R/3 Industry System for Hospitals IS-H Overview

1. R/3 Industry System for HospitalsIS-H Overview Dr. Roland Bürkle SAP AG

2. 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

3. Overview IS-H FI Finance CO Controlling MM Material Manage- ment R / 3 Client / Server ABAP / 4 AM Asset Manage- ment PS Project system OC Office & Communi- cation PM Plant Main- tenance IS-H Hospital Systems HR Human Resources IS-HPM Patient Manage- ment IS-HPA Patient Accoun- ting IS-HCO Hospital Con- trolling IS-HCM Communi- cation R/3 Hospital Solution . . . . 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.

4. 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

5. Overview IS-H Patient Movement Case Master data Patient-rel. insurance relationship Risk informations Medical records Services Diagnoses Nursing acuity Assigned cases (e.g., companion) Case-related insurance rel. Movement data Assignment - to org. units - to building units Business partner Organizational units Building units -Clinic -Department -Station -Employee *Physicians *Nursing staff -External physicians -External hospitals -Insurance providers -Room -Bed location Catalogs Postal codes Risk factors Diagnoses ... Data Structures in IS-H Patient Management Admittance Inpatient Outpatient visit Patient Outpatient

6. Patient / patient related objects Hyperten- sion Risk factors Diabetes mellitus Patient 1000000292 Mr. R.Miller 03-12-1934 male Main Street 1 . . . Fa. Cartier Juweler Case Inpatient case 1 . . . Inpatient case n Outpatient case 1 . . . Outpatient case n Business partner : Employer AOK DKV Patient related insurance relationships Business partner : Insurance provider Self-pay patient Documents

7. Case / Movement Movement Admission Transfer Leave Outpatient Discharge Building units Organizational units Case 2000000821 Diagnoses Department: Surgery Case Newborn Department: Surgery 1000000222 Department: Surgery Appendicitis AD Appendicitis HD ... ... -Outpatient -Observation Case-to-case assignment Companion -Outpatient Case-related insurance relationship Case classification AOK -Refer. physician -Attend. physician Operations Patient group Treatment type: Dialysis PPR Newborn status . . . . . . . . . DKV Services Self- pay 01.02.EA1/S2 02.02.EA2/S2 03.02.EA2/S2 04.02.EA1/S2 05.02.EA1/S1 . . . . . . . . . 4711 Service 1 1623 Nursing A . . . . . . . . . Patient-related insurance relationship

8. Patient history Patient movements Surgery A A D M I S S I O N D E P T Station C1 L Station C2 AO Pre-admission treatment T A Emergency treatment Internal medicine B Outpatient treatment Stat. I1 Stat. I2 D Post-disch.treatment A: Admission (inpat./outpat.) O: Outpatient visit T: Transfer L: Leave D: Discharge

9. Nurse Station Management

10. Dr. Black Dr. Welby Outpatient Department Scheduling Outpatient Referral Treatment rooms Station 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

11. AOK Case 1 Insurance relationships Patient DKV Case 2 Self- payer 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

12. 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

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

14. 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

15. 100 80 60 40 20 0 1 2 3 4 5 6 Rechnung Summe GOÄ ... ICPM Patient Accounting - Overview AOK Insurance verification process Management Health insurance Patient Analyses Invoice AOK Service entry Insurance provider Health insurance

16. 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)

17. Charge Master 04 Service catalog Serv.cat.max.99 03 Inpatient services 02 GOÄ 01 DKF-NT Charge No. Service Points Special costs Genl costs Pat.-rel. costs Comp. costs 2 14 ... Consult Certification 86 31 1.90 1.90 1.90 11.50 4.20 Services Catalog columns max. 99

18. Billing Methods Inpatient Billing Outpatient 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 Self-pay patient invoice Direct patient billing Health ins. co. billing (via integr. 3rd party system) Outpatient surgery Worker’s Comp. billing (w/o spec. Worker’s Comp. reporting)

19. 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

20. CO- OPA CO- CCA CO- PA Hospital Costing and IS-H IS-H MM- SRV AM HR MM FI Capital Personnel Material Services Ext. services Misc.ext. proc. C o s t E l e m e n t s Accruals Direct costs Overhead costs Cost objects Cost centers Case Base nurs. charge Dept. treat. charge Proced. surcharge Flat rate per case IS-H Invoices Profitability analysis Patient, case category, service