October 27, 2020

The health plan’s Member Services department has recently captured attention for record-setting performance. Even amid an onslaught of change, their service has increased and improved.

Could it get any better?

With the implementation of Epic Tapestry next summer, health plan leaders say YES! The performance of the department – and the value they bring to members – is about to be better than ever.

Let’s start with our workforce …

“One of the most significant benefits Epic Tapestry will bring to our team is the use of one system,” said Opera Wagner-Ross, director of Member Services. “Right now, the team must use multiple systems to serve our members, which can be time consuming and complicated. Tapestry will eliminate this.”

Wagner-Ross adds that the implementation will also streamline the communication between all parties involved in a member’s care.

“It’s a domino effect,” she said. “Improved workflow brings improved employee satisfaction. And satisfied employees are certainly more productive.”

So, what are the primary benefits to our members?

In two words – CONVENIENT ACCESS.

Tapestry will allow for the development of an enhanced member portal. Through the portal, families can access a number of convenient tools 24 hours a day/seven days a week, which may reduce the number of phone calls they make or time they have to wait for information.

According to Wagner-Ross, only 5,000 members used the portal last year out of more than 400,000 members. She says the low numbers are due to the portal’s limited functionality and the inability to adequately meet our member’s needs. “We are very hopeful that this will change.”

Moreover, the enhanced portal will improve care for members who are also patients of Texas Children’s Hospital because the portal will integrate with MyChart.

The member portal also includes …
  • Benefit Information: Provides information about the member’s benefits associated with the coverage and links to metered benefits and out-of-pocket benefits.
  • Referrals: Gives members access to information, such as the provider who referred them, who they were referred to, the status of the referral, the start and expiration dates of the referral, and the number of authorized and remaining visits.
  • Claims: Allows members to view their Tapestry claims and paperless explanation of benefits. Members can take a look at what claims have been posted for services rendered to them.
  • TCHP/TCH linked access: Members who are also patients of Texas Children’s Hospital will have expanded access to view Health Plan member features and Texas Children’s MyChart patient features.
  • Temporary ID card: Members can access and print a temporary ID card and request replacements electronically.
  • PCP update: Gives members the ability to electronically request a PCP change via the portal.

Missed the first story in our series? It’s all about Healthy Planet.

Read all about Member Services’ stellar performance.

October 12, 2020

It doesn’t get more exciting than this. Next summer, Texas Children’s employees will begin using a new and improved version of Healthy Planet, a module within the Epic Tapestry health care management system.

The arrival of Healthy Planet means better outcomes for more than 400,000 members of Texas Children’s Health Plan. But it also means less stress for our employees, lower costs for our organization and an even higher level of care across the entire system. (Can we get an Amen?!)

But how exactly is this possible?

Epic’s Healthy Planet application will help us keep track of how well we serve our members. It includes real-time and predictive analytics, daily metric dashboards, wellness registries, and chronic disease registries. It also contains information that allows us to compare our member data to national data on a variety of illnesses.

The module, with its dashboard, gives health care systems and providers information that can help coordinate care delivery, monitor quality and cost, reduce financial risk and engage members through a centralized data warehouse.

Benefits on both sides

“The Health Plan will benefit from having all care coordination documentation in one software system,” said Diane Scardino, Vice President at Texas Children’s Health Plan. “The Texas Children’s System also benefits because documentation for shared members will now live in one location.”

Healthy Planet will also make it possible for clinical care to be better aligned with social and community support for our families. “Outcomes for families will continue to improve because we’ll be able to target populations early, proactively intervene, and align needs,” Scardino added. “Interventions can further be reinforced through both the payor and provider partnerships.”

And if that wasn’t enough, the result of these benefits are bound to cause operational efficiencies as we reduce the need for manual and often duplicative information sharing across the organization.

Which brings us back to Care Coordination …

“It’s fair to say that we currently have a lot of fragmented communication taking place between our teams, both within the health plan and among our care delivery partners,” said Ashley Simms, director of Care Coordination at the health plan. “This will no longer be the case. Integrating into one platform not only creates a tremendous amount of workflow efficiencies, but facilitates more effective communication between the various care teams that work toward optimizing a person’s health.”

With communication more streamlined, employees can spend less time putting out fires and more time performing tasks that bring a higher level of patient satisfaction. This may include tasks like accessing the chronic disease and wellness registries to provide preventative information to patients.

Part of the Epic Tapestry implementation

Healthy Planet is a module being implemented as part of the health plan’s Epic Tapestry implementation. Its build, testing and launch are under the direction of the health plan. However, employees across Texas Children’s will be required to train for its use as our members are cared for throughout the organization.

All parts of the Tapestry project are set to go live in June of 2021. Due to Healthy Planet’s ability to meet such a wealth of needs, it is one of the more anticipated offerings.

Employees will be trained on how to use Healthy Planet and the rest of Epic Tapestry. Training details and dates will be announced at a later date.

September 21, 2020

Like most parents, the Harts were nervous about their 10-month-old son’s surgery scheduled with Texas Children’s Division of Urology. In addition to regular jitters, they were especially concerned about their son undergoing general anesthesia.

“My husband did some research and found that it can be dangerous for young children,” Kayla Hart said. “So, needless to say, we were a little worried.”

Those worries were put to ease when their son’s pediatric anesthesiologist, Dr. Kevin Chu, and surgeon Dr. David Roth, explained the information the couple found online and offered another option, spinal anesthesia. Spinal anesthesia, numbs the lower part of the body to block pain versus general anesthesia, which puts a patient to sleep.

Texas Children’s Department of Anesthesiology and Department of Surgery recently started offering spinal anesthesia, when appropriate, to parents of young children. Rowan Hart was one of the hospital’s first patients to receive spinal anesthesia as an alternative to general anesthesia.

“When I went back to recovery, he woke up from the nap he was taking throughout surgery and was totally normal,” Hart said. “He wasn’t groggy at all and was even smiling.”

General Anesthesia Division Chief Dr. Olutoyin Olutoye said spinal anesthesia is a safe alternative to general anesthesia in patients under one year of age who are having surgery on the lower part of their body. She said if needed, the patient may receive a light sedative to make them relax but otherwise, they are awake during their procedure. There is no need for a breathing tube when a child receives spinal anesthesia and patients, like Rowan Hart, are alert and in good spirits post operatively.

“Even though anesthesia is much safer today than ever before, every anesthetic exposure and surgical encounter, has an element of risk and we must remain vigilant about communicating such risks to our patients and their families,” Olutoye said. “Offering an alternative to general anesthesia when appropriate is another way we can serve our patients and families in this capacity.”

On December 14, 2017, the U.S. Food and Drug Administration (FDA) released a drug safety communication about prolonged or repeated anesthetics in young children and pregnant women in their third trimester.

The FDA’s communication states:

  • A single, short exposure to anesthesia appears to be safe.
  • There is some evidence that longer (>3 hours) or repeated exposures could have negative effects on behavior or learning.
  • Much more research is needed.

As a result of the communication Texas Children’s Hospital changed its anesthesia practice and started discussing the warning before surgery with the parents of all children 3 years of age and younger.

In addition, Texas Children’s Hospital adopted the warning’s recommendation that a discussion occur among parents, surgeons, other physicians and anesthesiologists about the duration of anesthesia, any plan for multiple general anesthetics for multiple procedures, and the possibility that the procedure could be delayed until after 3 years of age. Parent-education materials that cover these topics are available to our patients and their families.

“I think offering spinal anesthesia is another way we can remain on the leading edge of this issue,” said Roth, who helped spearhead the use of spinal anesthesia together with the Department of Anesthesiology, and who has operated on the patients who have received it thus far. “It’s a safe alternative that we can use to reduce any potential risks of general anesthesia in our younger population.”

Anesthesiologist-in-Chief Dr. Dean B. Andropoulos agreed and said the benefits of anesthesia must always be weighed against the risks of anesthesia itself and Texas Children’s does a good job at doing that.

“We are very serious about educating our patients and families prior to surgery about any risks and any options that can be taken to mitigate such risks,” Andropoulos said. “Using spinal anesthesia is a nice addition to what we already are doing to mitigate potential risk.”

August 31, 2020

Expecting mothers will soon receive even higher quality service when they visit The Center for Children and Women.

In response to patient feedback, the obstetrics services at both the Greenspoint and Southwest locations will treat patients with a new personal care team model. This will prevent families from seeing up to 10 different providers and instead offer them their own team of no more than four providers.

“We are excited about this change, especially because it has been made in direct response to one of our most common patient complaints,” said Dr. Faunda Armstrong, assistant medical director for The Center at Greenspoint. “The smaller team model will allow providers to develop a patient plan together, build a closer relationship with families and increase trust at every appointment.”

To ensure that this change – set for mid-September – achieves the intended results, The Center will continue to use the patient satisfaction firm, Press Ganey. The firm’s annual survey results will show the effects of the change.

Additional recent changes include an increased use of telemedicine appointments to keep patients and families safe amid COVID-19 concerns. For more information about The Center for Children and Women visit https://www.jointhecenter.org/.

August 24, 2020

2020 has been an unprecedented year filled with many challenges. We’ve engaged in social distancing practices like we have never done before. We are wearing protective face masks, both at work and in public, in an effort to protect ourselves, each other, and prevent the further spread of the coronavirus.

But despite the uncertainty and daily disruptions caused by the COVID-19 pandemic, this health crisis has prompted our physicians, nurses and other patient care staff to explore innovative, non-traditional approaches to patient care processes – like e-rounding – to enhance the provider/patient experience.

Daily patient rounding has been around for centuries, and is an important part of the patient care process. Before COVID-19, a group of multidisciplinary staff would gather in or outside a patient room to discuss the patient’s condition and plan of care with the patient’s family, taking into account the experience, concerns, questions and needs of the patient. Through this multidisciplinary, family-centered approach, each team member would then contribute their expertise to support the best possible care/outcomes for the patient.

To adapt to COVID-19 and to ensure social distancing practices are followed, our critical care teams began conducting patient e-rounding in April, which has been a beneficial change from the norm.

“E-rounding has been a big change for us,” said Dr. Jordana Goldman, attending physician in Critical Care. “Rounds are as old as time in medicine and so it takes a little bit of practice to get use to it. But once you get the flow of it, it really works well. Our physician and nursing leaders, and the e-Health and IS teams have been very supportive in helping us leverage new technology to make e-rounding possible.”

Through the VidyoConnect platform, virtual “rooms” are created that are then available for all rounding team members to join. During e-rounding, an attending physician, bedside nurse and family member, can be outside the patient’s room in front of a computer screen while maintaining social distancing, and can communicate virtually with remote team members including our consultants, the provider team (consisting of APPs, fellows and residents) dietitian, pharmacy, Respiratory Therapy support and other members.

“We facilitated the implementation of e-rounding by working with Dr. Goldman and Dr. Aarti Bavare to integrate their ideal workflow using the software and hardware that we already had available,” said Dr. Robert Ball, medical director of e-Health. “It was the team work of Information Services, e-Health and the physician champions that made it a reality. When you have amazing innovators in every corner of our organization working together to enhance this process, there are no obstacles that cannot be overcome.”

Since e-rounding was first introduced in the PICU and CICU in April, e-rounding has expanded to other parts of the hospital including the acute care cardiology floor. PHM has been working on the acute care side on a version of e-rounds to help with the education of the residents and medical students. Plans are underway to expand e-rounding capabilities to the Pavilion for Women and NICUs with the option of e-rounding being made available to all inpatient areas at our three hospital campuses in the coming weeks.

Our e-Health teams are also working on the ability to leverage VidyoConnect to communicate with families in a HIPAA compliant way so they can join rounds when they are not able to be at the bedside.

“The disruption of COVID-19 has allowed us to take a closer look at our rounding practices and see how we can improve them for our patients, team, learners and consultants,” Goldman said. “This is a very new process for us, but our team’s willingness to engage in this novel approach has been pretty phenomenal.”

August 17, 2020

For patients like 5-year-old Legend Pruitt, a visit to the doctor’s office can be a scary place for a child, especially if they don’t know what to expect when they come in for a medical procedure. A few months ago, when Legend had his MRI at Texas Children’s, his mother was surprised by how well he did, and how calm he was during the scan.

“He didn’t move at all because he knew he had to stay still for the MRI,” said Legend’s mother Niayeshua Joseph. “When my son had MRI scans before, he would have to be placed under anesthesia, because he could not stop moving. He is now more comfortable and the noises from the MRI machine don’t bother him.”

In an innovative effort to decrease the need for anesthesia in our MRI patients, Texas Children’s Radiology team bought the organization’s first mock MRI scanner last year thanks to a generous donation from one of our patient families. The mock MRI scanner provides a realistic simulation of what patients can expect before the real exam.

“This innovation allows patients to practice their scan before they enter the real scanner so they can understand their role (to lie still) and are more comfortable with something that is unfamiliar to them,” said Texas Children’s Radiologist-in-Chief Dr. Thierry Huisman. “Mock MR scanner training and familiarity with the MR imaging procedure enhances patient experience, reduces patient and family anxiety, and optimizes patient cooperation which can improve image quality or may allow for imaging without the need for patient sedation or general anesthesia.”

The mock MRI scanner on the fifth floor of Texas Children’s Lester and Sue Smith Legacy Tower, looks and sounds like a real MRI scanner. It has a bed that patients can lie on and travel into a tunnel similar to a real MRI scanner. The MRI scanner makes loud noises while the pictures are being taken. The mock MRI scanner simulates those noises and prepares a child for what to expect before they are scanned using the real machine. One additional advantage is that the mock MRI scanner does not include the “big magnet” and allows patients and families to attend without limitations. Furthermore, the mock MRI scanner does not use costly time as the real MRI unit.

Patients can get prepped with the mock MRI scanner in two ways. If the radiology pre-call nurse identifies a patient through their screening, they can schedule an appointment with a child life specialist several days before their procedure. Patients can also test out the mock MRI scanner immediately before their MRI appointment.

After introducing the mock scanner in July 2019, Radiology has seen amazing conversion results. Since June of this year, 67 patients have used the mock MRI scanner and 39 MRI patients scheduled for general anesthesia were converted to non-sedate procedures.

“We are really excited about our initial success,” Dr. Huisman said. “We are grateful to have this resource available to our patient families, and incredibly grateful to the Cook family’s philanthropic donation to make this all possible.”

A generous gift to help others

Brady and Nancy Cook know first-hand the challenges patient families face when a young child has to undergo an MRI especially for the first time. When their daughter, Alyssa, was in kindergarten, she started having complex partial seizures and was later diagnosed with a brain tumor. The brain tumor was believed to be in the area of the brain where speech is generated but doctors didn’t know for sure unless they performed a functional MRI on her.

“With a functional MRI, the patient has to be awake in the MRI machine and respond to images that flash up on the screen inside the MRI without moving because it would distort the quality,” said Brady Cook. “For that reason, it’s typically not done on 5-year-olds, because they are unable to hold still for an hour and follow instructions like that.”

But everything changed when the couple came across a research study on the use of mock MRI scanners that taught kids how to be more comfortable around the MRI machine to the point where young children could endure it. Out of desperation, they got creative and built a mock scanner in their garage. They used a big refrigerator box, a dolly that you lay on to get underneath a car, a softball mask to simulate the cage that goes over the patient’s head, a school locker sized mirror, age appropriate flash cards, and downloadable sound effects mimicking an MRI machine.

“We practiced this on our daughter so she could get comfortable with the MRI machine,” said Cook. “Soon after, she was able to successfully complete a functional MRI without moving. Her MRI scans showed us that the tumor was nowhere near the area of her brain that generates speech, and therefore the tumor could be removed safely.”

Since the mock MRI scanner helped their daughter, the Cook family wanted Texas Children’s to have the capability of helping patients become more comfortable with the MRI machine. Through their generous donation to Texas Children’s, the family is grateful that the mock MRI scanner is making a positive impact on patients and families.

“As parents who have been through this before and the desperation we felt at the time, we would do anything to ensure patients are comfortable during this process leading up to surgery,” Nancy Cook said. “Now that we have a mock scanner here, we hope that it will continue to give parents and children added comfort and reassurance.”

August 4, 2020

Five years ago, Texas Children’s Special Isolation Unit (SIU) opened at Texas Children’s Hospital West Campus to provide safe, effective care to patients with highly contagious infectious diseases. The decision to build the SIU came shortly after an unprecedented Ebola outbreak, resulting in the realization that Texas Children’s must always be prepared as an organization to handle any emerging infections that come our way.

Texas Children’s Special Isolation Unit at West Campus – the only one of its kind in Texas and among only a few in the United States – allows our teams to treat pediatric patients who are infected with highly contagious diseases in a state-of-the-art environment. The SIU is fully equipped with all of the latest scientific and technological approaches to biocontainment to assure the safety of the health care team, other patients and their families. The types of highly contagious pathogens that can be treated in the SIU include Ebola, influenza, measles and respiratory illnesses like MERS, SARS and RSV. Today, as many health care organizations face another global health pandemic, the SIU team at West Campus has been busy over the last several months providing care to COVID-19 adult and pediatric patients.

“As a virologist, I always thought in the back of my mind that we would possibly face a pandemic one day whether it be avian influenza or another coronavirus like SARS or MERS,” said Dr. Amy Arrington, medical director of the SIU at West Campus. “But I think until you’re really in that moment, it’s hard to imagine what responding to a pandemic like COVID-19 would be like for our team and the organization.”

Housed on the fifth floor of West Campus, the SIU has eight dedicated beds and up to 18 overflow beds on the fourth and fifth floors to care for COVID-19 patients, with the potential of expanding bed capacity as the need arises. The SIU is activated when patients meet a specific criteria, and in this case, are COVID-19 positive.

“We have nurses and doctors embedded in many clinical areas across our campuses who serve as clinician reservists on standby,” said Denise Tanner-Brown, Assistant Vice President of Nursing of Community and Ambulatory Nursing. “Once we activate them, they are pulled out of their home clinical areas to support the SIU.”

Since the pandemic began in early March, the West Campus SIU has been activated 12 times. The last time the SIU was activated was on May 30 and has remained open since then. As of July 31, 184 patients have been admitted to the SIU and 75 of those patients were admitted in June. West Campus has had 13 COVID-19 positive adult patients admitted to the SIU since it started taking care of adult COVID-19 patients on June 24. In May and June, the SIU saw a 48 percent increase in the average daily census.

Tanner-Brown says the SIU is on the downswing compared to previous months. Texas Children’s has seen a recent decline in COVID-19 admissions which demonstrate that masking protocols are working to curb the spread of the virus. However, the SIU team remains ready to care for increased patient volumes if warranted.

“When we began accepting adult patients in our SIU on June 24, we were a little worried about how they would perceive us as they came into a pediatric hospital setting for care,” Tanner-Brown said. “They have been more than grateful and extremely appreciative of our willingness to take good care of them.”

Since many of the adults who have COVID-19 or who required admission had some underlying disease presence, the SIU team collaborated with education coordinators from Houston Methodist West who provided guidance on general and COVID-19 specific care to ensure the best outcomes for these patients.

View a photo gallery of inside the SIU at West Campus below.

Preparing for a potential second wave

While some school districts are reopening campuses and others are sticking to virtual learning at least for the time being, Texas Children’s is ready and prepared to respond if the Houston area experiences another surge in COVID-19 cases after school starts and into the fall months during flu season.

“We are always in a constant state of readiness and we are not letting our guard down especially with the mounting uncertainty surrounding this unprecedented pandemic,” said Tanner-Brown. “As patient volumes decrease, we have a deactivation strategy where we can temporarily close down units. But we also have an activation strategy in place where we can turn it back on really quickly should the situation change. In general, many people are getting COVID fatigue, and may not feel the need to continue practicing social distancing or taking other safety precautions, so I anticipate that we may see more new cases emerge.”

For the 70 days and counting that the SIU at West Campus has been activated, the recent milestones achieved would not have been possible without the 100 percent collaboration from our team members across the system.

“I think as an organization, we have just really stepped up to the plate to provide good quality and safe care for these patients and our staff,” said Arrington. “It takes a huge village to put this together and to carry this out day after day. And it’s exhausting work, but it is work that is incredibly rewarding too.”