Transcript IS-H Overview - ERP Database

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
MM
CO
Material
Management
Controlling
AM
R/3
Asset
Management
Client / Server
ABAP / 4
PM
Plant Maintenance
IS-H
HR
PS
Project
system
OC
IS-HPM
using relational data bases
in standard
networks
IS-HPA
with standard
interfaces
Patient
Patient
ManageAccounment IS-HCO ting
IS-HCM
Hospital Con- Communitrolling
cation
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 3
as client-server
configuration
Office &
Communication
Hospital
Systems
Human
Resources
with an open
system architecture
to an integrated overall model.
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
Movement
Case
Admittance
Inpatient
Outpatient visit
Patient
Outpatient
Master data
Patient-rel. insurance
relationship
Risk informations
Medical records
Services
Diagnoses
Nursing acuity
Assigned cases
(e.g., companion)
Case-related insurance rel.
Business partner
Organizational units
-Employee
*Physicians
*Nursing staff
-External physicians
-External hospitals
-Insurance providers
-Clinic
-Department
-Station
Movement data
Assignment
- to org. units
- to building units
Building units
-Room
-Bed location
Catalogs
Postal codes
Risk factors
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 5
Diagnoses
...
Patient / patient related objects
Hypertension
Diabetes
mellitus
Patient
Risk
factors
1000000292
Mr. R.Miller
03-12-1934
male
Main Street 1
.
.
.
Case
Inpatient case 1
.
.
.
Inpatient case n
Fa. Cartier
Juweler
Business partner :
Employer
Outpatient case 1
.
.
.
Outpatient case n
AOK
Business partner :
Documents
Insurance provider
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 6
DKV
Self-pay
patient
Patient related insurance
relationships
Case / Movement
Movement
Admission
Transfer
Leave
Outpatient
Discharge
Case
2000000821
Case
Newborn
1000000222
Case-to-case
Companion
assignment
-Outpatient
-Observation
Building units
Organizational units
Diagnoses
Department:
Surgery
Department:
Surgery
Department:
Surgery
Appendicitis AD
Appendicitis HD
...
...
-Outpatient
Case-related
insurance relationship
Case classification
AOK
DKV
Selfpay
Patient-related
insurance relationship
Services
4711 Service 1
1623 Nursing A
. . .
. . .
. . .
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 7
Operations
Patient group
01.02.EA1/S2
02.02.EA2/S2
03.02.EA2/S2
04.02.EA1/S2
05.02.EA1/S1
. . .
. . .
. . .
Treatment type:
Dialysis
PPR
Newborn status
. . .
. . .
. . .
-Refer. physician
-Attend. physician
Patient history
Patient movements
Surgery
AO
A
A
D
M
I
S
S
I
O
N
D
E
P
T
A
Station C1
L
Station C2
Pre-admission
treatment
T
Emergency
treatment
Outpatient
treatment
Internal medicine
B
Stat.
I1
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
Stat.
I2
D
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
Patient
Case 1
DKV
Case 2
Selfpayer
Ins.relationship: Patient
Ins.relationship: Case
• Validity period
• Insurance provider
• Type of coverage
• Data about insured
- Name, address
- Employer
• Remarks
• Record identifier
• Remarks
• Ranking
• Co-payment
agreements
 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
Insurance verification reminder
Insurance verification extension
• Forms
• Procedure
stipulations
• Data medium
exchange
Health insurance
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 13
Confirm. /
Rejection
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
Management
Health insurance
Patient
100
80
60
40
20
0
1
2
3
4
5
Analyses
6
Rechnung
Invoice
Summe
AOK
GOÄ
...
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
Services
04 Service catalog
03 Inpatient services
02 GOÄ
01 DKF-NT
Charge Service
Points
Special
No.
costs
2
14
...
Consult
Certification
86
31
Genl
costs
Pat.-rel. Comp.
costs
costs
1.90
1.90
Catalog columns max. 99
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 17
1.90
11.50
4.20
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 postdischarge flat rates
Other services
Observ. patient services
Direct patient billing
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 18
Worker’s Comp. billing
(w/o spec. Worker’s
Comp. reporting)
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
AM
HR
MM
Capital
Personnel
Material
IS-H
MMSRV
FI
Services
Ext. services
Misc.ext. proc.
Cost Elements
Direct costs
Overhead costs
COOPA
IS-H
Invoices
Cost objects
Cost centers
Case
Base nurs. charge
Dept. treat. charge
Proced. surcharge
Flat rate per case
COPA
Profitability analysis
Patient, case category, service
 SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 20
Accruals
COCCA