IS 2022 Benefits Realization Analysis by Penn Medicine Information Services

Information Services

Benefits Realization Analysis State of Corporate Information Services Supplement

PURPOSE OF THE REPORT The 2022 Penn Medicine Information Services Benefits Realization report reviews thirty-two (32) high-profile, high-quality projects implemented in fiscal years 2020 and 2021. The Penn Medicine Information Services (IS) team collaborated with operational and clinical partners to generate substantial financial and qualitative benefits in this year’s report. The projects are grouped into five categories that define key strategic goals of Penn Medicine: Empowering Technologies, Digital Healthcare, Making Data Meaningful, Making the Connection, and Research. In this edition, there is also a COVID-19 Section which describes extraordinary collaboration between IS and the Penn Medicine clinical and operational leaders in responding to the worldwide pandemic. In addition, there is a look ahead spotlighting the multiple projects that were completed in support of the University of Pennsylvania - Pavilion launch in the fall of 2021.

The mission of Information Services is to transform data into value to support our caregivers, business administrators and patients. During fiscal years 2020 and 2021, IS initiated thousands of projects in support of this mission. As projects are completed, Penn Medicine has realized substantial value from the investments of time, resources, and empowering technology in terms of: • • •

Quality patient care and safety. Patient, family, staff, and physician satisfaction with the care and services provided. Education and research support.

To assess the direct patient care value realized from IS projects, many of them feature measured and evaluated financial and qualitative returns derived from these investments.

A Penn Medicine Information Services Publication http://www.pennmedicine.org/information-services/

MESSAGE FROM THE CIO

Penn Medicine’s core mission of world class patient care, education, and research is the primary focus of the Information Services team. This mission has never been more critical than over these past two years.

This report documents essential projects in fiscal years 2020 and 2021 that resulted in substantial operational savings, future cost avoidance, new revenue, and/or qualitative benefits. As we look back at the remarkable progress Penn Medicine’s IS team has made in the past two years, we are both humbled and inspired by the accomplishments achieved during these unprecedented times. Who could have predicted the massive challenges facing us as a Nation brought on by the COVID-19 pandemic? The role of IS supporting the organization and digital innovation has never been more critical. Penn Medicine’s clinicians, researchers, and operators have responded to the pandemic in outsized ways, while the information services department has supported their efforts on a daily basis by leveraging the power of innovative technologies. The achievements shared in this report are a testament to the teamwork, dedication, and commitment to our community that is emblematic of the Penn Medicine culture. We are proud to present a rich set of projects selected from the many initiatives completed that moved operational, financial, and clinical outcomes to new levels. While COVID-19 required new and innovative approaches to the digital experience, the IS team collaborated with leadership to make significant advances in core operations, supported growth strategies, met consumer needs, and expanded our research capabilities with world class development of innovative solutions. Our IS team met the challenge of supporting the organization, staff, providers, and most importantly our community with safe patient experiences through the pandemic, all while maintaining uninterrupted support services and ongoing IS systems development and implementations. We have embraced a new era of technology innovation with the ability to leverage artificial intelligence and machine learning which has brought new speed and depth to the insights available to create predictive models for operations improvements, clinical outcomes, and research. Our teams have embraced these advances; even receiving worldwide recognition while keeping in mind the patient and those who care for them. Our deepest gratitude to all our colleagues as we rose to the remarkable challenges in ways that set the foundation for Penn Medicine to excel in this new world.

TABLE OF CONTENTS COMPLETE REVIEW OF FINANCIAL IMPACT` vi BREAKDOWN OF SAVINGS viii SAVINGS AND COST AVOIDANCE BREAKDOWN ix

TECHNOLOGY INNOVATION AND RAPID RESPONSE SUPPORTS THE HEALTH SYSTEM THROUGH THE COVID-19 CRISIS EMPOWERING TECHNOLOGIES Strengthening Our Technology Value Supply Chain Through Vendor Contract Management 19 Microsoft Office 365 and Virtual Collaboration Platform Integrates Business Services More Efficiently 20 Network Backbone Refresh is at the Core of Health System Infrastructure Expansion 21 Automated User Workstation Patching Increases Technology Platform Security and Stability for Perelman School of Medicine 22 IS Supports the Transition of The Hospital of The University of Pennsylvania at Cedar Avenue Serving the West and Southwest Philadelphia Community 23 Penn Medicine Launches Chester County Hospital’s New Patient Tower 24 Radnor Medical Campus Opens New Multi-Specialty Outpatient Facility 25 Information Services Supports Penn Medicine Medical Group Practice Acquisitions 26 Foundation Business System Implementation Keeps Penn Medicine Running with PennforPeople 27

DIGITAL HEALTHCARE Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data 29 PennChart Integrates Further with Implementations and Expansions 32 Realizing the Value of our PennChart Integrated EHR Through Expansions, Upgrades, and Enhancements 37 Our Commitment and Investment in Creating Positive Patient Experiences 41 Penn Medicine Deploys Innovative Voice Dictation Technology 43 Penn Medicine Princeton Health Transitions to Enterprise Voice Dictation Technology 44 Point-of-Care Ultrasound Image Integration with PennChart 45 Ophthalmology Image System Replaced With Modern Technology 46 Penn Medicine Cherry Hill Expands Clinical Footprint 47 Personalizing the Patient Journey "Home to Hospital" Using Innovative Digital Tools 48 Remote Telemedicine ICU Module for Penn-Elert Program 50 Bar Code Medication Administration for Inpatient Chemo Infusions Suites 51

MAKING DATA MEANINGFUL Patient Accounting Automated Document Management System Eliminates Paper Trail 53 Pre Check-in Coverage Verification and Payment Automation Enables Low Touch Patient Experience 54 Real Time Insurance Eligibility Verification 55 Penn Medicine Provides Price Transparency With Patient Self Service Estimates 55

MAKING THE CONNECTION Text Messaging Solution Transition Results in Greater Efficiency and Significant Cost Savings Healing at Home - Automation Leads to Early Discharge for Parents and Newborns

57 58

RESEARCH Abramson Cancer Center Support Grant - NCI Comprehensive Cancer Center 60 Electronic Quality Documentation System Supports Novel Research Therapies Within Penn Medicine Manufacturing Cores 61 Abramson Cancer Center Clinical Research Unit Kit Management 62 Cellular Vaccine Production Facility Inventory and Equipment Management 63

STATE OF THE ART TECHNOLOGY DESIGNED TO SUPPORT: THE PAVILION AT THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA 64 IS ACTIVITIES YIELD SUBSTANTIAL ON-GOING SAVINGS AND COST AVOIDANCE 65 GLOSSARY 66

COMPLETE REVIEW OF FINANCIAL IMPACT TECHNOLOGY INNOVATION AND RAPID RESPONSE SUPPORTS THE HEALTH SYSTEM THROUGH THE COVID-19 CRISIS PROJECT NAME

YEAR 1

YEARS 2-3

YEARS 4-5

QUALITATIVE

YEAR 1

YEARS 2-3

YEARS 4-5

Strengthening Our Technology Value Supply Chain Through Vendor Contract Management

$11,161,320

$15,704,001

$13,005,824

Microsoft Office 365 and Virtual Collaboration Platform Integrates Business Services More Efficiently

$2,480,000

$1,285,000

$1,035,000

$651,781

$1,303,562

Automated User Workstation Patching Increases Technology Platform Security and Stability for Perelman School of Medicine

QUALITATIVE

IS Supports the Transition of The Hospital of The University of Pennsylvania at Cedar Avenue - Serving the West and Southwest Philadelphia Community

QUALITATIVE

Penn Medicine Launches Chester County Hospital’s New Patient Tower

QUALITATIVE

Information Services Supports Penn Medicine Medical Group Practice Acquisitions

QUALITATIVE

Radnor Medical Campus Opens New Multi-Specialty Outpatient Facility

QUALITATIVE

Foundation Business System Implementation Keeps Penn Medicine Running with PennforPeople

QUALITATIVE

$14,293,101

$18,292,563

$15,344,386

YEAR 1

YEARS 2-3

YEARS 4-5

Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data

$2,950,000

$5,900,000

$8,500,000

PennChart Projects: » PennChart Integrates Further with Implementations and Expansions » Realizing the Value of our PennChart Integrated EHR Through Expansions, Upgrades, and Enhancements » Our Commitment and Investment in Creating Positive Patient Experiences

$2,280,375

$2,648,000

Penn Medicine Deploys Innovative Voice Dictation Technology

$760,000

$1,520,000

Penn Medicine Princeton Health Transitions to Enterprise Voice Dictation Technology

$48,000

$96,000

$1,000,000

$2,000,000

$25,000

Penn Medicine Cherry Hill Expands Clinical Footprint

QUALITATIVE

Personalizing the Patient Journey "Home to Hospital" Using Innovative Digital Tools

QUALITATIVE

Remote Telemedicine ICU Module for Penn-Elert Program

QUALITATIVE

Bar Code Medication Administration for Inpatient Chemo Infusions Suites

QUALITATIVE

$7,063,375

$12,164,000

$12,116,000

30+ IS Projects Focused on COVID-19 Pandemic Response

EMPOWERING TECHNOLOGIES PROJECT NAME

Network Backbone Refresh is at the Core of Health System Infrastructure Expansion

SAVINGS

DIGITAL HEALTHCARE PROJECT NAME

Point-of-Care Ultrasound Image Integration with PennChart Ophthalmology Image System Replaced With Modern Technology

SAVINGS

MAKING DATA MEANINGFUL PROJECT NAME

YEAR 1

YEARS 2-3

YEARS 4-5

Patient Accounting Automated Document Management System Eliminates Paper Trail

$400,000

$800,000

Pre Check-in Coverage Verification and Payment Automation Enables Low Touch Patient Experience

QUALITATIVE

Real Time Insurance Eligibility Verification

QUALITATIVE

Penn Medicine Provides Price Transparency with Patient Self Service Estimates

QUALITATIVE

$400,000

$800,000

YEAR 1

YEARS 2-3

YEARS 4-5

Text Messaging Solution Transition Results in Greater Efficiency and Significant Cost Savings

$150,000

$300,000

Healing at Home - Automation Leads to Early Discharge for Parents and Newborns

QUALITATIVE

$150,000

$300,000

YEAR 1

YEARS 2-3

YEARS 4-5

Abramson Cancer Center Support Grant - NCI Comprehensive Cancer Center

QUALITATIVE

Electronic Quality Documentation System Supports Novel Research Therapies Within Penn Medicine Manufacturing Cores

QUALITATIVE

Abramson Cancer Center Clinical Research Unit Kit Management

QUALITATIVE

Cellular Vaccine Production Facility Inventory and Equipment Management

QUALITATIVE

SAVINGS

MAKING THE CONNECTION PROJECT NAME

SAVINGS

RESEARCH PROJECT NAME

SAVINGS AND AVOIDANCE BREAKDOWN

TOTAL

Cost Savings

$11,138,630

Cost Avoidance

$47,253,045

New Revenue

$23,631,750

$82,023,425 $90,000,000 $80,000,000

TOTAL FINANCIAL IMPACT YEAR 1

$21,906,476

YEARS 2-3

$31,556,563

YEARS 4-5

$28,560,386

TOTAL

$82,023,425

$70,000,000 $60,000,000 $50,000,000

$31,556,563

$40,000,000 $30,000,000

$21,906,476

$28,560,386

$20,000,000 $10,000,000 $0

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL

vii

BREAKDOWN OF SAVINGS $14,293,101 YEAR 1

$18,292,563 YEARS 2-3

EMPOWERING TECHNOLOGIES These projects are focused on technologies and processes to address the administrative and physical infrastructure that includes financial services, operations, human resources, managed care, contracting, billing, materials management and others.

$15,344,386 YEARS 4-5

TOTAL FINANCIAL IMPACT: $47,930,050

$7,063,375

$12,164,000

YEAR 1

YEARS 2-3

DIGITAL HEALTHCARE These projects are focused on implementation and enhancement of the Electronic Medical Records applications in which clinical documentation is captured and used to support patient care delivery. Mobile Health and Patient Engagement tools are also

$12,116,000 YEARS 4-5

represented.

TOTAL FINANCIAL IMPACT: $31,343,375

$400,000 YEAR 1

$800,000 YEARS 2-3

MAKING DATA MEANINGFUL

$800,000 YEARS 4-5

These projects are focused on effective capture and use of data from the clinical and financial systems to support improved care delivery, financial management and quality improvement.

TOTAL FINANCIAL IMPACT: $2,000,000

$150,000 YEAR 1

MAKING THE CONNECTION These projects are focused on using technology to enhance the communication and sharing of information between providers and patients across the continuum of care.

TOTAL FINANCIAL IMPACT: $750,000

viii

$300,000 $300,000 YEARS 4-5

YEARS 2-3

SAVINGS AND COST AVOIDANCE BREAKDOWN $11,138,630 13%

$47,253,045 58%

$23,631,750 29%

COST SAVINGS

NEW REVENUE

PROJECTS

COST AVOIDANCE

SAVINGS

COST AVOIDANCE

NEW REVENUE

$11,138,630

$47,254,045

$23,631,750

Strengthening Our Technology Value Supply Chain Through Vendor Contract Management Microsoft Office 365 and Virtual Collaboration Platform Integrates Business Services More Efficiently Network Backbone Refresh is at the Core of Health System Infrastructure Expansion Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data (Multiple Projects) Realizing the Value of our PennChart Integrated EHR through Expansions, Upgrades, and Enhancements (Multiple Projects) Patient Progression Health System Roll Out Laboratory System Integration with Quest Reference Lab System Penn Medicine Achieved Cum Laude Status in Epic Honor Roll Program Penn Medicine Deploys Innovative Voice Dictation Technology Penn Medicine Princeton Health Transitions to Enterprise Voice Dictation Technology Point of Care Ultrasound Image Integration with PennChart Ophthalmology Image System Replaced With Modern Technology Patient Accounting Automated Document Management System Eliminates Paper Trail Text Messaging Solution Transition Results in Greater Efficiency and Significant Cost Savings TOTAL FINANCIAL BENEFITS

Note: Some projects have both a one time savings and avoidable costs financial benefit.

Since the onset of COVID-19 appearing in the United States, healthcare organizations have been struggling against the myriad of challenges that this virus has presented and its force continues to wreak havoc throughout the world. Since this pandemic began, Penn Medicine’s Information Services team embraced this challenge with results that have provided direct value to consumers, patients, staff, and operations. The timeline illustration depicts the rapid response of the IS teams as they built and deployed technology solutions to support an infrastructure that changed the lives and operations for the entire community and the Penn Medicine Health System. The results derived from these investments provided both quantitative and qualitative benefits that will continue to be valuable beyond this pandemic. Although technology alone cannot drive significant change, these projects provide credence to the people and processes that enabled technology to save lives and help Penn Medicine maintain financial stability. Many local and national hospitals struggled to survive with dramatically decreased financial volumes during the pandemic. In a Kaufmann Hall article (September 2021) it is expressed that U.S. hospitals are expected to lose $54 billion in net income through the coming year. According to the estimates, more than a third of U.S. hospitals will maintain negative operating margins through the year’s end. Despite these projections, direct financial data shows that in June of 2020, Penn Medicine visit volumes returned to a normal inpatient volume and ambulatory visits at 97% pre-pandemic. Penn Medicine leadership managed the health system through the crisis to “nearly” recover by September 2020. This work and the resulting benefits are a direct testament to the crucial contributions provided by the Information Services (IS) staff who worked collaboratively with operational and clinical leaders in support of the spirit of Penn Medicine’s mission. The IS team undertook more than 30 distinct projects that were specifically aimed to support the Penn Medicine COVID-19 rapid response. These projects are wide ranging and are organized to reflect the IS benefits attributed to consumers, staff, and operations of the Penn Medicine community. The direct financial benefit of many of these projects may not be fully quantifiable today, however the cumulative savings have built a foundation for operational, financial, and research success that will last far into the future.

RESEARCH ACCELERATION • Institutional Review • Board Alignment • Participation in Multiorganizational Studies • Privacy & Confidentiality

SURGE PREPAREDNESS RESURGENCES • WHEN, HOW, WHAT • Locations, Pace • Communications...

• Expansion within Existing In-Patient Settings • Expansion at Alternative Health System Locations • Utilization of Regional Facilities • Utilization of Federally Provided Facilities

PATIENT CARE & PATIENT SAFETY • Appropriate Testing Kits & Supplies • Remote Testing Locations • Proper COVID-19 Identification & Isolation • Protocol Development & eICU Monitoring

EMPLOYEE SAFETY & WORK BEING • Personal Protective Equipment • Elective Surgeries & Many Clinics Postponed • Prepaid Local Hotel Accommodations • Parking Adjustments • Employee Assistance Program

Technology Innovation and Rapid Response Supports the Health System through the COVID-19 Crisis The graphic below depicts the major milestones that occurred as the Nation responded to the COVID-19 pandemic and Information Services major projects that were rapidly executed to support Penn Medicine at each critical phase of the ongoing crisis.

CDC Confirms 1st US CoronaVirus Case February 1

CMS Expands Use of Telehealth March 26

US Declares National Emergency February 15 WHO Announces CoronaVirus Pneumonia January 1

2020

States Reverse Re-Opening Plans July 1

HHS, DOD Pfizer/ BioNTech Vaccine Distribution Agreement July 10

FDA Grants Remdesivir EUA May 1

RT-PCR Diagnostic Panel February 20

FDA Approves Saliva Test August 1

J&J Vaccine Approved for EUA May 30

FDA Grants EUA to Abbott’s Rapid Test September 1

Truvian EUA Approved for Rapid Antibody Test July 29

CARES Act March 6

Government Vaccine Distribution Plan Released October

FDA Approves Emergency use for Pfizer/Moderna Vaccines Full Approval October 1

STABLE AND RELIABLE SYSTEMS IS SERVICES DESK SURGE CAPACITY REMOTES ACCESS / VPN

JAN 1 - DEC 1

LOW TOUCH ENHANCEMENTS FOR PATIENT APPOINMENTS & MESSAGES

24/7 VIRTUAL AGENT TO GUIDE PATIENTS THROUGH COVID-19 RELATED QUESTIONS (CHATBOT) TELEMEDICINE DELIVERY MODEL - OVER 100,000 COMPLETED TELEHEALTH VISITS DASHBOARDS - RAPID INFORMATION ACCESS AND DECISION MAKING PROJECT QUAKER RAPID TEST FOR STUDENTS/STAFF FOR COVID-19 VIRTUAL VISIT SURGE FROM 40 VISITS/DAY TO OVER 500/DAY OPEN PASS APP UNIVERSITY WIDE/COVID-19 SYMPTOMS TRACKING FOR WORK/SCHOOL CLEARANCE SUPPORTED RESEARCH ACTIVITY INCLUDING 70+ CLINICAL TRAILS/RESEARCH STUDIES ENHANCED RESEARCH DATA TRACKING FACILITATED EXPANDED INTERNATION COLLABORATION TOUCHLESS CONSENT BIOBANK RESEARCH (PNBB) CONFIGURED BILLING SYSTEMS FOR COVID-19 CLAIMS ED AND 24 UNITS CONVERTED FOR OVERFLOW AND FLEX SPACE CONVERTED CONFERENCE ROOM SPACE TO COVID-19 PRE-PROCEDURE SCREENING USE SUPPORTED VACCINE DEVELOPMENT/TREATMENT PROTOCOLS CONFIGURED LAB SYSTEM FOR COVID-19 DRIVE-THROUGH TESTING SITES REMOTE CONSENT/E-SIGNATURE EXPEDITING CLINICAL TRIALS/TREATMENT PRINCETON AND LGH LAB INTERFACES FOR COVID-19 TESTS BARCODE INDEXED BIOBANK FOR 4,600 STUDY SPECIMENS FOR FUTURE VACCINE DEVELOPMENT BIOBANK PROJECT BARCODING FOR @18,000 LAB RESULTS PENN OUTREACH PROGRAM-HOTLINE, TESTING, OUTREACH, AND VACCINES

ANALYTICS

Consumer/Patient Facing COVID-19 Initiatives Remote Consent and Electronic Signature BACKGROUND DESCRIPTION COVID-19 required an immediate remote consent and electronic signature solution which was critical to moving clinical trials and treatment ahead in a touchless fashion. The remote consent process supported by e-signature solution was implemented to provide an electronic consent experience that would meet research requirements and speed up the development of essential COVID-19 trials. This project also enabled within Penn Medicine Biobank Research (PNBB) to adopt the same process, rapidly streamlining research operations. This project was requested and approved at the end of March 2020, and was activated by April 7, 2020. This rapid activation facilitated essential clinical research such as COVID-19 treatment protocols in a remote and minimal-contact environment.

BENEFITS REALIZED These projects allowed Penn Medicine to continue essential clinical research. Enabling this technology positioned Penn Medicine to remotely consent patients for trials, reducing the financial burden of on-site resources, as well as reducing the need for physical contact between patients and study teams. Penn Medicine’s low touch initiative also increased patient satisfaction along with the elimination of onsite visits to sign consent forms in person. Although Penn Medicine has not reported specific benefits, the Total Economic Impact™ Of DocuSign Cost Savings and business benefits as illustrated in the 2020 Forrester Report, shows that as a point of reference, other organizations who have initiated the use of eSignature through DocuSign reduced their contract process time by 83%, saving over $4 million on contract processing costs and increasing revenues by close to $339,000 over three years. Many of those organizations also reduced their reliance on outside contract support, saving over $1.3 million in outsourced costs and reducing their risk of exposure by 5%. Additional benefits were achieved in staff time productivity improvements, patient satisfaction and speed to clinical trials. While these benefits are qualitative in nature, the potential for increases in HCAHPS scores, staff productivity, and uptick in clinical trials all provide immeasurable benefit to Penn Medicine and the community.

Outreach Program-Hotline, Testing, Outreach, and Vaccines A multi-faceted approach was developed to reach the community using a hotline, patient outreach, and care coordination which produced dramatic results for the community. These projects started in mid-February, 2020 and were rapidly rolled out in March of 2020. This massive work effort was supported by daily huddles to evaluate service desk and appointment capacity, patient emails and reminders, health messaging and outreach, care coordination and remote patient monitoring. To support this work, “low touch" tech enabled appointment reminders in myPennMedicine patient portal provided streamlined opportunities for communication, education and self-pay features. Additionally, the instant activation project removed the need for the use of a social security number and increased use of this valuable tool. A Chatbot was created to streamline communication for consumers. The 24/7 rapid response virtual agent was designed to answer the COVID-19 related questions of Penn Medicine consumers over chat, voice, and social channels by integration of the agent into Pennmedicine.org, myPennMedicine, and our telephony systems. Gaining the ability to rapidly and accurately test consumers and staff for COVID-19 was instrumental in early detection and slowing the spread of COVID-19. Project Quaker was initiated to rapidly test students and staff for COVID-19. To ensure the safe return of students, faculty, and staff to the University of Pennsylvania campus, on-site COVID-19 collection sites and an in-house COVID-19 lab were established. The goal was to create capacity to collect and perform 40,000 COVID-19 tests per week beginning January 2021 for the spring semester. In early September 2020, a multi-disciplinary team mobilized across the University and the Health System and Project Quaker was formally kicked off. Representation included facilities, regulatory, human resources, information services, supply chain and communications departments. Undergraduate students were required to test twice per week and facility staff once per week. Compliance has been closely monitored by the University and Open Pass was leveraged to indicate the status of tests and compliance.

continued... Outreach Program-Hotline, Testing, Outreach, and Vaccines Detailed design was applied to ensure that students, faculty, and staff felt safe while complying with the newly created policies and procedures. This included print and electronic campaigns, as well as, establishing a COVID-19 call center to respond to questions and concerns. This large and complex project needed to be completed in four short months. The IS team supported the accomplishments of this initiative including: • Established eight COVID-19 saliva collection sites across the university campus. Included five indoor locations totaling 25,000 square feet and three tent locations totaling 14,900 square feet. • Renovated and outfitted 17,000 square feet of lab space with the necessary lab and IT equipment. • Procured over 1.2m specimen tubes and caps to collect and process COVID-19 saliva tests. • Configured and built interfaces and feeds between 6 + applications across the university and health system. • The safe return of facility and staff to campus may have contributed to continued employment during the pandemic. In addition, some of the furloughed university staff were able to work at the testing collection sites. For example, athletic activities were paused during the fall semester and some athletic staff worked on the project and at the collection sites. • The COVID-19 labs created new career opportunities and advancement for existing employees. • Collection sites and new COVID-19 labs created new positions for employees via a partnership with West Philadelphia Skills Initiative (WPSI). • Hired and trained over 100 full-time employees. Approximately 50 staff were hired through WPSI. • On-boarded 50 university volunteers including Accelerated Bachelor of Science in Nursing (ABSN) students who worked at the collection sites to earn clinical hours. To open the campuses safely during the COVID-19 pandemic, the University of Pennsylvania and its health system with six hospitals and hundreds of outpatient practices needed to develop an early warning system to identify infected and exposed campus members including 70,000 faculty, staff, and students at risk of transmitting the virus. This warning system would help minimize future spread by preventing individuals with concerning symptoms or recent exposures from coming into contact with others, and when necessary, streamline access to testing, self-isolation guidance, contact tracing, and medical care. The team’s solution to this challenge was to design, implement, and continuously improve two interconnected, internally developed software products: Penn OpenPass and the Red Pass Management System. The team determined that the most effective way to keep the campus safe from COVID-19 relied on the earliest possible detection of possible COVID-19 cases. If actual or suspected cases could be identified early and isolated, that would minimize the ability of COVID-19 to spread between members of our community. To accomplish this, the team designed and built Penn OpenPass, an in-house developed web application and SMS text message delivery system that allowed staff to get daily reminders and report if they have any COVID-19 symptoms or if they may have been exposed to someone with COVID-19. The web application was designed to be convenient and easy to use, so that members of our community could quickly complete the survey on their smartphone or any computer with a web browser. From the collected data the team developed dashboards to help monitor trends related to COVID-19, to enable timely allocation of resources for campus health and safety. From June to December 2020, over 68,000 campus members had enrolled in PennOpen Pass. Over 2.6 million daily surveillance checks had been completed with nearly 19,000 red passes having been issued and managed by the Red Pass Management and PennOpen Pass teams. Exposures accounted for 51% of the red passes, whereas for those with symptoms, cough (20%), fatigue (18%), and fever (16%) were the most common. Through automation and iterative improvements, the teams reduced the median time of red pass clearances from a peak median time of 45 hours in mid-November to 27 hours by the end of December. This effort also improved the care of patient populations. The value of this innovation was to enable students, faculty, and staff of the university and health system to safely return to campus for school and work. The work life of healthcare providers was also enhanced. The value of this innovation for healthcare providers was to provide daily screening and decision support for possible COVID-19 infections, and to decrease the risk of occupationally acquired COVID-19. Two additional IS initiatives introduced streamlined operations that supported patient safety, effective tracking and rapid COVID-19 results. First, the biobank project developed new procedures supported by barcoding results in the Laboratory Information Management System (LIMS) system matching them to medical records.

Consumer/Patient Facing COVID-19 Initiatives continued... Outreach Program-Hotline, Testing, Outreach, and Vaccines Samples were tracked as they moved among several research labs, saving time and money on re-labeling and improving quality. This process provided accurate barcoded sample tracking for approximately 18,000 residual samples sent to research labs and immune processing labs. The second barcoding project established a barcode indexed biobank of specimens for 4,600 study participants to inform future vaccine development, novel treatment strategies, and to provide a basis to justify future grant eligibility and funding. To further streamline the process of COVID-19 testing, new interfaces were developed to send COVID-19 lab tests from Princeton and Lancaster General for processing. This work eliminated the need to use external labs which positively impacted surgery patients. Lab tests were processed internally within the health system in a 24-hour period versus taking as much as 48-hours for results turnaround. The success of this project was due to the dedication, collaboration and partnership by both the university and health system.

BENEFITS REALIZED The attached tables show Penn Medicine’s outreach, testing, vaccination, care coordination, remote patient monitoring, and virtual visits that resulted in creating an educated and vaccinated community. Upon pandemic onset, virtual visit demand escalated from 40 visits a day to more than 500 a day almost overnight. The connected health team was able to pivot and flex up in providing virtual visits due to the initial investments made in building the foundation of the telehealth program several years prior. The benefits gained from the eConsult/telemedicine initiative were all encompassing. The ability to support patients remotely in their healthcare journey created a “stickiness” with Penn Medicine and has the potential to further reduce admissions and emergency department visits, while maintaining wellness. This investment made in virtual visit infrastructure sets Penn Medicine up for a future in which virtual visits will remain a key component of the care delivery system. The efficiencies gained by introducing barcoding have been well documented in studies here and highlights the benefits. Key components are: • • • •

Order to collection times improved 32-40%. Order received times improved 24-31%. Increased revenue of $1m in one year from improved turnaround times. Eliminated the use of an outside lab and processing results. Internally added revenues and provided quick access to results, reducing cancelled surgeries, and speeding up treatment times.

These graphic displays provide a snapshot view of how the combined efforts of the IS, business, and clinical staff quickly mobilized to produce outsized results in the battle against COVID-19 during the first months of the pandemic.

Outreach Center Outcomes COVID-19 Outpatient Results Management Center Total Positive & Negative COVID - All Outpatient Results

POSTIVE TESTS

NEGATIVE TESTS

ADDITIONAL INFORMATION • Total COVID-19 Outpt. Orders: 14,423 • Total Resulted as of 4/18: 10,248 • 4,175 Results Outstanding • 82 “High Risk” Facilities identified the week of 4/13 with positive COVID-1 Patients: • Nursing Homes, Correctional Facilities, Public Transit Workers, LTACs, Rehabs, Dialysis Centers • DOH Notified

Vaccine Total Doses Administered from December 2020 through March of 2021 Note: The rate of vaccinations continued to increase throughout 2021.

Penn Medicine Vaccines Administered DOSE 1

DOSE 2

149,710 TOTAL DOSES

PUBLIC FIRST DOES ADMINISTERED

8,222

11,085

15,310

7,578

5,638

6,418

54,251

SECOND DOSE ADMINISTERED

4,343

7,316

5,811

190

2,243

3,104

23,007

On Demand Telemedicine Visit Volumes Note: There was a dramatic spike in virtual visits with the onset of COVID-19 in February 2020. The telemedicine platform and processes supported the volume increase based on years of prior experience.

Provider and Staff Support COVID-19 Initiatives Remote Workforce BACKGROUND DESCRIPTION A vital component of maintaining the health system’s financial position was the rapid escalation of a remote workforce. When the pandemic initially struck, it was of paramount importance to maintain a fully operational service desk while ensuring staff safety and efficiency. Within the course of the first three days, the IS Service Desk transformed into a hybrid staffing model. Seventy percent of staff were able to use new software to take calls remotely. Software was procured, tested, loaded, and installed to enable staff to work from home within the Delaware Valley. The technology support needs of Penn Medicine never experienced any interruption in service. Technology support calls were seamlessly handled during this unprecedented event. All members at the service desk were also able to stay safe and continued to practice social distancing.

BENEFITS REALIZED • No service downtime experienced: IS Service Desk employees were able to quickly transition to remote status which allowed service to Penn Medicine employees and patients to be uninterrupted. • Kept staff working: The IS Service Desk was able to support the huge spike in calls for employees who were working remotely for the first time. • Facilitated improved access to patient care: IS Service Desk was able to support the exponential increase in the telehealth delivery of care throughout Penn Medicine. • Increased patient volume per day: IS Service Desk was able to support all the COVID-19 testing initiatives for our patients.

Clinical Space Expansion BACKGROUND DESCRIPTION The need to expand clinical space during COVID-19 became critical and was a key component in keeping up with service demands. The IS department supported these efforts by providing the technical infrastructure to make clinical space expansion possible. In rapid succession, the IS team supported the following space expansion initiatives with technology solutions and services: • Equipped emergency department overflow unit flex space to accommodate first level COVID-19 surge response plans in the hospitals including expanded emergency department (ED) operations into tent spaces used for patient triage “flex spaces”. • Staged PennChart application build and administered application testing and patient device validations for 34 total patient care units, resulting in an efficient repeatable process. • Converted 11 units to non-ICU overflow in support of entity surge response plans. • Converted 13 units to ICU overflow in support of entity surge response plans. • Configured lab information system and related device technologies to support COVID-19 drive-through testing sites across the enterprise. • Converted conference room space to establish a COVID-19 pre-procedure screening location at the Hospital of the University of Pennsylvania to increase the health system’s capacity to perform COVID-19 lab screenings.

BENEFITS REALIZED The rapid response of the IS team to support the infrastructure needs for clinical space expansion yielded benefits that impact financial, operational and quality outcomes. All of these actions avoided spending dollars on new physical space renovation at a higher cost than using owned space.

Service Claims Processing and Reimbursement BACKGROUND DESCRIPTION A provision within the CARES act authorized and appropriated funds to health care organizations for the prevention, diagnosis, and treatment of COVID-19 for patients that do not have insurance. The PennChart revenue cycle teams partnered with revenue cycle operational leaders to identify the affected population and implemented a system to submit claims for reimbursement as well as ensure that our uninsured patients were not charged for any of these services. The system design and operational processes ensured that the claims complied with the CARES act and were submitted in the correct format for reimbursement. In addition, co-pay and insurance verification features were introduced to permit co-pay submission and insurance verification via the myPennMedicine patient portal, which streamlined the process supporting operational and financial benefits.

BENEFITS REALIZED • By enabling these PennChart system updates, uninsured patients were more likely to pursue testing and treatment for COVID-19, with the peace of mind that Penn Medicine was compliant with the CARES Act, ensuring that they were not billed for those services. • Penn Medicine was able to submit claims and receive reimbursement for all authorized services in the format and encounter documentation required for new COVID-19 services.

COVID-19 Research Initiatives BACKGROUND DESCRIPTION As a major academic research institution with continued success and focus on innovation, Penn Medicine immediately recognized the need to focus research to address the COVID-19 pandemic. Penn Medicine launched over 20 clinical trials and more than 50 clinical research studies, including vaccine development, novel testing methods, and treatment protocols related to COVID-19. These efforts were initiated in March 2020 and continued through the pandemic response. Research efforts included accelerating the activation of research studies by designing and implementing new technology solutions to review, approve, and enable clinical research across the institution. The team enabled new ordering, labelling, documentation, resulting, and reporting across multiple studies and trials. Over 30 research groups were combined to track over 225K samples for nearly 13K study participants in our enterprise lab inventory management (LIMS) system. This work was supported by the development of the barcoding solution previously mentioned.

BENEFITS REALIZED This effort resulted in long-term benefits for enabling clinical research by implementing novel technology solutions for specimen management and clinical study management that will persist far beyond the COVID-19 pandemic. This project also facilitated the activation of clinical research studies that continue to be critical to combating the pandemic, such as the Moderna COVID-19 vaccine trial and the Rapid COVID-19 Testing study. • Enabled clinical research studies to combat COVID-19 pandemic. • Accelerated research activation, reducing response rate from 60-90 days to 10-20 days. • Tracked data among collaborating laboratories in one system which enabled Penn Medicine researchers to rapidly track data and draw conclusions that they presented at international meetings. ° Helped further the scientific understanding and enhance the reputation of Penn Medicine as a leader in medical research and care.

BENEFITS CATEGORY

EMPOWERING TECHNOLOGIES

These projects are focused on technologies and processes to address the administrative and physical infrastructure that includes financial services, operations, human resources, managed care, contracting, billing, materials management and others. YEAR 1

YEARS 2-3

YEARS 4-5

TOTAL

$14,293,101

$18,292,563

$15,344,386

$47,930,050

Projects are reported for fiscal years 2020 and 2021. Projected financial benefits from projects completed in prior years are displayed in the ten-year summary on page 65.

EMPOWERING TECHNOLOGIES

Strengthening Our Technology Value Supply Chain Through Vendor Contract Management BACKGROUND DESCRIPTION The Information Services department is responsible for contracting with hundreds of vendors who provide Penn Medicine with software systems, hardware technology, and services. Our IS contracts consist of the following categories: New IS agreements for goods and services, contract renewals, amendments, supplements, and schedules, consulting agreements and third party value added resellers. IS executives and directors work closely with the IS Finance team to proactively renew vendor services when there is sufficient lead-time to seek alternatives should there be a better way to meet Penn Medicine’s business requirements. During the past several years, there were at least 36 contracts that resulted in noteworthy cost reductions or cost avoidance.

BENEFITS REALIZED Our contract review allowed IS to ensure that the maximum value from each contract is realized while maintaining a positive partnership with the vendor. The contracts were reviewed for pricing, expected level of service, the standard of quality, and warranties. Specific benefits included: • • • • •

Eliminated unnecessary vendor contracts. Renegotiated contracts with vendors, most often resulting in lower operational rates. Consolidated contracts, simplified ongoing contract management. Maximized the return on investment for PennChart implementation and integration. Total cost avoidance from over 30 contract changes in FY 2020 – 2025 was over $39 million.

$39,871,145 $40,000,000 $35,000,000 $30,000,000 $25,000,000

$15,704,001

$20,000,000 $15,000,000

$11,161,320

$13,005,824

$10,000,000 $5,000,000 $0

YEAR 1

EMPOWERING TECHNOLOGIES

YEAR 2-3

YEAR 4-5

TOTAL

Microsoft Office 365 and Virtual Collaboration Platform Integrates Business Services More Efficiently BACKGROUND DESCRIPTION In 2019, Penn Medicine started a multi-year project to consolidate numerous instant messaging platforms used across the health system and transition from their external teleconferencing supplier to Microsoft Teams. The project enhanced communications across Penn Medicine by integrating with the new Microsoft 365 mail system and reducing costs by moving externally sourced teleconferencing services to Microsoft Teams. COVID-19 drove the organization to rapidly transition to a remote working model in early 2020. Information Services responded by restructuring the project to move to an accelerated rollout of Microsoft Teams across Penn Medicine. In three months, over 1,400 new Microsoft Teams accounts were activated, allowing clinicians, researchers, and other health care professionals to virtually meet and work together regardless of their location. By June of 2020, all 1,200 users of Penn Medicine’s external teleconferencing service had been transitioned to Microsoft Teams.

BENEFITS REALIZED • • • • •

Rapid implementation of a collaborative environment supported clinical and remote workers due to COVID-19. Document storage environment was accessible from desktop, mobile devices, and through web browsers. Common messaging and virtual meeting environment was enabled across Penn Medicine. Retirement of Skype infrastructure that was at end-of-life. Fewer IS staff needed to support and maintain Microsoft Teams in Penn Medicine’s Microsoft 365 environment and the environment was quickly scaled to bring on new users, practices, and hospitals. • First year cost avoidance of approximately $948,000 in external teleconferencing supplier costs. Total 5-year savings projected to be approximately $4,800,000 (including 3% annual organic growth and transition to hybrid work model).

$4,800,000

$5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000

$2,480,000

$2,000,000

$1,285,000

$1,500,000

$1,035,000

$1,000,000 $500,000 $0

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL EMPOWERING TECHNOLOGIES

Network Backbone Refresh is at the Core of Health System Infrastructure Expansion BACKGROUND DESCRIPTION The network backbone consists of core switches and fiber pathways which ties together all of the major Penn Medicine locations. All data communications pass through the network backbone including Internet, PennChart electronic health record, voice, and video services. Over 300 trillion bytes of data pass through the core network switches in a typical day. The current backbone was put in place eight years ago and needed a refresh to replace end-of-life equipment as well as support the continued growth and expansion of the health system. Fiber carrier negotiations began in the spring of 2020 to develop the next generation solution. A key aspect of the transition was to maintain health system operations over the course of the project with little or no downtime. The network team worked through numerous after-hour change windows over the course of a year and a half, building a parallel network. By summer of 2021 the transition to the new infrastructure was complete.

BENEFITS REALIZED The upgrades to Penn Medicine’s network backbone infrastructure established a solid foundation for all IS services for the foreseeable future. The new backbone provided much higher throughput than the legacy infrastructure and it also realized substantial cost savings. The new infrastructure will accommodate growth needs for the next five years including a move from 10 Gbps technology to 100 Gbps technology. The new backbone designs will also provide better resiliency and greater security. Highlights of the project are listed below: • Provided high performance connectivity to all hospitals, data centers, and major locations throughout Penn Medicine needed to support continued growth of data systems. • Resulted in over $1.5 million dollars in operating expense savings over the 5-year contract term versus the current solution. • Incorporated architectural elements for the physical expansion of Penn Medicine, including the addition of HUP Patient Pavilion. • Eliminated capacity issues and upgraded links at risk of saturation. • Eliminated single points of failure at PAH, Rittenhouse, CCH, and Brownstown data center. • Enabled migration services and replaced end-of-life equipment. • Enhanced security and segmentation through expanded use of fabric virtualization technology. • Savings achieved were $750,000 included in an additional avoidable costs of over $3.2 million over a five-year period.

$3,258,905

$3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000

$1,303,562

YEAR 2-3

YEAR 4-5

$651,781

$500,000 $0

YEAR 1

EMPOWERING TECHNOLOGIES

TOTAL

Automated User Workstation Patching Increases Technology Platform Security and Stability for Perelman School of Medicine BACKGROUND DESCRIPTION With evolving cyber-security risks and potential threats to Penn Medicine’s operations, the organization recognized the need for increased security awareness and to develop a more effective means of patching end-user devices used by the Perelman School of Medicine. One critical consideration was the requirement to ensure the high availability of these devices, to allow for minimal interruptions in user workflows and operations. The best method of satisfying this requirement is to keep workstations up to date with recommended security and stability patches. Previously, the system utilized a group policy object that set the local machine’s update policy but lacked an automated method for “pushing” patches and required users to reboot their machines. This was a major concern understanding the number of high and critical level alerts we receive from the Penn Medicine Information Security Teams. For many of the “specialty” devices, for example equipment control machines, our Client Services Group (CSG) would be forced to manually update the device. Using Microsoft software packages, we were able to automate the process and bring patching in line with established Penn Medicine patching policies. By testing all patches prior to the next automated deployment date, we have reduced potential negative operational impact for end user devices significantly while dramatically increasing our “patch level” across our supported operations. Our patching process also includes the Microsoft Office productivity suite for local device installations.

BENEFITS REALIZED • Reduced security event risks through the ability to push patches via frequent, scheduled updates. • Lowered interruptions of user workflow by ensuring high availability from rapid deployment of recommended security and stability patches. • Ability to quickly respond to Penn Medicine Information Security bulletins and high/critical level incidents. • Reduced effort requirements for our Client Services Group having to manually update devices. • Centralized validation of required patch levels of devices for compliant agreements such as Grants, Data Use Agreements, Collaborative Agreements, Biotechnology and Pharmaceutical Contracts and Memorandums of Understanding. • Increased user productivity using Microsoft Office by allowing for added features, stability improvements, compatibility and security updates via frequent, scheduled patches.

EMPOWERING TECHNOLOGIES

IS Supports the Transition of The Hospital of The University of Pennsylvania at Cedar Avenue - Serving the West and Southwest Philadelphia Community BACKGROUND DESCRIPTION In September 2020, Trinity Healthcare announced plans to close their Mercy Philadelphia hospital campus within six months. Given that the hospital had been so integral to the healthcare system in the West Philadelphia region, Penn Medicine sought an alternate solution. A partnership was formed with Penn Medicine, Public Health Management Corporation and Independence Blue Cross / Blue Shield that allowed clinical operations to be maintained at that location. Operating under the license of The Hospital of the University of Pennsylvania (HUP), Penn Medicine would continue to provide behavioral health services, acute medical beds and emergency medicine. Partnering with executive leadership at HUP and the departing health system, Information Services diligently worked to replace all the technology associated with clinical care of patients. If the hospital had closed, patients in the area would be required to travel further to seek clinical services. The community was included in making key decisions related to the hospital. The objective for Penn Medicine was to maintain continuity of clinical services to the community. Over the course of six months, the IS department worked diligently on a comprehensive plan to remove all existing Trinity Health technology assets and replace them with Penn Medicine standard information technologies and systems. Examples of the technologies and achievements are listed below: • • • • • • •

Deployed over 100 Penn Medicine standard applications. Oriented and trained 650+ new staff members and physicians. Replaced 500+ printers, laptops, and desktops. Installed and integrated several new laboratory instruments. Added innovative devices to support telemedicine. Replaced 40+ medical dictation devices. Installed new and improved pharmacy medication dispensing equipment.

This project was unique because the team did not have the ability to complete this work prior to the night of go-live. All of the information systems were replaced overnight, as the ownership of the building and services transitioned. The hospital remained open throughout the transition and continued to provide clinical care to the community.

BENEFITS REALIZED • Penn Medicine was able to avoid the costly transition services agreement by migrating overnight to standard processes and computer systems, therefore saving a significant amount of money. Extending our standard systems such as PennChart EHR, clinical imagining and human capital management allowed for reduced costs for licensing and professional services. The use of the existing network infrastructure and telephony services also provided a significant time and cost savings which have not been quantified at this time.

EMPOWERING TECHNOLOGIES

Penn Medicine Launches Chester County Hospital’s New Patient Tower BACKGROUND DESCRIPTION Information Services played an integral role in preparing for the opening of the Chester County Hospitals’ (CCH) new patient tower and procedural platform. The multi-phased building project included an expanded emergency department, 15 new modern operating rooms (ORs), new post-anesthesia care unit (PACU), 3 high-tech labs for catheterization and electrophysiology, 1 hybrid OR for cardiology, new areas for non-invasive cardiology and pre-procedure testing, 99 new private patient rooms, and a new outpatient pharmacy. An IS project team was formed in the spring of 2019 to work alongside an IS Infrastructure project team and assist with all tasks needed to construct Chester County Hospital (CCH). CCH campus migrated to voice over internet protocol (VoIP) phone system as part of UPHS’ five-year plan to transition each major hospital to the new voice infrastructure. Former analog lines and digital handsets at over 1,200 locations throughout the health system were replaced with VOIP handsets and connections to the data network for phone calls. The telecommunication department met with every department to redesign workflows, changing the automated attendant and call tree choices to be more efficient and customer focused.

BENEFITS REALIZED The IS team provided support to all new unit openings at CCH from late January all the way through mid-June 2020. • There may be reductions in monthly telecommunications lines bills by our carriers. (Initial projections were based on previous local and long-distance carriers and their recurring monthly charges). These benefits will be tracked on an ongoing basis. • Large savings resulted in placing calls over the data network (IP) that no longer required a carrier. • Eliminated monetary charges for placing calls between hospitals, since they never leave the internal data network. • Seven digit dialing implemented between all UPHS hospitals – no area codes needed. • Centralized voicemail system for CCH and eliminated local voicemail servers for local staff to manage/store. • Standardized button palette for access to security, creating one button touch for safety events or security events. • Increased system performance and reliability. • Voice Over IP (VoIP) softphones have enabled remote workers to handle patient calls.

SAVINGS QUALITATIVE

EMPOWERING TECHNOLOGIES

Radnor Medical Campus Opens New Multi-Specialty Outpatient Facility BACKGROUND DESCRIPTION A new multi-specialty outpatient facility was built at Penn Medicine’s Radnor location to support the growing patient demand and expand the practices directly in that suburban area. To successfully move to the new location, 63 new application departments were created and tested within PennChart. Almost all of the clinical equipment, devices, and hardware were new. All of these components had to be installed and tested for data integration prior to the opening of the building.

BENEFITS REALIZED The new location extended comprehensive cancer care, including radiation oncology and chemotherapy provided by the Abramson Cancer Center, as well as primary care, women's health, heart and vascular, orthopedic, rehabilitation medicine, gastrointestinal/ endoscopy procedures and 6 outpatient operating rooms. • PennChart EHR enabled providers to see patients across all departments in the building. This was particularly important during COVID-19 safety precautions because of the pandemic. IS created ways in the system to flag pending COVID-19 tests, positive cases, and symptomatic patients that allowed practices and operations to know ahead of time how to manage that in-person visit. • Increased patient safety and quality by implementing the PennChart EHR operating room module for the endoscopy suite. ° Enabled the replacement of many paper documents, specifically anesthesia documentation, resulting in higher quality equipment integration. ° Increased the ability to identify abnormal heart rhythms that were unable to be seen before. • The transition to VOIP has avoided costs, and has decreased the number of phone outages. By installing a redundant electrical system, the possibility of losing power is significantly reduced. • The system functionality has increased the ability to collect co-pays at the point of service. ° Increased cash collection rate to above 98% across departments. • The patient experience has been greatly enhanced in the new building. The patient centered model was designed to give families back time when it matters most, making the highest quality academic healthcare care accessible to even more patients. “It’s all a person’s care in one convenient location, close to home, and with all the clinical excellence of Penn Medicine,” said Tracey Commack, associate executive director. The graph below shows the daily volume growth from the old location to the new location, which results in additional revenue. (Blue represents tele-health visits, orange represents in-person visits and yellow signifies prospective scheduled appointments.)

COUNT OF COVID-19 TELEHEALTH VS. OTHER VISIT TYPES: How have COVID-19 Telehealth visits trended relative to all other visits?

ENCOUNTER COUNT

CONTACT DATE

EMPOWERING TECHNOLOGIES

Information Services Supports Penn Medicine Medical Group Practice Acquisitions BACKGROUND DESCRIPTION There were many physician practices added to the Penn Medicine Medical Group (PMMG) over the past several years. These practices added value to Penn Medicine by expanding our overall patient base, increasing access to care and expanding the array of clinical services. It also positioned the organization for strategic growth and expansion. The IS department has been supporting the transition of the newly acquired practices in several ways: • • • • • •

Managed all aspects of the technology deployment. WAN / LAN infrastructure development. Device replacement. PennChart EHR build, test, training and go-live support. Archived practice legacy EHRs. Extended patient portal to new consumer base.

BENEFITS REALIZED • IS expedited the replacement of legacy EHRs in the practices with either Community Connect or PennChart, which provides continuity in patient care and can reduce costs within the physician practice. • Increased functionality with PennChart in the practices to support: ° Ease of referrals to specialists and other providers within the Penn Medicine Network. ° Improved patient appointment flow. ° Enabled more efficient use of Penn Medicine ancillary services, such as laboratory, radiology, and other reimbursable services. ° Increased access to information to support population health, reduced admissions and overall community benefit. • The advanced features that come with PennChart help clinically support the team for Penn Medicine quality programs. • Patients often express overall higher satisfaction with their experience in the medical practices when PennChart is in place. In particular, the use of the patient portal and Care Everywhere enables the fully integrated patient record.

SAVINGS QUALITATIVE

EMPOWERING TECHNOLOGIES

Foundation Business System Implementation Keeps Penn Medicine Running with PennforPeople BACKGROUND DESCRIPTION Penn Medicine’s main business administrative system to support human resource functions will be at end of life in a few years. There are dozens of third-party business applications that create an inconsistent user experience, require custom interfaces, a high level of support and expertise to maintain, as well as, leading to inconsistent data definitions and splintered reporting. Penn Medicine sought to implement a modernized cloud-based comprehensive human capital management solution (HCM). PennforPeople (Penn Medicine’s branded HCM system) includes a diverse set of full feature modules that will consolidate the platform with only a few third-party applications required. This core HCM platform allows for add on future robust modules including talent acquisition, performance management, learning management, workforce management, and benefits management.

BENEFITS REALIZED • Employee and manager self-service features present a more modern look and feel as well as expanded functionality. • Manual and paper processes have been converted to more efficient electronic workflows. • Employee and organizational data have been re-engineered to support our expanded growth and is easily scalable for future organizational change. • Data is more easily accessible via the application, eliminating the need for hundreds of custom reports. • New robust analytics and reporting module delivers pre-packaged content that can be modified for our business needs. • The new multi-tenant cloud-based technology provides easier scalability and disaster recovery plans and processes. • Role based security simplifies support and reduces risks.

SAVINGS QUALITATIVE

EMPOWERING TECHNOLOGIES

BENEFITS CATEGORY

DIGITAL HEALTHCARE

These projects are focused on implementation and enhancement of the electronic health record applications in which clinical documentation is captured and used to support patient care delivery. Mobile health and patient engagement tools are also represented. YEAR 1

YEARS 2-3

YEARS 4-5

TOTAL

$7,063,375

$12,164,000

$12,116,000

$31,343,375

Projects are reported for fiscal years 2020 and 2021. Projected financial benefits from projects completed in prior years are displayed in the ten-year summary on page 65.

DIGITAL HEALTHCARE

Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data Penn Medicine’s Predictive Healthcare Team designs and implements Artificial Intelligence (AI) technology to create critical insights from millions of patient and clinical data into re-imagined clinical workflows. These newly engineered innovations have had a significant impact on improving patient outcomes, reducing healthcare waste, avoiding unnecessary burdensome cost, and contributing to translational research. Through the creation of Penn Signals, an open-source platform, and a ground-breaking, repeatable process that safely and effectively integrates AI into clinical workflows, Penn Medicine’s Predictive Healthcare Team has successfully deployed five noteworthy AI applications which address a wide variety of operational challenges and currently have many new programs in development. The applications running in Penn Medicine’s hospitals are positively impacting tens of thousands of patients annually and create a significant competitive advantage. Penn Medicine’s Predictive Healthcare Team was recognized with a Future Edge award in 2021 which is given to organizations who are leading the way with new technologies to advance their business for the future.

BENEFITS REALIZED The combined financial benefits for the Predictive Healthcare projects described below is:

$17,350,000

$18,000,000 $16,000,000 $14,000,000 $12,000,000

$8,500,000

$10,000,000 $8,000,000 $6,000,000 $4,000,000

$5,900,000 $2,950,000

$2,000,000 $0

DIGITAL HEALTHCARE

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL

continued... Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data

AI Powered Clinical Documentation Improvement - CDI Connect BACKGROUND DESCRIPTION Penn Medicine built the Clinical Documentation Improvement (CDI) solution, CDI Connect which enables CDI Analysts to review patient charts to address gaps in patient documentation. CDI Connect applies both heuristics and artificial intelligence (AI) to help analysts speed up identification of documentation gaps and highlights cases that may have otherwise been missed. To help identify sepsis patients with missing documentation, an AI model was created. This model was trained on millions of patient notes to identify patients likely to be diagnosed with sepsis. The team integrated this model into the analysts’ workflow by embedding it directly into PennChart. The program resulted in approximately 10% more efficient patient reviews with increased annual revenue. The additional information discovered by CDI Connect often results in a change in the principal diagnosis, which can then change the Diagnostic Related Group (DRG) assigned to the patient encounter. The DRG is what determines the reimbursement. The CDI team tracks the number of queries performed. The revenue gained on average is $850 per query. A review of the historical cases and actual patient encounters using CDI Connect is producing the anticipated result of $2.6 million per year. The CDI department is tracking the realized increase in reimbursement as a result of using this tool.

BENEFITS REALIZED • • • • •

Penn Medicine deployed the CDI Connect program to 5 hospitals across the enterprise. Higher rates of queries per CDI review rose from 59% to 84%. FY20: 6,744 (560/month) additional queries compared to FY19. FY21: 10,220 (850/month) additional queries compared to FY19. FY21: 3,097 (258/month) queries out of the 10,220 queries, directly connected to Sepsis, Malnutrition, BMI and the CDI Connect Program. • FY21 $2.6M estimated increase in reimbursement from reviews based on only the additional Sepsis, Malnutrition and BMI queries. • Higher rates of documents updated per query increased from 72% to 75% which enables a stronger defense against Recovery Audit Contractor (RAC) audits. ° The query to document update rate had a mean increase from 65% to 75%. ° Malnutrition query to document update rate had a mean increase from 79% to 84%. ° Sepsis query to document update rate had a mean increase from 67% to 80%.

$15,600,000

$16,000,000 $14,000,000 $12,000,000 $10,000,000

$7,800,000

$8,000,000 $6,000,000 $4,000,000

$5,200,000 $2,600,000

$2,000,000 $0

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL DIGITAL HEALTHCARE

continued... Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data

Penn Medicine Built Digital Simulation Suite Creates Emergency Department “Digital Twin” For Optimizing Patient Flow BACKGROUND DESCRIPTION A digital simulation suite using machine learning techniques created a “digital twin” of an emergency department (ED), allowing hospital management to optimize staffing and increase throughput. Not only did this suite reduce expensive, disruptive staffing experiments (that often take weeks) down to a minutes-long digital simulation, it also reduced the number of patients who leave without being seen (LWBS) which can have the effect of increasing revenue. Properly staffing an ED requires designing an optimized and efficient workflow to accommodate variability in patient need while avoiding bottlenecks in throughput. Optimal staff configuration minimizes wait times, which maximizes patients receiving proper care as well as departmental revenue. Traditionally, determining optimal staff configurations requires real life experimentation that is organizationally challenging. ED Flow solved this problem by providing fast paced simulated experimentation. By conducting the experiment virtually, staff were not interrupted as frequently during their shift. Furthermore, the simulated environment was not bound by operational timescales, quickly producing many years of results essential for fine tuning modest improvements. Actual use of this tool has allowed for selection of better configurations with a potential gain of $200k-$500k by avoiding lost revenue annually. Additional actual use has allowed the Hospital of The University of Pennsylvania ED to proactively respond to external demands by rapid change to staffing configurations, all the while understanding the impact on team goals.

BENEFITS REALIZED • Planning with the ED Flow improved “Left Without Being Seen” (LWBS) performance by an estimated reduction of 0.5% - 1%, resulting in an estimated annual revenue increase for Penn Medicine of $300K - $600K. • Optimized staffing due to low cost and ease of experimentation. The ED department ran between 12 to 18 experiments yearly using ED Flow, compared to 2 to 3 experiments yearly before ED Flow. • Mitigated impact of staffing redistribution needed by the HUP Cedar project on the HUP 34 LWBS rate, preserving access to care for the community, and mitigation of the threat of revenue loss associated with increase in LWBS. • Non-disruptive ED Flow tests avoided organizational turmoil regarding staff schedule changes.

$1,750,000

$1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000

$700,000

YEAR 2-3

YEAR 4-5

$350,000

$200,000 $0

DIGITAL HEALTHCARE

YEAR 1

TOTAL

continued... Predictive Healthcare Creates Critical Insights for Powerful Use of Clinical Data

Conversation Connect - An Award-Winning AI Application Leverages Machine Learning to Meet Patient End-of-Life Goals BACKGROUND DESCRIPTION Conversation Connect is an AI application that uses machine learning to identify patients who would benefit most from a timely conversation about their end-of-life goals, prompting clinicians to have these conversations before patients’ illnesses progress too far. The results, from one of the first randomized trials of any machine learning-based intervention, showed that Conversation Connect led to a quadrupling in documented rates of conversations. Penn Medicine’s Predictive Healthcare Team was awarded the Future Edge Award in 2021 for their work on Conversation Connect.

BENEFITS REALIZED • Serious Illness Conversations (SICs) between patients and their oncologists increased four-fold. • 15% increase in patients, or approximately 500+ additional patients in FY20 and FY21, enrolled into Penn Medicine Hospice care. • 3% increase in rate of hospice patients with stays greater than 3 days.

PennChart Integrates Further With Implementations and Expansions BACKGROUND DESCRIPTION The investment a health system makes in its electronic health record (EHR) can translate to significant value to an organization. At Penn Medicine, the IS team never rests in their drive to leverage the electronic health record, named PennChart, for maximum value and return on investment through implementing a variety of initiatives and application features in pursuit of excellence. In FY 2020 - 2021, Penn Medicine performed PennChart upgrades and implemented new system features to further drive clinical quality and process efficiency. On a periodic basis, Epic Systems releases application improvements to PennChart. Although these changes can be technical, most changes reflect the vendor’s commitment to deliver consistent and continuous improvements for both clinical and revenue cycle applications. The IS department is committed to maintaining PennChart to provide application enhancements to the Penn Medicine community. The upgrades provided Penn Medicine’s users with new functionality and enhancements to ensure use of the latest and most advanced software. Application teams and supporting user groups worked together to coordinate education efforts and provide go live support. The upgraded versions of PennChart were well received by users, serving as a catalyst of benefits realized across Penn Medicine. Additional specific initiatives highlighted our health system’s commitment to quality of care and innovation, and returned a variety of benefits, often creating new industry standards and best practices.

BENEFITS REALIZED The highlights of the most recent PennChart updates implemented over the past two fiscal years delivered notable improvements. The changes reflect improvement for clinical, front end, and revenue cycle operations.

AUGUST 2020: • Due to COVID-19 restrictions, PennChart used a hybrid model of command center support for the first time, using both onsite and virtual support. The use of Microsoft Teams made this possible. • Approximately 3,600 changes were applied with minimal command center ticket volume. • A total of four quarterly software updates were loaded in this upgrade to bring PennChart to the current version. • Notable enhancements included: • New documentation options in the physical exam SmartForm used in provider notes. • Clinicians’ shortcuts to activities via patient lists feature. • Updated scheduling orders for “appointment requests,” functionality in the appointment desk, and work queues. • Enhancements to the Medicare Secondary Payer Questionnaire (MSPQ), allowing faster documentation. • Clinicians can now add a visit diagnosis from anywhere in an office visit using the taskbar.

DIGITAL HEALTHCARE

continued... PennChart Integrates Further with Implementations and Expansions FEBRUARY 2021: • Approximately 730 changes were implemented. • A total of three quarterly software updates were loaded to bring PennChart current on the February 2021 version of the application. • For the first time, Penn Medicine was an early adopter of the updates received in the package for February 2021. Notable enhancements included: ° MyPennMedicine homepage redesign. ° Spellcheck dictionary conversion. ° Social determinants of health documentation received a new location in the flowsheets activity and navigator.

BACKGROUND DESCRIPTION Penn Medicine pursued further expansion of the PennChart EHR by enhancing the existing infrastructure within specialty clinics, connecting with community affiliates, and adopting clinical science programs. Expansion allowed for further collaboration, integration, and partnership between Penn Medicine and its various programs and services.

BENEFITS REALIZED The combined financial benefits derived from PennChart projects are:

$4,928,375 $5,000,000 $4,500,000 $4,000,000 $3,500,000

$2,648,000

$3,000,000 $2,500,000

$2,280,375

$2,000,000 $1,500,000 $1,000,000 $500,000

DIGITAL HEALTHCARE

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL

continued... PennChart Integrates Further with Implementations and Expansions

Patient Progression Now Integrates With PennChart BACKGROUND DESCRIPTION The PennChart ambulatory patient progression module allows practices to track patients throughout their visit, from check-in to checkout. Patient progression for perioperative services allows the staff to coordinate activities as the patients flow from the admission and reception areas to pre-op, intra-op, and post-op care settings. The implementation team leveraged the surgery, anesthesia, cardiology, and radiology builds and workflows to develop status boards in various surgical areas in HUP, PPMC, PMUC, and PCAM. While our prior vendor contract was concluding at the end of 2020, we also needed to develop a more advanced model for the new HUP Pavilion. This project included preparing relevant patient flow information specific to each practice, as well as designing PennChart build, performing testing, delivering training, and supporting the go-live. The project included implementing patient progression for 30+ ambulatory practices as well as various status boards to track patient movement from reception to postop locations, including new PennChart tools for the surgical support staff.

BENEFITS REALIZED • • • • • • • •

Gained over $1.3M in cost savings by terminating vendor contract. Created new dashboard that provided drill down data for the infusion center. 90+ new configurable status boards; 50+ new boards in peri-operative locations. Ensured timely patient movement for surgical cases and orchestration of staff and resources. Transitioned to the PennChart tools used for environmental services and transport to align with the rest of the organization. Reduced patient waiting time and increased patient satisfaction. Increased transparency and eliminated confusion regarding a patient’s specific location within department. Reduced exam time and total clinic time.

$1,400,000

$1,329,625

$1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL DIGITAL HEALTHCARE

continued... PennChart Integrates Further with Implementations and Expansions

PennChart Genomics Module Incorporates Discrete Genetic Data BACKGROUND DESCRIPTION Genetic testing results were historically scanned into a patient’s medical record in a report format that would be stored with other lab results. This process made it very difficult for clinicians to find and act upon genetic data. The genomics module project has allowed our clinicians to order and receive genetic tests directly within PennChart. This has improved clinical efficiency; no longer requiring entry of orders in a separate system. These orders were now placed directly into PennChart and transmitted electronically to an outside laboratory. From there, results come back into PennChart linked to the order, and have allowed better querying of results and genetic variants to be classified from the original result. The PennChart precision medicine tab also allowed providers to more efficiently locate genetic orders, results, and reports on a patient’s chart. These fundamental steps have substantially expanded the application of precision medicine throughout the health system in numerous ways, ultimately improving patient care management and outcomes. The success of this project is being measured through the clinician’s adoption rate of placing orders and the return of results. The number of associated orders and results that are filed into the PennChart precision medicine tab and the number of departments entering orders are also being tracked. As the orders and results interface was deployed, clinicians experienced the effectiveness of finding the testing results with great satisfaction and enthusiasm to roll it out further. The IS team has been working on creating the same interface with four other outside genetic labs and interest continues to grow in popularity.

BENEFITS REALIZED • The custom precision medicine tab was designed to be a specific area in the patient’s chart that allows clinicians to quickly look up orders, results, and other genetic testing information. • Positively impacted the vendor’s pharmacogenomics-specific functionality by helping to identify what information was important to store and display for pharmacogenomic variants vs. “traditional” germline variants. • Built in clinical decision support based on results allow our clinicians to make clinical choices on what medications to prescribe to a patient based on genetic results. • The automated process ensured that the results were consistently uploaded into the system, significantly reducing delays, errors, and omissions in the process. • Storage of discrete genetic results within PennChart allowed for queries of genetic results using the data analytics function. ° Allowed new ways to identify patients with specific genetic variants to target clinical trials and new therapeutic options become available. • The genomics module - As of September 1st, 2021 53 departments and 34 providers have placed orders on 1,900 patients for genetic/genomic testing. • The Precision Medicine Tab – As of September 1st, 2021 1,503 departments and 19,304 clinicians have accessed the tab 207,954 times.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

continued... Pennchart Integrates Further with Implementations and Expansions

Long-Term Care Module at Penn Presbyterian Skilled Nursing Facility Increases Efficiency and Compliance BACKGROUND DESCRIPTION The Penn Presbyterian Skilled Nursing Facility (SNF) is governed by specific complex long term care standards and regulations. At its core is the Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS); part of a federally mandated process for comprehensive clinical assessment of all residents in a Medicare certified SNF. SNFs are required to submit specific clinical documentation on a regular basis and in a particular sequence to receive per diem reimbursement for the care they provide to their residents. Prior to the Epic long term care module implementation, SNF-specific workflows were being completed with a combination of paper, Microsoft Excel spreadsheets, some general PennChart documentation, and with some double documentation performed by clinicians. MDS data were submitted to CMS from a different electronic system called JRaven. Through workflow analysis and implementation of the LTC module, paper and Excel processes were eliminated and SNF clinicians now document only once in PennChart. Furthermore, the added SNF-specific features in the module led to more efficient documentation and integrated seamlessly with existing PennChart functionality.

BENEFITS REALIZED • MDS entry and completion can be done electronically in PennChart, eliminating the need to reference various paper forms and spreadsheets. • Improved CMS compliance by eliminating human error associated with visually scanning outside documents, tabulating, and entering data manually. • MDS-generated validation reports allow checking for any portions of the MDS that are still outstanding or compromised prior to submission to CMS. • Eliminated manual work for billers and coders because the values from the MDS assessment are pulled into the hospital account. • The module was directly linked to the CMS.gov Resident Assessment Instrument (RAI) Manual from within the patient chart for questions regarding MDS completion/interpretation.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

Realizing the Value of our PennChart Integrated EHR Through Expansions, Upgrades, and Enhancements Laboratory System Integration with Quest Reference Lab System BACKGROUND DESCRIPTION This project enabled the integration of the Penn Medicine laboratory system with the Quest reference lab systems. The interface supports order and results to be exchanged between the two systems.

BENEFITS REALIZED • Streamlined laboratory specimen receiving and processing workflow at HUP and PAH. • Reduced various specimen transport algorithms which saves time and costs. • Allowed filing of electronic results to Cerner and PennChart (no scanning), freeing up staff resources in Pathology and Lab Medicines Client services offices as well as other lab staff. • Improved patient care, allowing a shorter turnaround time for lab results that are now reaching providers electronically. • Consolidation of thirty separate send out labs to only three to save $317,000 in the first year and $1 million per year with the Quest 3-year contract (2019-2021).

$2,317,000

$2,500,000

$2,000,000 $2,000,000 $1,500,000 $1,000,000 $500,000

$317,000 $0

DIGITAL HEALTHCARE

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL

continued... Realizing the Value of our PennChart Integrated EHR Through Expansions, Upgrades, and Enhancements

Penn Medicine Achieved Cum Laude Status in EHR Honor Roll Program BACKGROUND DESCRIPTION Honor Roll is a recognition program based on strategies, lessons learned, and best practices distilled from PennChart EHR vendor experience, serving well-respected healthcare organizations. There are three levels of program achievement based on the number of components completed. Completing all eight components of the program helps ensure that the organization draws the most value from the Epic software, and helps to improve the health and wellness of the communities we serve. This nine-month initiative was driven by the PennChart application teams, with involvement and adoption needed by operational counterparts. Six of the eight components were successfully met. They included: • • • • • •

Enterprise Data and Analytics (15%). Financial Performance (10%). Health Information Exchange (10%). Infrastructure Stability and Performance (10%). Population Health (10%). Staying Current (10%).

BENEFITS REALIZED This program has helped to achieve continuous improvements in patient outcomes, quality of care, workflow efficiency, and financial performance. The tools and processes put in place have helped to engage patients in the care process, make our software easier for clinicians to use, and keep pace with the rapid advancement of health technology and medical knowledge. In June 2020, Penn Medicine achieved the Cum Laude status and received $633,750 for meeting the relevant program components. Honor Roll will be an ongoing program and there is continuous financial incentive and recognition to achieve the highest level of status.

$1,281,750

$1,400,000 $1,200,000 $1,000,000 $800,000

$633,750

$648,000

$600,000 $400,000 $200,000

TBD

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL DIGITAL HEALTHCARE

continued... Realizing the Value of our PennChart Integrated EHR Through Expansions, Upgrades, and Enhancements

Enterprise Integration of IV Pumps to PennChart BACKGROUND DESCRIPTION While the current state of using barcode medication workflow for IV medication administration supports safe medication administration practices, it did not safeguard the clinician and patient when the infusion pump was manually programmed and was subject to human error. IV pumps and PennChart interoperability closed the IV medication administration loop by bringing pump and syringe infusion programming into the barcode medication workflow, increasing patient safety. The implementation of IV pump interoperability process included scanning the patient wristband, the IV medication barcode, and the infusion pump, allowing for the wireless programming of infusion parameters into the pump. This reduced the number of keypunch related errors, while also dynamically updating PennChart with the appropriate infusion data as the medications were administered. The internal multidisciplinary teams from nursing, pharmacy, clinical engineering, quality and safety, informatics, and PennChart partnered with two vendors in June 2020 to develop the infusion module. HUP was implemented in October 2020, and the rest of the health system (including the infusion suites) were completed in November 2020. By integrating the previously stand-alone infusion pumps with PennChart, the technology was harnessed to help close the loop of IV medication safety and improve the quality of care provided to patients.

BENEFITS REALIZED • Positive identification of patient, pump, and medication through barcode medication administration process. • Standardized IV medication infusions across the enterprise leading to decrease in variation of practice since pump libraries are shared. • Decreased keystrokes on pump use by 75%, reducing avoidable errors. • Improved accuracy and timeliness of infused medication documentation. • Decreased the nursing manual documentation of infused medications. • Decreased the number of high-risk medications overrides, significantly indicating increased compliance with the safety “guardrails” dose limits in the pump software. • Decreased drug selection cancelation by 73%. • Increased efficiency in system, allowing pharmacy to use a triggered fill process for IV medication refills based on up-to-date infusion rate documentation PennChart.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

continued... Realizing the Value of our PennChart Integrated EHR Through Expansions, Upgrades, and Enhancements

PennChart Storyboard Provides a Tailored Experience for Clinicians BACKGROUND DESCRIPTION Storyboard streamlined our user’s EHR experience, reducing the number of required clicks, mouse movements, screen switches, and ultimately allowed staff to focus more on the patients and workflow. This is something Epic had researched, developed and tested for years. At the time of implementation, Epic had spent seven years and worked with over 100 health care organizations to develop Storyboard. During that time, they conducted 1,000 usability tests involving clinical, revenue cycle, and patient access users.

BENEFITS REALIZED • Storyboard provided a more tailored experience, each designed for a particular role, specialty, or context. • Improved presentation and clarity related to several criteria within PennChart: ° Patient information, status codes, allergies, and precautions. ° Care team and treatment plans. ° Family and contact information. • Patient satisfaction increased by being able to view relevant information in one single place versus several clicks to find what is needed. • Increased the number of users who are accessing the Storyboard versus the Patient Header. • Patients can access care gaps, problem lists, social determinates of health, and the ability to see what is in health maintenance and address it quickly. This is also a benefit for the primary care providers. • Patient preferred name is now available which creates comfort for the patient when the clinicians call them by the name of their preference. • IS benefits from customizable templates for specialties making it easier to add information to the storyboards. “Storyboard has enabled revenue cycle resources to work more efficiently. The functionality has reduced the number of “clicks” required by the billing staff when reviewing accounts.” - Ryan Hammonds, Finance

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

Our Commitment and Investment in Creating Positive Patient Experiences Automated Eligibility for Patients in the Lung Screening Program BACKGROUND DESCRIPTION The EHR lung screening module was implemented in PennChart to find eligible patients for the lung screening program. This implementation included workflow definition, followed by build and thorough testing prior to activation. Training was also completed to ensure radiologists, providers and coordinators followed the appropriate workflow for accurate submission. This implementation allowed Penn Medicine to remain compliant with industry targets and meet CMS requirements for reimbursement for lung screening procedures.

BENEFITS REALIZED The use of this module included three main benefits: • Automated eligibility identification based on age and smoking history. • Implemented monitoring of follow-ups by using PennChart tools to track patients that require follow-up and automatically closing open recommendations when the patient returns. • Instituted electronic submission of data to the ACR Lung Cancer Screening Registry (LCSR).

SAVINGS QUALITATIVE

Ambulatory Procedural Electronic Consent Improves Communication Between Providers and Patients BACKGROUND DESCRIPTION As part of the Clinical Practices of the University of Pennsylvania (CPUP) Risk Reduction Initiative, the project to transition from paper to electronic consents with standardized consent language received increased focus across all the ambulatory practices starting in FY19. The first phase of the transition process was the review, standardization, and revision of paper consents into patient friendly language. The second phase was the review and approval by the Office of General Counsel. The final phase was not only the technical consent build in PennChart, but the education and training on the new consent workflow by the PennChart Advanced Clinical Education Team, which was pivotal to the success of the consent transition.

BENEFITS REALIZED • The modifications to a standardized consent documentation process will help to improve communication between providers and their patients, leading to improved patient care, and helping to decrease medical liability risk to the providers. • The utilization of electronic consents facilitates version control and ensures that “outdated” paper consents are not being used. • Electronic consents also reduce the risk of lost, incomplete or missing consents. • Having procedural consents in PennChart ensures that the signed consent is fully and accurately populated, and easily accessible in the patient’s chart. This improves coordination of patient care across multiple providers, specialties, and clinical sites. • The number of consents that were electronically signed from January 2021 until July 2021 increased from 6,469 to 15,411.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

continued... Our Commitment and Investment in Creating Positive Patient Experiences

OncoLink Award Winning Cancer Information Website Integration With PennChart BACKGROUND DESCRIPTION OncoLink is an award-winning cancer information web site that was originally developed at Penn Medicine. OncoLink provides up to date, evidenced-based oncology patient education and survivorship care plans. These patient education tools were integrated with PennChart. The integration allowed custom documents to be built and saved directly to the patient record. It also eliminated the need to exit PennChart, create and print OncoLink documents, and scan them into the patient’s chart. The tools are easy to use, and the created PDF documents are sent back to the chart. The documents are auto-released into the patient’s myPennMedicine account.

BENEFITS REALIZED • Integration resulted in time savings for clinicians, improved documentation of education provided, and assured documents are labeled and filed correctly. • Reduced the average time it takes to complete the process of generating and filing a survivorship care plan from 14 minutes to 2.5 minutes. • Eliminated the need for downloading, scanning, and the potential to introduce errors. • In the first year, this integration has resulted in 10,000 education documents being generated for oncology patients.

SAVINGS QUALITATIVE

PennChart Supports Outpatient Physical Therapy at Home BACKGROUND DESCRIPTION Penn Medicine at Home (PMAH) provides home health services under Medicare Part A. To qualify for these services, patients must be homebound and need a supportive device or the assistance of another person to leave the home. As a home care provider, PMAH wanted to venture into providing home-based Medicare Part B outpatient therapy services (PT/OT/SLP). For patients who are not eligible for the home health benefit, home outpatient therapy provided under Medicare Part B provides Penn Medicine with a tool to deliver health care to patients in their home and in the community, that they could not previously receive. Penn Medicine’s competitors also provide outpatient therapy in the home and refer patients to their outpatient clinics. Penn Medicine’s outpatient therapy program began in late 2020 by implementing a new PennChart department, revenue location, patient class, episode type, visit types, clinical documentation, referral orders, and billing process.

BENEFITS REALIZED • Outpatient therapy in the home provides Penn Medicine with a tool to deliver health care to patients in their home and in the community, that they could not previously receive. • Service leads to improved outcomes for patients through continued connection to Penn Medicine providers, reduced readmissions, and increased post-acute follow-up care. • Outpatient therapy in the home is the least costly method of providing post-acute care, which will result in cost savings to payers and to Penn Medicine.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

Penn Medicine Deploys Innovative Voice Dictation Technology BACKGROUND DESCRIPTION Penn Medicine identified an opportunity to realize cost savings and operational efficiencies with the implementation of a voice dictation solution to replace the previous technology. The Penn Medicine IS enterprise strategy directed that the new solution be deployed and that a transition of all existing dictation users to the new solution be completed. In partnership with the voice dictation vendor, the IS department transitioned to an enterprise installation of modern highly functional voice dictation technology. The solution established a new Penn Medicine enterprise standard for voice dictation.

BENEFITS REALIZED • • • • • • • • • • •

Aligned enterprise dictation solution standards to a single platform with centralized cloud hosting. Increased the efficiency, accuracy, and completeness of clinical documentation. Improved coding compliance and billing accuracy. Offered providers more flexibility and distributed access to voice dictation tools. Improved patient safety and elevated quality of care. Delivered cost savings and reduction in contract commitments with multiple dictation vendors. Introduced best-in-class language recognition with industry standard dictionaries for relevant medical specialties. Ensured availability of provider preferences from any PennChart device. Introduced the capability to use mobile devices as a dictation microphone. Replaced multiple legacy dictation systems and vendor transcription services with a single enterprise standard for voice dictation. The anticipated savings are $3.8 Million over 5 years.

$3,800,000

$4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000

$1,520,000

YEAR 2-3

YEAR 4-5

$760,000

$500,000 $0

DIGITAL HEALTHCARE

YEAR 1

TOTAL

Penn Medicine Princeton Health Transitions to Enterprise Voice Dictation Technology BACKGROUND DESCRIPTION Penn Medicine Princeton Health (PMPH) went live on PennChart in 2018. At that time, the entity retained their dictation and transcription vendor. By November 2019, PMPH began the migration to our organization’s enterprise solution in order to align with the integrated workflow for voice dictation. The goal of switching dictation sourcing and services was twofold. The first aim was to enable PMPH physicians to dictate their reports by calling a dedicated phone line. The second aim was to align dictated patient reports to be accessible in PennChart for all providers. After performing integrated testing, training, and the proper communication planning, PMPH was successfully transitioned onto the new voice dictation solution in February 2020.

BENEFITS REALIZED • Standardized workflow by no longer requiring that physicians dictate history & physical reports. • Offered voice recognition training on the standardized workflows at the start of the transition. As a result, the average number of dictated reports was reduced from 1500 to 800 per month. • Scaled greater efficiencies using a centralized model for resolving issues, troubleshooting, reporting, and billing services. • Reduced average monthly transcription service costs from $7,500 to $3,500. The total savings over 5 years will be $240,000.

$240,000

$250,000 $200,000 $150,000

$96,000

$100,000 $50,000

$96,000

$48,000

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL DIGITAL HEALTHCARE

Point-of-Care Ultrasound Image Integration with PennChart BACKGROUND DESCRIPTION In October 2019, a new point-of-care ultrasound (POCUS) committee was convened, consisting of leadership and clinical stakeholders, the IS team, general counsel, and clinical engineering to leverage imaging technology that would enhance clinical care. The foremost priority of the committee was to establish a universal workflow solution that allowed for image storage, quality assurance, training, and downstream visibility of clinical exams in PennChart. After extensive review, a new enterprise workflow solution was selected for its superior user interface, mobile application availability, customization options, customer service, and growth potential. This workflow solution was well suited for the needs of the heterogeneous clinical user group and diverse technology at Penn Medicine. These point-of-care ultrasound (POCUS) examinations, performed by appropriately trained professionals, proved valuable for expediting patient care by decreasing time to diagnosis, increasing diagnostic accuracy, and by improving safety of procedures. The full benefits of POCUS scans were realized through responsible practice aligned with robust clinical governance.

BENEFITS REALIZED The result of the project allowed the third-party POCUS devices to provide ultrasound study results with online Cloud storage, integration to the Penn Medicine vendor neutral archive (VNA) and access through PennChart. Standardization of POCUS devices allowed visibility by the organization to determine current and future POCUS device needs and assess the current state of cart-based ultrasound devices. • • • • • • • • • •

Sunset legacy POCUS Ultrasound PACS solution. Increased access of ultrasound results in PennChart. Implemented enterprise standard PACS and quality assurance system for all point of care ultrasound devices. Reduced duplicate provider documentation in both third-party solutions, resulting in improved PennChart billing workflow for emergency and trauma areas. Increased provider satisfaction by creating more efficient workflow with fewer manual tasks. Increased diagnostic accuracy of the ultrasound studies by using the state-of-the art wand technology with the new devices. Improved safety of the ultrasound studies by using infection control features of the new devices. Reduced costs across Penn Medicine for POCUS devices and support fees by using standardized cart-based devices, integration standards, and centrally managed cart-based device inventory. Centralized planning and capital budgeting for POCUS devices at the enterprise level. Increased revenue capture for clinically indicated studies with appropriate documentation, resulting in $1 million per year.

$5,000,000 $5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000

$2,000,000

YEAR 2-3

YEAR 4-5

$2,000,000 $1,500,000

$1,000,000

$1,000,000 $500,000 $0

DIGITAL HEALTHCARE

YEAR 1

TOTAL

Ophthalmology Image System Replaced With Modern Technology BACKGROUND DESCRIPTION The Ophthalmology Department (Scheie) was using a picture archive and communication system (PACS) that was slowly growing out of date, expensive to maintain, and not compliant with current modalities. Penn Medicine moved to replace this older system with Zeiss Forum, a less expensive alternative that offered more functionality and integration with current modalities. The new technology combined Ophthalmic PACS with clinical displays and workplaces for all ophthalmic subspecialties as well as integration with PennChart, reducing the number of transcription errors by directly transmitting patient demographic information into the imaging modality. The new Zeiss system also launches the patient’s images directly from in PennChart, reducing errors by eliminating the need to manually search for the patient. The Ophthalmology departments at PPMC (Scheie), PCAM, Radnor, and Media all were within scope of the project. The project started in February 2018 and Concluded in April 2020.

BENEFITS REALIZED • • • • • • •

Integrated documentation in PennChart, eliminating the need for clinicians to input patient data into three separate systems. Provided “Tap n’ Go” badge access to the systems, which included single sign-on for PennChart/Forum. Increased patient safety by reducing transcription errors. Fully integrated with PennChart Modality worklist. Centralized user administration (LDAP) and supports single sign-on (SSO). Embedded link in PennChart available to Ophthalmology and Neurology. Realized a one time savings of $25,000.

$25,000

$25,000 $25,000 $20,000 $15,000 $10,000 $5,000

YEAR 1

YEAR 2-3

YEAR 4-5

TOTAL DIGITAL HEALTHCARE

Penn Medicine Cherry Hill Expands Clinical Footprint BACKGROUND DESCRIPTION The cardiology practice, Clinical Care Associates (CCA) practices, and CPUP service lines at Penn Medicine Cherry Hill needed to increase their exam room counts and ultrasound testing capacity to meet their growing patient volume. As a result of the expansion: cardiology gained two ultrasound rooms, one vein treatment room, four new exam rooms, four new touchdown spaces, an enlarged reading room, one new shared office and one new private office. CCA and CPUP service lines gained thirty exam rooms, two CPUP procedure rooms for pain medicine, several provider offices and touchdown spaces. All spaces were outfitted with the necessary technology to get up and running efficiently. The expansion also permitted hematology oncology to turn its existing, two-year-old space over to CCA obstetrics and gynecology, which relocated from the opposite end of the floor. This placed those providers next to aligned specialty practices, maternalfetal medicine and specialty gynecology-oncology.

BENEFITS REALIZED • Ob-Gyn’s relocation placed their patient services associate at the MFM/Gynecological Oncology checkout so female patients need only visit one area of the second floor for all specialty care needs. • The CCA primary/specialty and CPUP multi-specialty service lines gained greater capacity to accommodate their rapidly growing patient bases. • Pain Medicine gained two procedure rooms (with a shared fluoroscopy C-arm) to treat patients closer to home. • Cardiology gained more exam and testing space, accommodating a rapidly growing patient base.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

Personalizing the Patient Journey "Home to Hospital" Using Innovative Digital Tools BACKGROUND DESCRIPTION Penn Medicine began a new venture with Independence Health Group and Quil, a Comcast company, to deliver a “digital front door” for patients to access a better patient experience before and after surgeries as well as other medical procedures, and in managing longterm health conditions, such as knee replacement surgery. More specifically, the program sought to give patients access to digital tools to educate, prepare themselves, and more confidently approach their own important healthcare needs in partnership with their trusted healthcare providers. By developing an innovative means to connect doctor and patient during a healthcare episode, doctors could now recommend the app to their patients, who would then receive notifications for their personalized guides, leading them to instructional step-by-step videos, interactive quizzes and checklists, links to schedule necessary appointments, and FAQs, among other helpful tools and resources. The tools were designed to be easily accessible through whichever device a patient chooses, whether that’s through their phone or computer, or even their television. Each notification has been designed to meet the patient at the exact point in their health care journey when they will need the information. The IS team worked in partnership, enabling the patient guides to be viewed within PennChart. Invitations were also designed and sent to eligible patients directly in email from within PennChart so that they can enroll. To make this possible, IS built a launch button within PennChart to allow providers to automatically log into the application. This workflow saved providers time from having to open a separate window and application, and provided a more comprehensive view of the patient, thus leading to better care. “We are committed to offering new solutions to help our entire patient community at all points in the continuum of care. Our mission to provide outstanding patient care throughout the world requires a focus on health literacy, which we know is tightly linked to patients’ ability to manage their care and make the choices to keep them well,” said University of Pennsylvania Health System CEO Kevin B. Mahoney. “Importantly, this partnership widens the door to maintaining health at home, which is an increasing focus of our work to prevent and manage chronic conditions and ensure safe recoveries after hospitalizations.” All of these paths are designed to guide patients through their health care experiences in partnership with family and friends. An example of a typical patient “journey” in the platform for someone having knee replacement surgery includes pre-op messages sent weeks in advance that include videos on, for instance, what to expect during the hospital stay and guides for caring for the incision site, as well as pre- and post-op surveys. Immediately after surgery, to support bedside care, the patient receives instructional videos on getting in and out of bed and using a cane. Later, messages are timed to reach the patient when they progressively reach different stages of physical rehabilitation, including videos showing exactly how to properly perform exercises such as heel slides or mini squats without aggravating the joint. “We know that patients who are compliant and actively engaged in their care pathway have better outcomes. One challenge most patients and families have is consuming all of the medical information that is provided while they are in our offices, and very few people are going to read all the materials you give them to prepare. People consume information in small bite size amounts, like news feeds or social media on their phones and we crafted a patient journey with Quil that matches how people consume information and we make it readily available to them whenever they want to consume it.” Neil Ravitz, Chief Administrative Officer, Musculoskeletal & Rheumatology Service Line and Chief Operating Officer, Department of Orthopedics. “An informed patient is a patient that already has a leg up on their health,” said C. William Hanson III, MD, Chief Medical Information Officer at Penn Medicine. “We believe that this system, using technology that meets patients where they are, will greatly enhance the ability to create more informed and engaged patients. At the same time, we expect this to give providers a greater insight to the people they care for, how they maintain their health, and where they could use a little more help to stay well.”

DIGITAL HEALTHCARE

continued... Personalizing the Patient Journey Home to Hospital Using Innovative Digital Tools BENEFITS REALIZED The preliminary benefits being monitored in the initial phase one program include: • • • • •

Increase in patient feeling prepared for surgery (83% ENT Surgery and 75% for hip and knee surgery). Fewer cancelations in elective surgeries. Reduced call volumes resulting in enhanced staff efficiency. Improved adherence to post-operative care plans. Lower risk of post-operative complications and improved success rate, which can strengthen the clinical brand for Penn Medicine.

Patient Journey Impact

ENT

SINUS SURGERY Do you feel prepared for surgery?

Orthopedics

Fewer cancelations Lower Anxiety è Better Patient è Fewer postOp complications

HIP AND KNEE

Orthopedics

Reduction in call volumes

HIP AND KNEE

Staff efficiency

ENT

SINUS SURGERY Adherence to postOp Care plans

Lower risk of postOP Complications Imporved Success Rate è Strong Clinical Brand

Bariatrics

BARIATRIC SURGERY

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

Remote Telemedicine ICU Module for Penn-Elert Program BACKGROUND DESCRIPTION The remote telemedicine ICU module for Penn-Elert project was established to implement and upgrade the remote ICU telemedicine capabilities using state-of-the-art telemedicine technologies across Penn Medicine care sites. The new technology consists of wall mounted APS (access point of care systems) which contains high fidelity microphones and speakers, infrared lights for low light and night vision and a high-definition camera. These systems are proactively monitored and remotely managed to ensure availability and reliability. This state-of-the-art telemedicine technology was implemented at both Chester County Hospital and Princeton Medical Center in December 2020. The Center for Connective Care at Penn Medicine Rittenhouse is the location where remote monitoring of patients takes place. Critical care registered nurses perform consults 24/7 and critical care intensivist physicians perform consults daily overnight. The team is board certified as intensivist physicians from the departments of trauma, anesthesia, pulmonary, neuro critical care, or emergency medicine. The Center for Connected Care, IS teams including medical decision support, platform engineering, PennChart, clinical applications, as well as operational and clinical leaders collaborated on this enterprise-wide initiative to enhance care for our critically ill patients.

BENEFITS REALIZED • Leveraged an existing platform, infrastructure and knowledge base to expedite the continued deployment of this key capability. • Clinical teams caring for some of the sickest patients can now use telemedicine consults to assist in clinical decision making, especially during: ° Emergency situations when a patient is clinically unstable requiring a rapid response to be activated. ° Urgent situations when a patient’s condition is worsening when the patient may need an escalation of care to a higher-level of service, perhaps a transfer to the critical care team. ° Routine situations where the patient and the nurse may have a clinical question or concern. • Enhanced experience allowing patients to receive this level of care at any Penn Medicine facility and enabling the patient to stay closer to home. • During COVID-19 pandemic, this program provided protection for clinicians by reducing direct contact. • Allowed for continuous monitoring and earlier interventions of critically ill patients. • Increased awareness of high acuity patients for proactive monitoring. • The patients who were monitored pre-pandemic were about 500 per month (60,000 per year). Since December 2020, there have been more than 1.15 million patient cases completed.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

Bar Code Medication Administration for Inpatient Chemo Infusions Suites BACKGROUND DESCRIPTION In July 2019, the infusion department requested the implementation of barcode medication administration (BCMA) in all their outpatient infusion suites across the health system for increased safety with the administration of high-risk chemo drugs to patients. Lack of barcode medication administration increases the risk of medication errors due to the manual processes involved. The project’s goal was to implement an automatic barcode medication administration (BCMA) solution for 10 infusion offices, while reducing errors in drug administration. In February 2020, the BCMA scanning workflow was updated to ensure the process is smoother and accurately confirms that the right medication and dosage is administered to the correct patient. Key departments collaborated between the infusion department, IS education, Regulatory, PennChart pharmacy; oncology and ambulatory teams.

BENEFITS REALIZED • BCMA scanning workflow was improved. The average compliance was in the low 70% when health system goals were above 95%. There was a 10-20% increase in compliance. PCAM increased compliance to the high 80% and the newly on boarded infusion sites compliance was in the high 90%. • There were no medication errors intercepted at the point of administration. The BCMA process created a more robust doublecheck process for medication administration and allowed utilization of the full functionality of the Alaris pump interoperability and Alaris pump drug library. • The medication administration documentation has been automated and captures in real-time what transpired during a patient’s infusion, which helps in the billing process. • Reduced errors in medication administration - CCH had two safety events prior to implementation. Since implementation, there have been no safety events identified.

SAVINGS QUALITATIVE

DIGITAL HEALTHCARE

BENEFITS CATEGORY

MAKING DATA MEANINGFUL

These projects are focused on effective capture and use of data from the clinical and financial systems to support improved care delivery, financial management, and quality improvement. YEAR 1

YEARS 2-3

YEARS 4-5

TOTAL

$400,000

$800,000

$2,000,000

Projects are reported for fiscal years 2020 and 2021. Projected financial benefits from projects completed in prior years are displayed in the ten-year summary on page 65.

MAKING DATA MEANINGFUL

Patient Accounting Automated Document Management System Eliminates Paper Trail BACKGROUND DESCRIPTION Patient accounting representatives have managed numerous hand-offs of patient-related documents between departments in order to process the financial components of patient care services. Penn Medicine implemented document management software to make the process automated, more efficient, and remove the need for physical documents to be collected and maintained. Prior to this project, these documents were received in paper format and required physical request and transfer of paper folders to multiple parties for review. Obtaining physical copies of these documents was difficult, time consuming, and unsustainable in a remote working environment. The IS team collaborated with the document management and lockbox vendors, as well as patient accounting leadership to define the involved document types to be converted. Upon implementation, the document management software installation allowed physical documents to be digitally scanned, allowing access to these documents electronically. As a result, the patient accounting staff gained access to information in a timely manner from any remote location and from one centralized, virtual location.

BENEFITS REALIZED • Remote staff were enabled to access scan queues and index the scanned documents directly to the affected guarantor or hospital account. • Remote workstation capabilities were added so that each user could quickly and easily access all correspondence documents. • Patient and insurance correspondence documents were linked directly to the affected guarantor or hospital account and view directly within PennChart. • Patient accounting staff that were no longer needed as a result of this technology enhancement were reduced through retirement attrition resulting in $400,000 per year.

$2,000,000 $2,000,000 $1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000

$800,000

YEAR 2-3

YEAR 4-5

$800,000 $600,000

$400,000

$400,000 $200,000 $0

MAKING DATA MEANINGFUL

YEAR 1

TOTAL

Pre Check-in Coverage Verification and Payment Automation Enables Low Touch Patient Experience BACKGROUND DESCRIPTION Penn Medicine implemented many safety measures during the COVID-19 pandemic. One effort specifically supported a low touch patient experience for healthcare visits needed during the pandemic. The pre-check-in, co-payment collection, and insurance verification features were activated in the myPennMedicine patient portal and limited face-to-face interactions between patients and the front desk staff. In the span of one-month, numerous participating teams from IS and business operations collaborated to make this functionality a reality. In June 2020, patients began to see two new steps in pre check-in for most ambulatory in-person appointments. These features complemented existing pre check-in steps, including verification of patient information, medications, allergies, health issues, as well as electronic consent signatures. Also, the option to update insurance was made available for patients to take advantage of as soon as they are aware of new coverage. Patients were enabled to upload an image of their insurance card within the patient portal. Allowing patients to have the opportunity to make these updates in the patient portal, ahead of their appointment, streamlined the check-in process and reduced administrative human interactions at the practice.

BENEFITS REALIZED • Provided patients with a convenient, centralized location in myPennMedicine to make payments and update coverage information. • Activated pre-visit co-payments and insurance updates in the myPennMedicine web site and mobile app allowing patients to update their healthcare coverage information and satisfy co-pay requirements online, ahead of their upcoming appointments. • Ensured patient and front desk staff safety, reducing contact between patients and staff at the practice. • Realized positive impacts to registration time and authorization workflows. • Leveraged RTE (Return to Eligibility) functionality to query third-party carrier results in accurate co-pay amount collections. • Insurance card image uploads provided front desk users with total transparency when adding or updating coverages for a patient. • Penn Medicine implemented related initiatives in a shortened timeline: • Co-pay collection in myPennMedicine for telemedicine visits. • Pre-payment workflow for behavioral health sites, allowing for time of service payments in myPennMedicine. • Implemented co-pay collection workflow for radiology visits. • 14% of co-pays collected in the health system were collected via myPennMedicine since 6/29/2020. Total of $1,134,399.45 was collected in myPennMedicine since 6/29/2020. • There have been 309,787 insurance card image uploads in myPennMedicine since 6/29/2020 (increased from 119,667 unique patients). • This report shows the volume of steps completed by patients during pre-check-in since the go-live of insurance verification and co-payments (6/29/20), by date of completion.

myPennMedicine Patient Pre Check-In Utilization Summary Reporting Period: 6.29.2020 - 4.30.2021 Patient Utilization

$1,200,000 $1,000,000

954,805

904,576

917,017

847,774 739,259

$800,000 $600,000

309,905

$400,000 $200,000

26,568

7,200

Allergies

eSign Documents

294,619 75,423

195,550 40,123

59,168

144,183

$0 Health Issues

Insurance

Medications

TOTAL PRE-CHECK INS: 1,076,434 Insurance Verifications: 1,013,973 Payments: 40,129

Payments

Personal Information

Questionnaires

Skipped Updated Verified

MAKING DATA MEANINGFUL

Real Time Insurance Eligibility Verification BACKGROUND DESCRIPTION As part of the overall Penn Medicine strategy to migrate to real time healthcare insurance eligibility verification, a replacement system was implemented. As a follow-up to that implementation, Penn Medicine chose to implement enhanced benefits filing which automatically files the copay, coinsurance, and deductible information into discreet fields in the benefits collection screen in PennChart. Those fields also flow to the payment collection screen during the check-in/check-out process so that patients are able to enter copayments during pre check-in. Prior to benefit filing, users manually transcribed insurance benefit information from the previous system into PennChart. The implementation of benefits filing eliminated that manual effort and leads to more accurate co-pay collections upon patient arrival for in person visits as well as within myPennMedicine. Benefits filing was implemented across the enterprise and has been continually optimized since the initial go-live in December 2019.

BENEFITS REALIZED • Accurate, timely, and complete patient insurance eligibility information. • Streamlined workflows resulting in time savings. • Improved accuracy in insurance billing.

SAVINGS QUALITATIVE

Penn Medicine Provides Price Transparency With Patient Self Service Estimates BACKGROUND DESCRIPTION The Centers for Medicare and Medicaid Services (CMS) issued a final rule to address improving price and quality transparency in American healthcare. The price transparency legislation was enacted as a way to put patients first and enable them to shop for the most effective, lowest-cost health care available. The Price Transparency Rule promoted policies for consumers to choose a facility for elective procedures and encourage competition among healthcare facilities. It also aimed to drive value based care and helped engage patients with Penn Medicine as they actively shopped for healthcare services. The new rule became effective January 1, 2021. Penn Medicine complied with the regulation by implementing the PennChart selfservice estimates module to allow current and prospective patients to create a patient estimate. The tool’s user-friendly web-based price transparency feature enabled estimates of authorized services or procedures for patients before services are rendered, informing patients of payment expectations. The estimate is based on validating the patient’s current insurance eligibility and coverage information. This functionality improved the patient experience by offering patients clear, accessible, and easy to understand estimates, and their financial obligations before services were performed.

BENEFITS REALIZED • The patient self-service estimate tool empowered patients to make better informed decisions about their care and render payments in advance of services. • Increased up-front collection of payments either prior to or at time of service. • Eliminated the need for financial advocate staff to manually create estimates.

SAVINGS QUALITATIVE

MAKING DATA MEANINGFUL

BENEFITS CATEGORY

MAKING THE CONNECTION

These projects are focused on using technology to enhance the communication and sharing of information between providers and patients across the continuum of care. YEAR 1

YEARS 2-3

YEARS 4-5

TOTAL

$150,000

$300,000

$750,000

Projects are reported for fiscal years 2020 and 2021. Projected financial benefits from projects completed in prior years are displayed in the ten-year summary on page 65.

MAKING THE CONNECTION

Text Messaging Solution Transition Results in Greater Efficiency and Significant Cost Savings BACKGROUND DESCRIPTION Penn Medicine switched vendors for SMS text messaging services, resulting in cost savings and greater control and flexibility of text campaigns. The new solution provides a direct SMS gateway connection to our PennChart EHR and allows one-direction patient texting based on specific events and triggers. The project involved standardizing the script to be leveraged for the majority of office visits across multiple service lines and then developing texting scripts and campaigns requiring additional configuration, such as behavioral health, radiology, and telehealth. Text messages that are sent to patients include appointment reminders, confirmations, and cancellations.

BENEFITS REALIZED • • • •

The new platform delivers all patient appointments reminders, including surgical updates and myPennMedicine notifications. Processes established for front-line staff to update PennChart communication preferences. Patients can also update their communication preferences via myPennMedicine. Cost savings of $150,000 annually in operational costs with the transition of vendors.

$750,000

$800,000 $700,000 $600,000 $500,000 $400,000 $300,000 $200,000

$300,000

YEAR 2-3

YEAR 4-5

$150,000

$100,000 $0

MAKING THE CONNECTION

YEAR 1

TOTAL

Healing at Home - Automation Leads to Early Discharge for Parents and Newborns BACKGROUND DESCRIPTION The Healing at Home project transformed a paper heavy process into a dynamic tool to facilitate earlier discharges for parents and newborns in the HUP obstetrics and postpartum clinical care unit. An interdisciplinary team worked together to create an algorithm with pertinent clinical information for both parent and baby on the “Green Pathway,” which indicates readiness for early discharge. Both parent and baby, as a couplet, must meet all criteria to be eligible for early discharge. This is facilitated by expedited lab draws, patient education, and discharge planning. Traditionally, the information in these columns was shared during care coordination rounds, among interdisciplinary team members, each using a different “report” that was manually transcribed. Using the medical record was too cumbersome to seek out all the different pieces of information, so the documentation was completed by the charge nurse on paper. Going into the project the average length of stay was approximately 60 hours and the goal was to reduce the length of stay to 36 hours.

BENEFITS REALIZED • During the first month of COVID-19, 235 patients enrolled and 20% decrease in length of stay was realized. • As a result of decrease in length of stay, there has been an increase in OB unit capacity supporting growth in admissions. • Postpartum staff and patient educators have more visibility into the plan of care and can prioritize labs, education, and discharge planning to facilitate reduced length of stay. • Provider/nursing satisfaction increased by using the tool for electronic documentation and real time visual indicators in PennChart. • Additional support is given to parents after discharge. Parents can text questions about themselves or the newborn for up to six weeks. Any concerns that need escalation are triaged by the health care team in real time. • Patient/family satisfaction increased. • Net promoter score = 57. • 800 users enrolled since March 2020. • 23% Edinburgh Perinatal / Postnatal Depression Scale EPDS (or 24) at risk screening captured. • Breakdown of patients in the program (38% first time parents, 67% EBF, 56% Black, 54% Medicaid). • Quality data is monitored to track unscheduled outpatient or ED visits for parent/baby, infant weight and bilirubin checks.

SAVINGS QUALITATIVE

MAKING THE CONNECTION

BENEFITS CATEGORY

RESEARCH

These projects are focused on using data and technology solutions to support fundamental and discovery science clinical research at Penn Medicine’s laboratories and hospitals to improve care for a wide range of medical conditions and provide the foundation for the next generation of therapies. The University of Pennsylvania encourages close collaboration between scientists and clinicians with the support of Information Services exemplified by its dozens of interdisciplinary clinical and research institutes, centers, and programs.

RESEARCH

Abramson Cancer Center Support Grant - NCI Comprehensive Cancer Center BACKGROUND DESCRIPTION The Database and Applications Group (DAG) team within the Digital Academic Research Transformation (DART) group is responsible for several applications that support the Abramson Cancer Center (ACC) Support Grant (CCSG), which is commonly referred to as “the core grant”. The DAG team is also responsible for generating many of the reports used to defend the grant. The DAG has built and maintains a suite of applications allowing ACC leadership to effectively manage the operational requirements of a designated comprehensive cancer center. These applications provide much of the data used for reporting to the NCI to support the core grant, allow ACC leadership to monitor clinical research progress in real-time, perform gap analyses, and implement improvements where needed. Through the DAG applications, ACC leadership has at its fingertips all the data necessary to track current performance against the past to ensure the center is meeting the NCI’s expectations, to steer advancements towards future goals, and to benchmark against other NCI cancer centers as well as other Academic Health Centers (AHC) in the greater Philadelphia region.

BENEFITS REALIZED • • • • • • •

• • • •

Supported CCSG grant process, which resulted in $45 million over 5 years. Helped the ACC to receive an “Exceptional” rating for the grant for three consecutive cycles. Applications and data allowed ACC leadership to balance their portfolio of studies. Ability to open and close studies based on performance data. Quickly adjust as new NCI requirements occur. Adjust research staffing. Easily able to defend: • Clinical trials accrual. • Clinical research portfolio. • Women and minority participation on clinical trials. • Community outreach and engagement. • Grants. • Publications. • Performance of NCI mandated committees such as the Clinical Trials Scientific Review and Monitoring Committee (CTSRMC) and the Data and Safety Monitoring Committee (DSMC). • Clinical trial performance and metrics such as time-to-activation; scientific progress monitoring; quality control, quality assurance and compliance; and pharmacovigilance. Three consecutive exceptional ratings have been achieved by less than a handful of NCI Designated Comprehensive Cancer Centers establishing the ACC as a leader among cancer centers. Addressing disparities in cancer care—specifically within the ACC’s community outreach and engagement program. ACC has led or co-led studies that resulted in 18 U.S. Food and Drug Administration (FDA) approvals of cancer therapies since 2017, with more to come in 2021. Only NCI cancer center to automate the reporting of clinical trial data in real-time to the NCI Clinical Trials Reporting Program (CTRP), resulting in extremely high quality, current, and accurate data. As a result of these efforts, the NCI has expressed confidence in ACC data integrity.

SAVINGS QUALITATIVE

RESEARCH

Electronic Quality Documentation System Supports Novel Research Therapies Within Penn Medicine Manufacturing Cores BACKGROUND DESCRIPTION As a leader in developing novel treatment therapies and diagnostic agents, Penn Medicine’s manufacturing groups include protocols related to drug therapies, gene therapies, radiopharmaceuticals, and cellular therapies. All of these groups are required to meet strict regulatory guidelines, including documentation compliance. These requirements are needed to facilitate commercialization and patent approvals for all novel therapies and diagnostic agents developed at Penn Medicine. The goal of “QualityDocs” is to run a compliant electronic system for all quality documentation for manufacturing groups. The implementation allows for an electronic method for manufacturing groups at Penn Medicine to meet or exceed regulatory requirements and guidelines. Meeting these requirements allows Penn Medicine manufacturing groups to receive FDA approval for commercialization and marketing of these novel therapies.

BENEFITS REALIZED • Transition from paper to electronic documentation streamlined quality documentation workflows, related to audits, deviations, and standard procedures. • Ability to meet GxP and 21 CFR Part 11 requirements. • Electronic and streamlined workflows for auditing and compliance.

SAVINGS QUALITATIVE

RESEARCH

Abramson Cancer Center Clinical Research Unit Kit Management BACKGROUND DESCRIPTION Participation in cutting edge clinical trials places Penn Medicine among the world’s top research institutions. The Abramson Cancer Center clinical research unit (CRU) provides the necessary infrastructure to support research spanning 130+ in-house and sponsored clinical trials. The CRU initially approached the Penn Medicine Laboratory Information Management Systems (LIMS) team in search of information technology support to help them improve the management of specimen collection kits and samples among their 12 study teams. The tools for tracking and communicating critical information that had worked for the group to date, such as emails, phone calls, and shared spreadsheets were becoming difficult to work with as the unit grew and took on more studies. The LIMS and CRU teams collaborated on new workflows in Penn Medicine’s enterprise LIMS system. The LIMS team completed a pilot implementation in early 2020 and proceeded with a full roll-out throughout the center. Approximately 75% of the CRU disease-specific study teams were implemented, expecting 100% conversion to using LIMS by the end of 2021. The LIMS and the CRU Education and Quality Assurance teams have partnered to integrate LIMS training into CRU’s professional development program. The full solution manages specimen collection kit inventory and expiration dates, kit assignment to specific study participants, and the status of whether the kit had been prepped, delivered, or used. In addition, the system streamlines communication via reports, emails, and electronic dashboards to facilitate scheduling and sample shipment requests. The enhanced communications and increased efficiency in the unit has enabled them to support more trials. BENEFITS REALIZED Productivity gains and cost savings are modeled by the following: • • • • • • • • • • • • •

76 clinical trials are currently managed in LIMS. An additional 60 trials are expected to be added by the end of 2021. Accurately track 1,626 collection kit types and 7,926 individual kits. Waste reduction by tracking kit expirations and manage kit inventory. Reporting allows for reduced overstocking of kit types and frees up storage space. Streamlined communication among multiple teams ensures kits are ready for patients, samples are sent back to sponsors, and reduced processing deviations. Electronic dashboards help staff plan their work. Increase operational efficiency to allow the ACC to support more clinical trials. Analytics can track key performance indicators, identifying any bottlenecks. Speeding up the kit prep process allows handling of a slightly higher workload per bio-specimen coordinator approximately 5-10 hours per week. Distributing kit prep throughout the week and creating a more efficient workflow results in fewer kit prep errors. Better information on kit expiration helps with space management. The new feature that allows the kits to be “refurbished” reduces the environmental impact and carbon footprint of our research. During late 2021, over 300 kits were refurbished which significantly reduced kit waste.

SAVINGS QUALITATIVE

RESEARCH

Cellular Vaccine Production Facility Inventory and Equipment Management BACKGROUND DESCRIPTION The Cellular Vaccine Production Facility (CVPF) needed to improve their handling of both inventory and equipment information. Penn Medicine’s Laboratory Information Management Systems (LIMS) team collaborated on developing a solution in the enterprise LIMS. As CVPF expanded its operations, the existing tools used to manage order requests and inventory levels, which were largely spreadsheet and email based, needed to be upgraded to avoid material unavailability and expiration, both of which can be costly problems. Similarly, managing the growing need to track scheduled and unplanned maintenance tasks and calibrations for scientific equipment was brought into LIMS, which has become a common platform for tracking laboratory information for CVPF. BENEFITS REALIZED New workflows were developed to support barcode inventory items, track material locations, notify of expiration and re-order warnings. The notifications of upcoming expirations resulted in reduced waste in the form of expired materials, ensuring that expiring materials are used first. Similar notifications for low inventory levels across multiple storage locations allowed more of a just-in-time mode of operation which reduces excess inventory and the corresponding need for storage space. This met a critical need regarding space-limited areas in center-city Philadelphia, where free space can be assigned to other clinical or research activities. In addition to managing which materials were available, the materials tracking capabilities of LIMS increased traceability between specific vendor lot numbers and the study participants to which these materials are linked. This readily available link and usage tracking saved significant time compared to collating multiple spreadsheets and handwritten records when this information is needed to predict future materials needs or investigate any issues. It is important to maintain proper calibrations on equipment and conduct regularly scheduled maintenance so that instruments are accurate and available. These activities also prolong the life of expensive instruments and save costs by avoiding the need to replace them. • • • • • •

375 types of materials are managed. 795 unique material lots are managed. 98K uniquely trackable items are managed as part of the inventory system. 409 pieces of equipment tracked. 81 work orders generated in the first 10 weeks of use. Inventory presented as a poster by CVPF at the International Society for Cell and Gene Therapy 2021 meeting in New Orleans “Implementation of a LabVantage-based Laboratory Inventory Management System in a High Volume Academic Cell Therapy Production Facility”.

SAVINGS QUALITATIVE

RESEARCH

The Pavilion at the Hospital of the University of Pennsylvania The Pavilion has been one of the most detail focused and innovative projects undertaken at Penn Medicine. The state-of-the-art technology integrated within the Pavilion transforms the manner in which Penn Medicine provides patient care and experience through detailed organization and design. Innovation and technology were the primary focus when designing each and every wall in the hospital as the goal is to deliver the treatment of today and the medical advances of tomorrow. The following projects represent the technology built to support the Pavilion and transform the patient care experience using smart building integration.

Security camera system platform was designed with new IP based camera

Introduced patient portal bedside module so patients and families can engage

system including hardware, software, security operations center design and

in their care through educational materials and by providing their lab results,

staff training.

vital signs, upcoming tests, health care team members.

Implemented over 55 employee time clocks throughout 1.5M square feet-

Deployment of clinical technology devices, including clinical engineering

determined placement, configured new low voltage wiring, programming and

equipment.

installation. Implemented robotic server and software technology for pharmacy Implemented technology supporting cafeteria systems to include point

operations and delivery of medications.

of sale stations, 10 large format food menu selection display boards and ensured system security and auditing capability for transaction history for

Introduced patient portal bedside module so patients and families can

sales accuracy.

engage in their care through educational materials and by providing their lab results, vital signs, upcoming tests, health care team members.

Installed an updated parking control system which secures payment, tracks vehicle flow, and establishes pay of foot capabilities on the 6 Pavilion parking

Activated 120 patient rooms early, to provide extra capacity for anticipated

garage levels.

surge in COVID-19 patients.

Go-live readiness assessments and dress rehearsals were done to prepare

Deployed 65 iPads for patient use.

for technology application transition, patient movement prep, and command center logistics.

Technology infrastructure constructed for 3rd floor connector bridge from the Pavillion to Perelman Center for Advanced Medicine (PCAM).

Emergency department and inpatient hospital electronic health record

Relocated peri-operative waiting room to PCAM.

workflow analysis, design, build, and testing were completed.

Peri-operative area was expanded into the old waiting room with (10) new patient bays. The old per-operative area was used as the new pathway from

Imaging and modality integration was coordinated for vendor installation

PCAM and onto the Paviliion connector bridge.

and configuration: Radiology PACS build, Cardiology PACS build, associated EHR build, connectivity testing, device testing and PACS / EHR integration

New dermatology suite was built adjacent to the a bridge area to coencide

testing for all of the clinical imaging equipment to be newly placed in or moved

with connector bridge space.

to the new Pavilion. Device modalities included (XRay, CT, MRI, Ultrasound, etc.) and diagnostic reading/tech workstations.

Patient flow manangement application and care team tool was implemented.

Application updates made to EHR modules OpTime, cardiology and radiology, supporting new innovative workflows and technology to support

Implemented a single enterprise information platform for managing content,

our clinicians in delivering exceptional care while improving the patient

increasing productivity and reducing cost.

experience. Prepared billing and claims processes, ensuring continuity in charge method, Implemented new equipment within the Pharmacies (robots and carousels)

structure and coding processes to align with the health system standards.

and Lab spaces (Microscopes & IT devices). HUP Pavilion - Revenue Cycle (HIM, EMPI) – Evaluation of HIM components Penn Medicine’s project management methodologies ensured the

for the Pavilion, ensuring the availability, accuracy and protection of clinical

deployment was on time while adhering to high quality standards.

information needed to deliver healthcare services.

Installed new virtual enterprise level Nihon Kohden physiological monitoring

Designed new electronic patient white board display for patient rooms.

system. Automated vitals data capture and EHR recording for critical care patients, ICU and OR clinical computing hub.

Implemented technology for nurse call system for patients to request help from their bed.

2015

$38

2016

$43

2017

$65

2019

$48

$29

2015 AND 2017 COMBINED REPORT

2018

$60

$24

2021

$32

$28

$22

2019 REPORT

2020

$48

$32

2022 REPORT

2022

$26

$16

2023

$16

ROLLING 10 YEAR BENEFITS REALIZATION (IN $ MILLIONS)

2024

$0.2

$14

2025

$14

This was particularly evident during the COVID-19 pandemic as Information Services confronted the challenge of providing rapid and innovative support to Penn Medicine through the worst of the crisis and maintained a full workload of ongoing projects.

This chart summarizes the cumulative savings and future cost avoidance associated with the IS projects features in the last ten years. It is evident that past IS activities continue to contribute to substantial savings and future cost avoidance to Penn Medicine. The contributions noted in this chart are reflective of the teamwork and collaboration between administration, clinical leadership, operations and Information Services.

This is the fourth edition of the Information Services Benefits Realization Analysis. This edition features (32) high profile IS projects that were completed in fiscal years 2020 and 2021. The savings and future cost avoidance derived from many of these projects is ongoing.

TEN YEAR LOOK

IS Activities Yield Substantial On-Going Savings and Cost Avoidance

GLOSSARY AHC: Academic Health Centers

LGH: Lancaster General Health

AI: Artificial Intelligence

LIMS: Laboratory Information Management System

BCMA: Barcode Medication Administration

LTC: Long Term Care

CCA: Clinical Care Associates

MDS: Minimum Data Set

CCH: Chester County Hospital (Penn Medicine Hospital)

MPM: myPennMedicine

CDC: Centers for Disease Control

MSPQ: Medicare Secondary Payer Questionnaire

CDI: Clinical Documentation Improvement

NCI: National Cancer Institute

CIO: Chief Information Officer

OR: Operating Room

CMIO: Chief Medical Information Officer

PACS: Picture Archiving and Communication System

CMS: Centers for Medicare and Medicaid Services

PAH: Pennsylvania Hospital

COVID-19: Corona Virus 2019

PCAM: Perelman Center for Advanced Medicine

CPUP: Clinical Practices of University of Pennsylvania

PE: Platform Engineering

CRU: The Abramson Cancer Center Clinical Research Unit

PennChart: Penn Medicine’s Electronic Health Record

CTRP: Clinical Trials Reporting Program

PHCS: Princeton Healthcare System (now Penn Medicine

CTSRMC: Clinical Trials Scientific Review and Monitoring

Princeton Health or PMPH)

Committee

PMACS: Penn Medicine Academic Computing Services

CVPF: Cellular Vaccine Production Facility

PMAH: Penn Medicine at Home

DAG: Database Applications Group

PMAR: Penn Medicine at Rittenhouse

DSMC: Data and Safety Monitoring Committee

PMO: Project Management Office

ED: Emergency Department

PMPH: Penn Medicine Princeton Health

EHR: Electronic Health Record

PMUC: Penn Medicine University City

EIO: Entity Information Officer; This is the IS Executive at

PNBB: Penn Medicine Biobank Research

each entity, including HUP, PAH, PPMC, HCHS, CCH, LGH, PMC, and CPUP/CCA

EPIC/ EpicCare: The enterprise ambulatory EMR system

e-Prescribing: The workflow of ordering a non-controlled medication in order entry and electronically transmitting it to a (retail) pharmacy using a certified e-prescribing vendor.

ERP: Enterprise Resource Planning EUA: Emergency Use Authorization EUS: End User Support, the desktop and network support, technicians who work at each entity facility

POCUS: Point of Care Ultrasound PPMC: Penn Presbyterian Medical Center PSOM: The Perelman School of Medicine Quil: Collaborative Venture for Patient Journey Home to Hospital

Radnor: Radnor Medical Campus RTE: Real Time Eligibility SKYPE: Previous meeting collaboration platform

FDA: Food and Drug Administration

SNF: Skilled Nursing Facility

Gpbs: Gigabit per second

Sunset: Retirement of technology system

HUP: Hospital of the University of Pennsylvania

UPHS: University of Pennsylvania Health System

ICU: Intensive Care Unit

VPN: Virtual Private Network

LCSR: Lung Cancer Screening Registry

WHO: World Health Organization WPSI: West Philadelphia Skills Initiative