R/3 Industry System for Hospitals

IS-H Overview

Dr. Roland Bürkle

SAP AG

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 1

 Overview IS-H

Hospital Requirements
 Improved cost efficiency
 Hospital and departmental budgets
 Seviceorientation instead of cost coverage
 Transparency of costs and services
 Efficency and Effectiveness
 Preference of outpatient
 Improved patient scheduling
 Faster resource availability
 Quality aspects
 Improvement in quality of care
e.g. by reduction of administrtion workload
 Improvement in medical services,
e.g. by faster access to information

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 2

 Overview IS-H

R/3 Hospital Solution

. . . . as a hospital-specific
information system . . . .

based on UNIX or NT
FI
Finance with an open
MM CO system architecture
Material Controlling
Manage-
ment AM
as client-server
R/3
Asset
Manage-
ment configuration

Client / Server PS
Project
using relational data bases
OC system
PM
Plant Main-
ABAP / 4 Office &
Communi-
in standard
IS-H IS-H
tenance
HR Hospital
cation networks
Human Systems
Resources
IS-HPM IS-HPA with standard
Patient Patient
Manage- Accoun- interfaces
ment IS-HCO ting
IS-HCM
Hospital Con- Communi-
trolling cation to an integrated overall model.

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 3

 Overview IS-H

Conceptual Approaches in IS-H

 Patient-oriented
 Integration of inpatient and outpatient areas
 Support of clinical scheduling
 Integrated station management
 General service entry
 Flexible and adaptable billing procedures

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 4

 Overview IS-H

Data Structures in IS-H Patient Management

Patient Case Movement
Admittance
Admittance
Inpatient
Inpatient
Outpatient
Outpatient visit
visit
Patient
Patient
Outpatient
Outpatient

Master data Services Movement data

Patient-rel. insurance Diagnoses Assignment
relationship Nursing acuity - to org. units
Risk informations Assigned cases - to building units
Medical records (e.g., companion)
Case-related insurance rel.

Business partner Organizational units Building units

-Employee -Clinic -Room
*Physicians -Department -Bed location
*Nursing staff -Station
-External physicians
-External hospitals
-Insurance providers

Catalogs
Postal codes Risk factors Diagnoses ...
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 5
 Patient / patient related objects
Hyperten-
sion Risk
Diabetes factors
Patient mellitus
1000000292
Mr. R.Miller Case
03-12-1934
male
Main Street 1
. Inpatient case 1
. .
. .
.
Inpatient case n
Fa. Cartier
Juweler
Business partner :
Employer Outpatient case 1
.
.
.
Outpatient case n

AOK
DKV
Business partner :
Self-pay
Patient related insurance
Insurance provider
Documents patient relationships

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 6

 Case / Movement Movement
Admission
Admission Building
Building units
units
Case Transfer
Transfer Organizational
Organizational units
units
2000000821 Leave
Leave
Outpatient
Outpatient Diagnoses
Discharge
Discharge
Department:
Newborn Case Surgery
Department:
1000000222 Surgery
Department:
Surgery
-Outpatient Appendicitis AD
Case-to-case
Companion -Observation Appendicitis HD
assignment ...
...

-Outpatient

Case-related
insurance relationship

Case classification
AOK
AOK Operations Patient group Treatment type: -Refer. physician
DKV
DKV Self-
Self- Services Dialysis
pay 01.02.EA1/S2
01.02.EA1/S2 -Attend. physician
pay
4711 Service 1 02.02.EA2/S2
02.02.EA2/S2 PPR
1623 Nursing A 03.02.EA2/S2
03.02.EA2/S2 Newborn status
.. .. .. 04.02.EA1/S2
04.02.EA1/S2 .. .. ..
Patient-related .. .. .. 05.02.EA1/S1
05.02.EA1/S1 .. .. ..
.. .. .. . . . .. .. ..
insurance relationship . . .
. . .

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 7

Patient history
Patient movements

Surgery
A
A
Station C1
D
M
I L
AO S Station C2
S
I Pre-admission
O treatment
A
N T
Emergency
D treatment
E Internal medicine
P
T Outpatient B
treatment Stat. Stat.
I1 I2 D
Post-disch.
treatment

A: Admission (inpat./outpat.) L: Leave

O: Outpatient visit D: Discharge
T: Transfer

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 8

Nurse Station Management

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 9

Outpatient Department Scheduling
Outpatient
Referral

Treatment rooms

Station
Dr. Black Dr. Welby

Employee / Physicians

Planning level: Outpatient visit

 Outpatient visit in waiting list status and plan status
 Resources: Treatment room, attending physician
 Avail. capacity: times when bldg units unavailable
 Waiting lists, pre-registration lists, appt notifications
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 10
Insurance relationships

AOK Case 1

Patient DKV

Case 2
Self-
payer

Ins.relationship: Patient Ins.relationship: Case

• Validity period • Record identifier
• Insurance provider • Remarks
• Type of coverage • Ranking
• Data about insured • Co-payment
- Name, address agreements
- Employer
• Remarks
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 11
Insurance Relationships

 As many as necessary
 Patient view: Advantages from return visits
 Can be set for each case
 Time-dependent: Change supported
 Ranking can be established
 Integration with Financial Accounting, e.g.
display of open items, co-payments, etc.
 Multiple insurance providers
 Verification of health care smart card

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 12

Insurance Verification Request Processing

Hospital
Request for insurance
verification
• Forms
• Procedure Confirm. /
Insurance verifi- stipulations Rejection
cation reminder • Data medium
exchange
Insurance verifi-
cation extension

Health insurance

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 13

Insurance Verification
 Allocation of a service to multiple insurance
providers
 Percent or absolute determination, relative to the
value of the service
 Request procedure can be based on individual
service or summarized in groups
 Analysis of ranking of insurance relationship
 Proposed values
 Pre-approved insurance
 Special forms for each insurance provider
 Dunning procedures
 Integration with service entry
 Extension of insurance verification
 High level of automation
 Monitoring of insurance verification

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 14

Patient Accounting - Overview
AOK

Insurance
verification
process
Health insurance Management
Patient 100
80
60
40
20
0
1 2 3 4 5 6

Analyses

Rechnung
Invoice
Summe

GOÄ AOK
Service
entry
...

ICPM

Insurance provider
Health insurance
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 15
Service entry

 'Case - service account'

 Multiple services for a single case
 Immediate service or extended service
 Billable or non-billable services
 Departmental per diem
 Automatic creation of service levels via
definition of treatment categories
 Integration with insurance verification
 Link to and additional processing in
Controlling (cost center and cost object
controlling)

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 16

Charge Master

. 99
ax 04 Service catalog
t. m
a 03 Inpatient services
c
rv. 02 GOÄ
Se
01 DKF-NT
Charge Service Points Special Genl Pat.-rel. Comp.
No. costs costs costs costs
2 Consult 86 1.90 11.50
Services

14 Certification 31 1.90 1.90 4.20

...

Catalog columns max. 99

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 17

Billing Methods
Inpatient Billing Outpatient Billing

General nursing charge Self-pay patient invoice

Procedures surcharge Direct patient billing

Departmental per diem Health ins. co. billing (via

integr. 3rd party system)
Flat rate per case
Outpatient surgery
Pre-admission and post-
discharge flat rates Worker’s Comp. billing
(w/o spec. Worker’s
Other services Comp. reporting)

Observ. patient services

Direct patient billing

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 18

Billing
 Billing of:
 Departmental per diem
 pre-admission, post-discharge treatment
 Flat rate per case
 Procedures surcharge
 Outpatient surgical procedures
 Interim billing, test billing
 Selective billing of certain services
 Selective billing by insurance provider type
or insurance provider
 User-defined forms
 User-defined pricing
 Flexible revenue accounting

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 19

Hospital Costing and IS-H
IS-H MM-
AM HR MM SRV FI

Capital Personnel Material Services Ext. services Misc.ext. proc.

Cost Elements
Accruals
Direct costs Overhead costs

CO- CO-
OPA CCA
Cost objects Cost centers

Case
IS-H Base nurs. charge
Dept. treat. charge
Proced. surcharge
Invoices
Flat rate per case

CO-
PA
Profitability analysis
Patient, case category, service

 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 20