SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 1 Dr. Roland Bürkle SAP AG R/3 Industry System for...

SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 1

Dr. Roland BürkleSAP AG

R/3 Industry System for Hospitals

IS-H Overview


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

Overview IS-H


R/3 Hospital Solution

Overview IS-H

OCOffice &

Communi- cation

PMPlant Main-

tenanceHR

HumanResources

MMMaterialManage-

ment

IS-HPAPatient

Accoun-ting

IS-HIS-HHospitalHospitalSystemsSystems

IS-HCOHospital Con-

trolling

IS-HPMPatient

Manage-ment IS-HCM

Communi-cation

AMAMAssetAsset

Manage-Manage-mentment

COCOControllingControlling

FIFIFinanceFinance

PSPSProjectProjectsystemsystem

R / 3R / 3Client / ServerClient / Server

ABAP / 4ABAP / 4

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

based on UNIX or NT

with an open system architecture

as client-server configuration

using relational data bases

in standard networks

with standard interfaces

to an integrated overall model.


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

Overview IS-H


Data Structures in IS-H Patient Management

Overview IS-H

InpatientInpatientAdmittanceAdmittance

PatientPatientOutpatient visitOutpatient visit

OutpatientOutpatient

Master dataPatient-rel. insurance relationshipRisk informationsMedical records

ServicesDiagnosesNursing acuityAssigned cases(e.g., companion)Case-related insurance rel.

Movement dataAssignment- to org. units- to building units

Patient Case Movement

Building unitsOrganizational unitsBusiness partner

-Employee *Physicians *Nursing staff-External physicians-External hospitals-Insurance providers

-Clinic-Department-Station

-Room-Bed location

DiagnosesRisk factorsPostal codes ...Catalogs


Self-paypatientSelf-paypatient

1000000292

Patient

Mr. R.Miller03-12-1934maleMain Street 1 . . .

Fa. CartierJuweler

Business partner :Business partner :EmployerEmployer

Inpatient case 1...

Inpatient case n

Outpatient case 1...

Outpatient case n

Case

Documents

DKVDKV

AOKAOK

Riskfactors

Patient related insurancerelationships

Business partner Business partner ::Insurance providerInsurance provider

Patient / patient related objectsHyperten-sionHyperten-sion

DiabetesmellitusDiabetesmellitus


Case / Movement

Department: SurgeryDepartment: Surgery

Building unitsOrganizational units

Building unitsOrganizational units

AdmissionTransfer

LeaveOutpatientDischarge

AdmissionTransfer

LeaveOutpatientDischarge

Department: SurgeryDepartment: SurgeryDepartment:

SurgeryAppendicitis ADAppendicitis HD......

Department: SurgeryAppendicitis ADAppendicitis HD......

01.02.EA1/S202.02.EA2/S203.02.EA2/S204.02.EA1/S205.02.EA1/S1 . . . . . . . . .

01.02.EA1/S202.02.EA2/S203.02.EA2/S204.02.EA1/S205.02.EA1/S1 . . . . . . . . .

-Refer. physician-Attend. physician

Operations Patient group

4711 Service 11623 Nursing A . . . . . . . . .

4711 Service 11623 Nursing A . . . . . . . . .

Services

Diagnoses

Treatment type:Dialysis

PPRNewborn status . . . . . . . . .

Treatment type:Dialysis

PPRNewborn status . . . . . . . . .

Case classification

Patient-relatedinsurance relationship

Case-relatedinsurance relationship

AOKAOKSelf-pay

Self-pay

DKVDKV

Movement

2000000821Case

Newborn

Companion

1000000222

Case

-Outpatient

-Outpatient-Observation

Case-to-case

assignment


Patient history

Patient movementsPatient movements

Station C1Station C1

Station C2Station C2

SurgerySurgery

ADMISSION DEPT

ADMISSION DEPT

Internal medicineInternal medicine

Stat.Stat.I1I1

Stat.Stat.I2I2

Pre-admissionPre-admissiontreatmenttreatment

EmergencyEmergencytreatmenttreatment

OutpatientOutpatienttreatmenttreatment

Post-disch.Post-disch.treatmenttreatment

AA

AOAO

AA

L

BB

D

TT

A: Admission (inpat./outpat.)O: Outpatient visitT: Transfer

L: LeaveD: Discharge


Nurse Station Management


Outpatient Department Scheduling

Treatment roomsTreatment rooms

Dr. BlackDr. Black Dr. WelbyDr. Welby

Employee / PhysiciansEmployee / Physicians

StationStation

OutpatientOutpatientReferral

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


Insurance relationships

PatientPatient

AOKAOK

DKVDKV

Self-Self-payerpayer

Case 1Case 1

Case 2Case 2

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


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


Insurance Verification Request Processing

HospitalHospital

Health insurance

Request for insuranceverification

Insurance verifi-cation reminder

• Forms• Procedure stipulations• Data medium exchange

Confirm. /Rejection

Insurance verifi-cation extension


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


Health insurance

Health insurance

Analyses

Management

AOK

AOK

Serviceentry

Invoice

Insuranceverification

process

Patient

Patient Accounting - Overview

100

80

60

40

20

01 2 3 4 5 6

Rechnung

Summe

ICPMICPM

GOÄGOÄ

...

Insurance provider


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)


Charge MasterS

ervi

ces

Ser

vice

s

ChargeNo.

Service Points Specialcosts

Genlcosts

Pat.-rel.costs

Comp.costs

214...

ConsultCertification

8631

1.901.90 1.90

11.504.20

Catalog columns max. 99Catalog columns max. 99

01 DKF-NT01 DKF-NT02 GOÄ02 GOÄ

03 Inpatient services03 Inpatient services04 Service catalog04 Service catalog

Serv.cat.m

ax.99

Serv.cat.m

ax.99


Billing Methods

Inpatient Billing

General nursing charge

Procedures surcharge

Departmental per diem

Flat rate per case

Pre-admission and post- discharge flat rates

Other services

Observ. patient services

Direct patient billing

Outpatient BillingOutpatient Billing

Self-pay patient invoiceSelf-pay patient invoice

Direct patient billingDirect patient billing

Health ins. co. billing (via Health ins. co. billing (via integr. 3rd party system)integr. 3rd party system)

Outpatient surgeryOutpatient surgery

Worker’s Comp. billing Worker’s Comp. billing (w/o spec. Worker’s (w/o spec. Worker’s Comp. reporting)Comp. reporting)


Billing

Billing of: Billing of: Departmental per diemDepartmental per diem pre-admission, post-discharge treatmentpre-admission, post-discharge treatment Flat rate per caseFlat rate per case Procedures surchargeProcedures surcharge Outpatient surgical proceduresOutpatient surgical procedures

Interim billing, test billingInterim billing, test billing

Selective billing of certain servicesSelective billing of certain services

Selective billing by insurance provider type Selective billing by insurance provider type or insurance provideror insurance provider

User-defined formsUser-defined forms

User-defined pricingUser-defined pricing

Flexible revenue accountingFlexible revenue accounting


Misc.ext. proc.Ext. servicesServicesPersonnelCapital

AM HR MMIS-H MM-

SRV FI

Material

CO-OPA

CO-CCA

IS-H

CO-PA

Hospital Costing and IS-H

C o s t E l e m e n t sC o s t E l e m e n t sOverhead costsOverhead costsDirect costsDirect costs

AccrualsAccruals

Cost objects

CaseBase nurs. chargeDept. treat. chargeProced. surchargeFlat rate per case

Cost centersCost centers

Profitability analysisProfitability analysis

Patient, case category, servicePatient, case category, service

Invoices

SAP AG IHP0021E (Dr.Bürkle) 17.06.1996 / 1 Dr. Roland Bürkle SAP AG R/3 Industry System for...

Documents

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