stage 7 designation.

“Our hospital is among a small, elite group of health care organizations in the nation that have been awarded Stage 7 designation for inpatient and outpatient facilities,” said Myra Davis, senior vice president of Information Services. “This collaborative milestone is a culmination of nearly a decade of implemented technological solutions and data gathering to advance patient outcomes and further differentiate Texas Children’s from other hospitals that provide care for children and women.”

Reviewers from HIMSS Analytics visited Texas Children’s Medical Center Campus on December 16 and 17 to validate the organization’s achievement of Stage 7 in our inpatient and outpatient facilities, including Texas Children’s Pediatrics on Kirby Drive. Staff answered questions about the hospital’s use of technology to support patient care including processes for clinical information documentation, tools for quality metrics and analytics, and the handling of paper documents.

“It was wonderful to hear reviewers acknowledge our Quality and IS collaboration as being ‘best in class’, among other notable mentions,” said Texas Children’s Chief Medical Information Officer Dr. Carla Giannoni. This has been a goal that we, as an organization, have been actively focused on achieving.

HIMSS reviewers noted several key IS achievements that contributed to our Stage 7 designation:

  • Optimizing clinical workflows – This has improved the quality of care across the system whether in the emergency center or at a primary care practice. Epic’s electronic mobile application suite allows providers to e-prescribe medications and improves the safe and secure transmission for patient health information among providers.
  • System integrations – Integration of the PACS link in Epic for imaging review and lab results has provided our providers with a holistic view to determine a more personalized plan of care. A system integration that was implemented is MyDining, a new room service feature that offers healthier menu options for patients during their hospital stay.
  • Electronic health record (EHR) enhancements – Examples of enhancing the EHR include decision support in the form of Best Practice Alerts that automatically notify staff of certain conditions such as the risk of Sepsis or the need for an influenza immunization.

“The maturity of health information technology and data analysis are key to advancing outcomes and experience for our patients and providers,” said Julie McGuire, director of Enterprise Systems for Information Services. “We are so grateful to have completed this last step in our Stage 7 journey. We were able to achieve this designation through the collaborative support from our dedicated partners.”

The tireless leadership of the planning team members from several departments that contributed to Texas Children’s obtaining Stage 7 designation included Quality, Radiology, Pharmacy, Texas Children’s Pediatrics/Texas Children’s Urgent Care, Health Information Management, Nursing Clinical Informatics, Chief Medical Information Officer and Associate Medical Information Officers, Mission Control, subspecialty services (Pediatrics, Surgery and Women’s Services), Pathology, Emergency Management and all employees and staff who hosted the site visits in their respective areas.

“Our goal is to optimize the digital tools that surround the providers so we can radically improve our performance and deliver better care,” said Texas Children’s Chief Quality Officer Dr. Eric Williams. “We are proud of the Stage 7 designation, but we are more proud of how our digital transformation has improved patient care.”

Physicians from across the globe traveled to Texas Children’s Pavilion for Women last week to attend Texas Children’s first Fetal Center Fetoscopic Neural Tube Defect Simulation Course. Teams from Australia, England, Belgium, Turkey, Germany, Colombia, Argentina, Brazil, Mexico, Costa Rica, Peru, and the USA were here to learn how to perform a specific fetal surgery procedure developed at Texas Children’s.

The two-day program included lectures and hands-on practice sessions with various experts in the field, including Texas Children’s Obstetrician and Gynecologist-in-Chief Dr. Michael Belfort and Pediatric Neurosurgeon Dr. William Whitehead. Whitehead and Belfort pioneered two-port fetoscopic neural tube repair surgery in 2014 when they performed the minimally-invasive procedure in–utero on 23-week-old Grayson Canezero.

Since then, Texas Children’s has become one of the only places in the world where people can go to correct neural tube defects, also known as spina bifida defects, fetoscopically. Advances in fetal surgery and the landmark clinical trial, known as the Management of Myelomeningocele Study (MOMS Trial), have proven that a fetal surgical repair leads to decreased rates of hydrocephalus and improved leg function compared to a postnatal repair.

Through their research and outcomes data, Belfort and his team have shown that performing the surgery fetoscopically yields the same outcome for the baby as the open repair, while being significantly less invasive for the mother. Texas Children’s continues to offer open fetal surgery for spina bifida, the standard of care since 2012, for patients who do not qualify for or opt not to undergo a fetoscopic repair.

Conference attendees learned how to select patients for the surgery, counsel and prepare them for the surgery, perform the surgery, manage patients after the surgery and follow-up after the child is delivered. The conference included several hands-on simulations of the procedure and other related surgeries.

“This is a great way to educate and equip surgeons all over the world with the knowledge and ability to perform a procedure that can make a huge difference in the lives of mothers and their unborn babies,” Belfort said. “I am very pleased we were able to provide this opportunity and I am especially grateful to our wonderful Texas Children’s team members who organized and managed the course and to Karl Storz who provided the equipment that made this possible.”

December 9, 2019

For the past two years, increasing access to care has been one of the central goals across the Texas Children’s system, resulting in several new programs and initiatives.

The most recent example was on December 2, when the Department of Surgery took yet another major stride in its effort to provide patients and families with even more access to Texas Children’s surgical care through the launch of the new After Hours Clinic for Surgical Care.

The After Hours Clinic is now open Monday through Friday, 5 p.m. to 7 p.m., on the eighth floor of Mark A. Wallace Tower, and is staffed by the Surgical APP Hospitalist Team, which currently cares for surgical patients in the Texas Children’s Emergency Center (EC) and inpatient areas.

This clinic provides access to care for post-surgical patients or those who need to be seen quickly for a large range of non-emergency or non-urgent medical issues.

“There are many situations, particularly in the early postoperative period, in which parents feel the need to have a surgical provider evaluate their child,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “Often this is just for reassurance or to provide additional instructions or guidance. The After Hours Clinic is designed primarily for families who feel they cannot wait to be seen until the following day.”

In addition to convenient clinic hours, patients and families will benefit from the relative low cost of clinic visits compared with visits to the EC or to urgent care. Usually a visit to the After Hours Clinic will cost the same as a regular clinic visit; and for post-surgical patients, it may even be covered within the global period.

Staff within surgical divisions can directly schedule patients to the After Hours Clinic in Epic. And in the coming months, pediatricians and families will be able to schedule as well by calling 832-822-2778.

After Hours Clinic for Surgical Care FAQs

When: Monday through Friday, 5 p.m. to 7 p.m.

Where: Mark A. Wallace Tower, eighth floor

Who is eligible?

  • New patients
  • Postop patients
  • Established patients

What types of conditions are treated?

  • All postoperative concerns
  • All wound concerns
  • Minor burns
  • Cast and splint issues (e.g., pain, swelling, wet or loose casts/splints)
  • Suture, staple or glue concerns
  • Cellulitis
  • Hair tourniquet
  • Gastrostomy button concerns
  • Foreskin concerns (e.g., balanitis, phimosis)
  • Fingernail infection (e.g., felon, paronychia)
  • Non-displaced fractures (bones are still in proper alignment)
  • Superficial lacerations (do not extend into the muscle or have exposed bone)
  • Ear and nose foreign body removal

What kinds of patients should be sent to an EC?

  • Patients who need EC resources, such as CT scans, sedation, etc.
  • Congenital heart patients
  • Patients with Ophthalmology concerns
  • Patients with Neurosurgical concerns

Who sees the patients?

Surgical Advanced Practice Providers (APPs) on the dedicated Surgical APP Hospitalist Team. The Surgical APP Hospitalist Team is cross trained in Pediatric General Surgery, ENT, Urology, Orthopedics and Plastic Surgery. While surgeons and physicians are not physically present during clinic hours, they will be contacted as appropriate.

How is a visit to the After Hours Clinic for Surgical Care different from a Same Day/A+ Clinic Appointment?

These are patients with a surgical concern who would otherwise go to the emergency room.

How does a patient get on the clinic schedule?

Surgery clinic staff, schedulers and/or ambulatory service representatives can directly schedule patients into an after-hour visit type in Epic. The templates will have 20-minute time slots starting at 5 p.m., Monday through Friday.

Who can I contact with questions or for additional information about the clinic?

For additional information about the After Hours Clinic for Surgical Care, please contact Kris Marsack or Susannah Ferguson.

December 8, 2019

 

When you think of a medical coder, what’s the first thing that comes to mind? Perhaps you conjure up images of someone feverishly attempting to solve a puzzle or decipher an ambiguous code.

Medical coding is often compared to the work of a detective. Medical coders analyze and translate complex information from patients’ charts into standardized medical codes. This job requires extensive knowledge of medical terminology, anatomy, physiology, disease processes and analytical skills.

When a patient receives care at Texas Children’s, every diagnosis and procedure is documented in the patient’s chart by their physician, detailing what is wrong with the patient and what services were performed. Since there are many diseases, procedures and services out there, medical coders must search through thousands of alpha numeric codes to find the right code for each procedure or diagnosis.

Since Texas Children’s cares for some of the world’s most critically ill patients, and those with medically complex needs, the more complex the diagnosis and procedure, the more complex the coding can be.

“Our team uses the ICD-10 system to classify and code all diagnoses, symptoms and procedures,” said Coding Quality Assurance Specialist Stephanie Koopmann. “From reviewing and deciphering physician notes to translating them into codes, our job requires meticulous attention to detail to ensure patients not only receive the right care, but that revenue for Texas Children’s services flows accurately and efficiently.”

While medical coders work behind the scenes to ensure the delivery of high quality patient care, they are also the lifeline of Texas Children’s Revenue Cycle. Every ICD-10 code entered into a patient’s electronic medical record – and on an insurance claim – eventually drives revenue for Texas Children’s Hospital

“Our coding team looks at every piece of patient documentation to ensure we code correctly from a compliance standpoint before the claims are sent to the payors,” said Brenna Thiem, assistant director of Coding Compliance and Clinical Documentation. “From ensuring the accuracy of revenue and physician reimbursements systemwide to creating a valid record of patient care history, proper medical coding is important so Texas Children’s can continue to meet the needs of our patients and families.”

Currently, there are 80 certified medical coders across the organization. Through a special partnership, Texas Children’s hopes to increase that number in 2020.

Since 2018, Texas Children’s has partnered with Volunteers of America, a recipient of the Healthcare Professionals Opportunity Grant administered by the Administration for Children and Families. Through this federal educational grant, over 20 Texas Children’s employees have completed classes to obtain their certification in either professional or outpatient coding, or certification to become a professional biller.

Syreeta Elkins, whose been with Texas Children’s for 10 years and works for the Revenue Cycle, first learned about the program from her manager. While the classes are free of charge to employees thanks to this grant, the program’s flexibility enabled her to balance work while attending classes in the evenings.

“This program has helped me prepare for a coding role in the future and broadened my knowledge of the Revenue Cycle process,” Elkins said. “This is a great program to help employees expand their skills, and it shows that the organization is dedicated to growing each individual and retaining exceptional talent.”

Due to the success of last year’s program, Volunteers of America has selected Texas Children’s for the last year of this grant, providing another invaluable opportunity for employees to obtain their certification to work in areas, such as medical coding and billing, that are vital to the success of Texas Children’s.

A total of 40 employees have enrolled for the next session that begins in January 2020. The classes are held two nights a week for three months at Texas Children’s Medical Center Campus. After students complete the course, they’ll take a certification test proctored onsite by an AAPC instructor.

“This grant has helped individuals who had wanted to further their education, but didn’t have the financial means to do so or had other barriers in their way,” Thiem said. “We are grateful for our partnership with Volunteers of America and for selecting Texas Children’s once again to benefit from this grant.”

November 26, 2019

Tamarah Rodriguez waited in eager anticipation for the November 20 patient move day to arrive. She and her 5-month-old son, Adriel Franco, had spent nearly a week in their hospital room on the seventh floor of the Abercrombie Building.

To ensure that her son received the best care possible, Rodriguez made the six-hour drive from her home in Edinburg, TX to Texas Children’s Hospital. Staying in one of Texas Children’s oldest buildings, she realized how small the room felt – not just for her and little Adriel – but also for her son’s care team.

“It was really hard to feel at home here,” Rodriguez said. “When we found out that we’d be moving in a newly renovated room with more space to walk around, I was very excited. And then, when I saw the room for the first time, it was simply amazing. It’s very spacious, cozy and the views are beautiful.”

On November 20, Texas Children’s reached an historic milestone when acute care services transitioned out of the 65-year-old Abercrombie Building and into 15 West Tower, which was formerly one of Texas Children’s cardiology units, and was renovated to meet the future growth of the hospital’s acute care patient population.

Beginning at 7 a.m., four specially trained clinical teams began safely transporting 33 acute care patients from Abercrombie 6 North and 7 South to their new, spacious, state-of-the-art rooms in 15 West Tower. Nine patients from Abercrombie 5 North relocated to 7 South, until the move to 7 West Tower occurs in February.

More than 50 Texas Children’s staff members were involved in the patient move to 15 West Tower, and the careful transfer of the patients took five hours, which was a lot sooner than originally anticipated due to the efficiency and effectiveness of the Abercrombie and 15 West Tower teams involved on Move Day.

The patient move involved teams from clinical support services, respiratory, facilities, security, nursing, administration, physicians, nurse practitioners, and all members of the acute care team. Patient and family services teams were assigned to each family member to help accompany and escort them from Abercrombie to the hospital’s new acute care unit. Throughout the move, the 15 West Tower Go-Live Support Center was set up in the Nursing Administration Director Workroom comprised of individuals who focused on patient move issue resolution and tracking from Abercrombie to 15 West Tower.

“The patient move was successful and flowed seamlessly,” said Rhonda Wolfe, Director of Nursing for Acute Care. “There was meticulous planning for several months leading up to Move Day which included reviewing patient move logistics, engaging staff, families and partnering with other departments to ensure roles were clearly delineated.”

Collaborating with our Facility Planning and Development partners, the 36-bed unit features larger patient suites (291 square feet), a playroom and two relaxing family rooms that give loved ones a space to gather. Dynamic features include four rooms engineered for the safety of patients with behavioral health needs and a simulation lab to provide state-of-the-art education. With these innovative technologies, 15 West Tower is well equipped to provide exceptional patient care for generations to come.

Impetus for historic patient move

The patient move is part of Texas Children’s West Tower Backfill Project, which involves transitioning patient care services out of Abercrombie. Abercrombie 7 South will remain “patient ready” and will be used as an overflow unit in times of high census. Abercrombie 5 North and 6 North will be decomissioned and designated for administrative use.

The smaller rooms (160 square feet) and limited technological capabilities in the 65-year-old building historically had presented challenges for providers, clinical care teams, patients and their families.

“When our executive steering committee looked at space planning and space management for our clinical programs, one of our guiding principles was to decrease or eliminate care in Abercrombie,” said Assistant Vice President of Nursing Jennifer Sanders. “The patient move from Abercrombie to West Tower, will enable our patient care teams to collaborate more efficiently in these new, enhanced spaces and will improve the experience for our patients and their families during their stay at Texas Children’s.”

The next phase of the West Tower Backfill Project will include moving patients from Abercrombie 7 South to 7 West Tower in February 2020. 7 West Tower will become a new 32-bed hematology and oncology unit.

November 18, 2019

During the final week of October, Texas Children’s Hospital hosted visitors from around the world for a very special Rett Syndrome Symposium and Workshop.

The two-day event was momentous for many reasons. It was the inaugural meeting held in the stunning new Auditorium and Conference Center at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital. It fortuitously coincided with Rett Syndrome Awareness Month. And the symposium also marked the 20th anniversary of the discovery of the underlying cause of Rett syndrome. In 2000, NRI director Dr. Huda Zoghbi’s research team made the pioneering discovery that loss-of-function mutations in methyl-CpG binding protein, MECP2, were the underlying cause of Rett syndrome.

Rett syndrome is a rare neurological disorder that primarily affects young girls between 6 months and 2 years of age. The children appear to hit normal developmental milestones until, inexplicably, their motor, cognitive and social skills start to rapidly deteriorate. Most patients develop autistic features, breathing difficulties, dementia, growth abnormalities, epilepsy and scoliosis.

The symposium opened with a warm welcome from co-organizers Dr. Adrian Bird – Buchanan Professor of Genetics and Welcome Trust Center for Cell biology at the University of Edinburgh, UK – and Zoghbi, who is also a professor at Baylor College of Medicine and Howard Hughes Medical Institute investigator.

“The purpose of this event was to bring together researchers who work on Rett syndrome and leaders from related areas of neuroscience working in academia, industry and government, to think deeply and spark new ideas,” said Zoghbi. “The hope is that out of the work and discussions that happened here, in five years, when we’re marking the 25th anniversary of the gene discovery of Rett syndrome, we’ll also be celebrating new treatments for people with Rett syndrome.”

The international symposium was sponsored by Rettsyndrome.org (formerly the International Rett Syndrome Foundation) and the Rett Syndrome Research Trust. The multidisciplinary group of attendees included scientists, physicians, members of the lay public, and representatives from the National Institutes of Health, the pharmaceutical industry, and several foundations, all brought together to look at Rett syndrome with a fresh, new perspective.

On the first day of the symposium, presentation topics ranged from clinical observations of MECP2 disorders like Rett and MECP2 duplication syndrome to pathogenesis (progression or development) of Rett syndrome, to discussions on neuronal circuit alterations and therapeutics. Texas Children’s pediatric neurologist Dr. Bernhard Suter spoke about MECP2 duplication syndrome, which typically affects male patients and causes symptoms such as hypotonia, motor delays, intellectual disabilities, gastrointestinal issues and epilepsy.

Following a day of stellar research presentations, the investigators split into three working groups that focused on Molecular Pathogenesis, Therapeutic Approaches and Young Investigators. The groups discussed the information presented over the course of the day and their vision for the future of Rett syndrome research. This included the systemic and technical challenges that currently exist, and the group brainstormed ways to overcome those. The next morning, key points from these discussions were shared with the audience.

  • Rett syndrome is a particularly challenging disorder to correct. The levels of MECP2 protein in the neurons need to be precisely regulated because too much MECP2 protein causes a different neurological condition, the MECP2 duplication syndrome. Despite these challenges, research in Rett syndrome is advancing at a rapid pace, having moved from gene discovery to promising clinical trials in under 20 years.
  • Gene therapy offers exciting opportunities to develop treatment for Rett syndrome and is an area of active research. However, there are challenges to overcome including controlling the level and distribution of the delivered gene.
  • While the ultimate long-term goal of researchers is to find a lasting cure using gene therapy, clinicians in the audience weighed in on the benefits of also developing short-term strategies to treat specific behavioral or motor issues and/or how to delay the age of symptom onset. This would be a huge step forward for patients, their families and caregivers who cope with this debilitating condition on a daily basis. Participants in the discussion also drew parallels to the field of breast cancer, where non-targeted treatment modalities serve as the workhorses to treat the majority of patients.
  • There is a dire need to develop early screening/diagnostic methods for Rett syndrome among newborns. Early diagnosis, in combination with specialized therapies – such as neuromodulation physical therapy, speech therapy or psychotherapy may provide maximal improvements in the quality of life of the patients.
  • Building collaborations between academia and industry, with a focus on multidisciplinary team science and data-sharing, is critical to facilitate the development of superior reagents (i.e., better viral vectors for gene therapy), biomarkers (i.e., meaningful measures of clinical outcomes) and therapies. Moreover, there was a general agreement that close partnerships between various key stakeholders, such as scientists, physicians, pharma/biotech industry, families, caregivers and advocacy groups, are crucial for developing effective therapies.

Learn more about Texas Children’s research efforts at the Jan and Dan Duncan Neurological Research Institute and world-class clinical expertise provided at the Rett Center.

October 29, 2019

On October 14, Texas Children’s Hospital Specialty Care – Sugar Land began seeing patients in its newly expanded Orthopedic and Sports Medicine Clinics located on the first floor.

This expansion makes it more convenient for patients to receive care and allows the staff to work in a more spacious area. Originally the clinic operated in two separate areas and today patients can receive x-rays and exams on the same floor. Orthopedic and Sports Medicine providers will move to the first floor, and the second floor will be for additional growth.

“It’s going to be a huge patient satisfier when it comes to our day-to-day flow,” Assistant Director of Ambulatory Services for the West and South Region, Betsy Sanford said. “Patients will no longer have to move from one floor to another to receive care, so we are all really excited for this new space.”

This is the first phase of the opening that includes eight exam rooms, a cast room with three spaces, two x-ray rooms, ultrasound, and a Quest Lab drawing station, for Texas Children’s Patients only.

One of the first patients seen was 17-year-old Marisa Garza who had been experiencing pain in her knees after years of performing difficult stunts on her local dance team.

“Her sophomore and junior years on the team she was required to execute moves that forced her to constantly slam on her knees to the ground, and over the years it has taken a toll on her,” her mother, Jessica Garza said. “As a former Texas Children’s employee and parent of patients over the past several years, I know first-hand the quality of care that is provided.”

Within the hour, Garza was checked in, her vitals were taken, and she was x-rayed and examined. With the additional space, the clinic expects to see more sports medicine patients once staff grows.

Texas Children’s Hospital Specialty Care locations provide many of the same pediatric subspecialty services available at our three hospital locations, just closer to home for patients and their families.

“It’s like having the Mark A. Wallace Tower in the community,” medical manager Allyson Jackson, RN, BSN said. “I really want people to understand how effective the clinic is for those that are in the community. The more we continue to grow, the more effective we can be.”

Phase two of this expansion is expected to open early next year and will include a new Sports Physical Therapy gym.

Click here for more information about the Specialty Care – Sugar Land and Texas Children’s Orthopedics.