SAP IS-H Functions in Detail - R3 System - Hospital Information System PDF

Functions in Detail - IS-H
R/3 System
Hospital
Information
System
Chapter 1
Current Challenges Facing Hospitals
Current Challenges Facing Hospitals

The hospital of today faces dramatic structural changes in the healthcare field. As Structural Changes in
a result, there are numerous requirements as well as new opportunities for suc- Healthcare
cessfully managing the hospital of the future, such as:
Competition between hospitals and the burden of financial risk shift from Competition between
insurance companies to healthcare provider leading to the need for better in- Hospitals and Risk Shift
ternal controlling of hospital processes.
Constant change of legislative requirements regarding charges leading to short New Types of Charge
possible reaction times for their fulfillment.
Larger hospital organizations with the need for better information structure.
Increased integration of inpatient and outpatient treatment (such as pre-ad- Integration of Inpatient and
mission and post-discharge treatment, outpatient surgery) and clinical and Outpatient Treatment
administrative tasks in hospitals.
Outdated technology infrastructure leading to high maintenance effort, redu- Technology Requirements
ced scalability and slow changes in the information infrastructure.
A critical component for meeting these requirements is the use of a hospital-wide Integration of Medical Care,
information and communications system which consistently reflects and offers Nursing Care and
integrated support for the processes involved in providing support for all admi-
Administration
nistrative business processes in hospitals, whether they are performed in the ad-
ministrative department or by nurses and doctors. A tight integration component
with departmental systems is also provided.
In partnership with hospitals and competent system houses, SAP AG has developed SAP Hospital Information
such a leading-edge hospital information system which meets these modern re- System
quirements and which has demonstrated its capabilities and reliability in numerous
customer installations. This system will be presented in the following chapters.
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Chapter 2
SAP Hospital Information System
SAP Hospital Information System

SAP Hospital Information System Components
This brochure describes the architecture and performance features of the Industry
Specific solution for Hospitals (IS-H). It provides a leading-edge, patient-orien-
ted Hospital Information System when used together with the standard SAP busi-
ness applications for:
Financial Accounting
Assets Management
Controlling
Material and Inventory Management
Maintenance Management
Human Resources Management
Fig. 2-1: The SAP Industry Solution for Hospitals
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2 SAP Hospital Information System
Overview of the Standard SAP Business Systems

The standard SAP business systems included in the healthcare industry solution
offer the following functions (for more detailed information see the brochures
describing the functions of the individual modules). If you want direct informati-
on on the patient management and accounting part, please proceed to Chapter 3.
Financial Accounting
Uniform Database The financial accounting applications use a uniform database for general ledger
and sub-ledger accounting which is also an important prerequisite for integrating
financial accounting and controlling.
Common Chart of Accounts At the core of this database is the shared chart of accounts which is flexible and
can easily be adapted to the needs of individual hospitals. Single documents are
Document Principle used to enter and store all posting transactions in financial accounting. These
documents contain both the data for general ledger and sub-ledger accounting
Integrated and account assignment information for controlling and allow integrated and in-
Interactive Processing teractive processing by simultaneously updating all financial accounting and con-
trolling data. You can display the latest financial accounting data such as account
Real-Time Processing balances, profitability analyses, or key figures. In addition, you can retroactively
display any document with all document lines and additional account assign-
ments or key data for interactive review of business transactions. In addition to
general ledger accounting, financial accounting offers the following functions:
Accounts Receivable The Accounts Receivable module handles the traditional tasks of accounts re-
ceivable management (open items, incoming payments, dunning, etc.). An
accounts receivable master record is created from Patient Management for each
patient with payment transactions and for each insurance provider (e. g.
health insurance companies). This master record tracks open items and inte-
grates down payments and copayments.
Accounts Payable The Accounts payable module maintains and manages the accounting data
for all vendors and integrates them with the purchasing functions of the Ma-
terials Management System.
Financial Controlling Financial Controlling is a tool for short-, medium- and long-term liquidity
planning with electronic banking support.
Financial Assets/ -Inputs Management of financial assets and inputs.

Funds Management Funds Management for planning and controlling budgeting and funds utili-
zation with active availability control.
Consolidation Consolidation to generate consolidated financial statements.
Financial Accounting is a real-time system independent of charts of accounts which is set

up based on the documentation principle. It offers fully integrated sub-ledger accounting
and extensive functions.
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SAP Hospital Information System 2
Asset Management
A look at balance sheets and capital spending lists confirms the importance of
fixed assets for todays hospitals: medical equipment and devices, physical plant
and technical equipment represent a steadily increasing percentage of a hospitals
physical and liquid assets.
The SAP Asset Management System covers the complete life cycle of fixed asset Compliance with Legal
items and contains all functions necessary to comply with government regulations: Requirements
The Investment Management module integrates planning and control of capi- Investment Management
tal with asset accounting. It allows alternative profitability calculations, bud-
geting of capital investment projects and monitoring adherence to budgetary
limits.
The Asset Accounting function records, calculates and processes acquisitions Asset Accounting
and retirement of assets, repostings, depreciation and write-ups. You can ap-
ply the legally mandated valuation methods as well as define and apply mul-
tiple depreciation and valuation methods for internal cost accounting. These
include preliminary invoicing and interactive simulation to analyze the Preliminary Invoicing
effects of parameter changes in such areas as depreciation methods. The
Reporting module allows controlling-oriented evaluation of key figures and Asset Information System
rankings of relevant objects in addition to government mandated reporting.
In the overall model, Asset Accounting is the sub-ledger accounting part of Integrated
the Financial Accounting System and is also fully interactive. The Asset Ac- Interactive Processing
counting System is integrated not only with Financial Accounting, but also
with the Cost Accounting and Materials Management Systems.
The options available in the system provide appropriate support for handling Support of Hospital
hospital-specific financing problems. Specifications
Technical Assets Management is used to administer and manage maintenance Technical Assets Management
orders. The features of this module include planning, entering actual data,
cost evaluation and settlement for common maintenance orders. For com-
plex, one-time maintenance orders a project system can be used, which is part
of Asset Accounting and provides advanced resource planning functions.
Integrated assets management allows you to meet legal requirements. In addition, it can
be used for planning and control of capital investment projects, detailed analysis of all
assets and for technical assets management.
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Controlling
Centralized Controlling Tool Controlling is generally understood to mean the hospital-wide control of all mea-
sures for optimizing profitability. This requirement can only be met by using a
comprehensive cost and income controlling system. The SAP Controlling System
offers the following tools:
Cost Element and Cost Cost element and cost center accounting for short-term planning and control
Center Accounting related to specific areas.
Order and Project Order and project cost accounting for the ongoing control and analysis of re-
Cost Accounting source utilization.
Cost Object Controlling Cost object controlling is used to plan and control costs and revenues from
hospital services, such as procedures surcharges, flat rates per case, or depart-
mental per diems.
Profitability Analysis Profitability analysis analyzes hospital services provided based on sales, costs,
and contribution margins with multiple summaries to show the results for
individual service groups.
Profit Center Accounting Profit center accounting generates periodic results analyses for individual ser-
vice areas of the hospital.
Executive Information The Executive Information System (EIS) is a flexible and easy-to-use system to
System (EIS) enter and process hospital-wide information from all functional areas.
Integration with Financial The efficient implementation of meaningful cost and profitability controlling re-
Accounting, Logistics and quires both the complete integration of the individual Controlling modules and
the integration between Controlling and Financial Management, Assets Accoun-
Human Resources
ting, the Logistics Systems of Materials Management and Maintenance, Human
Resources Management and in particular the hospital-specific patient accounting
systems, service communication and medical documentation. Cost object con-
Integration with trolling without complete, process-oriented integration between Controlling and
Patient Management Patient Management is simply not possible, since the Patient Management modu-
le maps all patient-related processes involved in providing hospital services.
Interactive, The SAP Controlling System is interactive and supports the simultaneous opera-
Various Cost Accounting tion of various cost accounting systems, from actual cost accounting to flexible
planned cost accounting.
Systems
Flexible Information System It offers a comprehensive, flexible reporting and information system with which
the displayed values can be traced back to the single document. The government
mandated cost accounting reports can be generated very easily.
The SAP Controlling System makes it possible to implement a meaningful cost and service
analysis including detailed cost object controlling.
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SAP Hospital Information System 2
Materials and Inventory Management

The Materials Management System facilitates fully integrated processing of all Central Warehouse
logistic transactions in the central warehouse and pharmacy utilizing the follo- and Pharmacy
wing functions:
Consumption-based materials planning according to the reorder point proce- Material Requirement
dure or based on forecasts. Planning
Purchase processing from requests for bids to vendor selection and monito- Purchasing
ring of order placement.
Stock and warehouse management with online display of the processes affec- Stock and Inventory
ting stock (goods received, stock removal, stock transfers, stock corrections, Management
etc.) with the option of managing various warehousing structures as well as
inventory management.
Largely automated invoice verification. Invoice Verification
Inventory Controlling with variable evaluation options. Inventory Controlling
The components of Materials Management are fully integrated into Financial Ac- Integration of Financial
counting and Controlling. This means that value-based stock is updated at the Accounting and Controlling
same time as quantity-based stock. In addition, material consumption data and
the corresponding account assignment (e.g. to a cost center or to an order which is
related to a cost object) are transferred directly to Cost Accounting. Based on this Analyses of Medication
data, you can perform detailed analyses of medication utilization, either for each
Utilization
nursing station (ward) or cost center and, if the controlling system is configured
accordingly, also for each cost object.
The Materials Management System integrated into Financial Accounting permits efficient
purchasing and inventory control as well as detailed consumption analyses.
Maintenance Management
Maintenance has gained in importance with the increasingly high-tech nature of
hospitals. The (Plant) Maintenance System (PM) provides extensive tools which Maintenance Planning
enable you to meet all requirements in this area, from management of non-patient
technical and medical equipment to maintenance planning and processing and
closing of maintenance work orders. The system also includes extensive analysis Maintenance Orders
capabilities that provide up-to-date overviews of the status and history of techni- Comprehensive
cal objects. This module is an integral part of the SAP system, which means that Analysis Options
data regarding the cost of maintenance work orders flows directly to Controlling
and Asset Management.
The Maintenance System is suitable for general maintenance and processing for the entire
technical structure of the hospital.
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Human Resources
Common Functions The SAP Human Resources System covers all aspects of human resources mana-
gement, from the selection of applications to master data administration, shift
planning, time management and payroll procedures and further education and
High Degree of Flexibility training planning. The system is flexible and can easily be adapted to legal and
pay scale requirements and to specific situations such as internal company agree-
ments. Like all SAP systems, it is completely interactive: all functions are availa-
Integration into Financial ble online and fully integrated with other SAP modules. Payroll as well as travel
Accounting and expense data is transferred automatically to Financial Accounting and Cost Ac-
Cost Accounting counting. Specifically, the Human Resources System covers the following areas:
Personnel Planning Personnel planning (organization and position descriptions, qualifications and
requirements, planning and management of further education and training
measures, etc.)
Recruitment Applicant management and selection
Personnel Data Management Personnel data management (flexible definition of subject matter and functio-
nal processes)
Shift Planning Work schedule and shift planning
Time Recording Time recording and evaluation
Payroll Management Flexible payroll accounting

Trip Costs Accounting Travel expense accounting
Statements Statements and numerous evaluations and statistics
Suitable for the Public Sector The system is suitable both for private enterprises and the public sector.
The Human Resources System supports all personnel aspects including payroll and repor-
ting for private enterprises and the public sector.
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Chapter 3
The IS-H Architecture
The IS-H Architecture

Structure and Components of the Hospital-Specific
IS-H System
The hospital-specific IS-H system supports all aspects of patient management. As Integrated Patient Database
the central component of the SAP Hospital Information System it manages the
(relational) patient database which contains integrated data for administrative,
medical and nursing purposes.
The IS-H system currently includes the following application components: IS-H Application Components
Patient Management (inpatient, outpatient) IS-HPM
Patient Accounting (inpatient, outpatient) IS-HPA
Hospital Controlling IS-HCO
Communication IS-HCM
All IS-H application components are based on a universal data model which is Universal Data Model
part of the central R/3 data model and ensures full integration with the other SAP
standard systems.
Data Model
The SAP Hospital Information System utilizes a hospital-wide data model. The Hospital-Wide Data Model
system formally maps all relevant data structures within the hospital, such as
patients, cases, diagnoses, services, invoices, etc. and the relationships between
them. For data modeling, an advanced version of the classical entity relationship Entity Relationship Model
model (ERM) which increases the transparency of large data models as they are
required for comprehensive, integrated information systems is used.
Modeling of the data structures within a hospital is an important step in the de- Essential Development Basis
velopment of a hospital information system, because it forms the basis for a logi- Open Data Model as
cally designed, flexible, fully integrated, and fully functional system. In addition,
Implementation and
the availability of a data model with open data structures facilitates the subse-
quent implementation of the system and any necessary enhancements. Enhancement Tool
Excluding the partial-data business models of the complete SAP Hospital Infor- Realistic Data Structure
mation System, the IS-H data model consists of approximately 150 entities which
ensures a sufficiently realistic system (see the IS-H data model excerpt in the ap-
pendix of this brochure).
The IS-H data model is:
Patient-oriented
In contrast to a strictly case-oriented approach, multiple cases (inpatient, out- Patient as Central Object
patient, observation patient) can be assigned to a patient, and corresponding
movements (admission, transfer, discharge, leave of absence, outpatient vi-
sits) can be assigned to these cases, which provides a comprehensive picture
of the patient including all relevant data.
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3 The IS-H Architecture
Integrated
Integration Requirements The IS-H data model takes account of the integration requirements of a hospi-
tal information system with regard to:
Integration between Integration between outpatient and inpatient areas to ensure transparency
Administration/Medical Care between these treatment types.
Integration between Nursing Integration of administrative, medical and nursing requirements by

Station/Outpatient Clinic providing a patient-oriented data model with all relevant data to avoid
duplicate data entries and redundancies.
Integration between Patient Integration of patient-related and business-related aspects to utilize

Care/Business patient-related information as a basis for charge determination and hospi-
tal controlling.
Administration
Realistically structured
Flexible, Linked Hospital The hospital structures are depicted in a flexible and realistic manner; the buil-
Structures ding structure and cost center structures are represented and linked together
as different views of a hospital rather than combined in an unstructured re-
presentation.
Implemented in a relational database
Open Relational Structures All data model objects and their attributes are stored in open tables of a rela-
tional database which is described in a central repository and is included in
each R/3 system delivered to the customer.
Functional Structure
IS-H currently contains the following application components:
Patient Management (IS-HPM)
Patient Accounting (IS-HPA)
Hospital Controlling (IS-HCO)
Communication (IS-HCM)
These components provide the following main functions:
Patient Management (IS-HPM)

Patient Movement
Movement-Related Movement-related processing of patient, case and movement data for inpati-
Processing of Patient, Case, ent or outpatient admissions, outpatient visits, pre-admission and post-dischar-
ge treatment, transfer or discharge and for the admission of companions and
and Movement Data newborns.
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The IS-H Architecture 3
Patient Master Data

Processing the specific, system-wide patient master data for each patient. This Managing the
patient master record is the basis for all further patient-related inpatient and Patient Master Data
outpatient information.
Case Data
Isolated data processing for a specific case such as case information, move- Processing Case Data
ments, insurance relationships, services or medical information.
Nursing Station Management
Planning of beds in an organizational unit which supports beds (such as a Bed Planning
nursing station) with the purpose of allocating a bed to a patient, recording
nursing categories as a basis for determining nursing acuities and performing Nursing Acuities
additional nursing station-related functions.
Outpatient Department Management
Scheduling appointments for outpatient visits based on the availability of re- Appointment Scheduling for
quired resources (e.g. physician, treatment room) and different types of visits, Outpatient Visits
status management for visits.
Patient Inquiry
Providing patient- or case-related information (such as master and movement Work Lists
data) for one or several specifically selected patients as work lists (e.g. patient
list, admission list, nursing station overview).
Forms and Work Organizers
Event-driven output of forms (such as admission forms) and work organizers Event-Driven Output of
(e.g. labels, magnetic cards) for a patient based on a preset number and on Forms and Work Organizers
freely selectable media (e.g. printer, card embosser) depending on the assi-
gned organizational unit.
Medical Record Administration
Management and administration of (borrowed) medical records and library Medical Record
management. Administration
Mandatory Patient Medical Information
Standardized patient-related documentation of treatment data, in particular Internal and External
diagnoses, risk factors and surgical procedures. Reports
Information Retrieval and Reporting
Statistical evaluation of patient and structural data for internal purposes (busi- Mandatory Patient Medical
ness policy) and external reporting. Information
IS-HPM covers all patient administration requirements for inpatient and outpatient pur-
poses and supports nursing station and outpatient department management as well as
mandatory patient medical information.
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3 The IS-H Architecture
Patient Accounting (IS-HPA)

Insurance Relationships
Patient- and Case-Related Patient- and case-related entry of multiple insurance relationships of a patient
Insurance Relationships with insurance providers, administration of self-pay patients and patients
required to make copayment.
Treatment Certificates
Different Types of Treatment For outpatient case billing, different types of treatment certificates can be en-
Certificates tered and the services performed can be assigned to them.
Service Entry
Case-Dependent and Case-dependent and case-independent documentation of services for service
Case-Independent billing, service planning, and service allocation in cost center accounting and
cost object controlling. Use of a hospital-specific service catalog to represent
Documentation of Services
the range of services for outpatient and inpatient cases.
Insurance Verification
Comprehensive Management Highly automated determination of a customers payment obligation (insuran-
of the Insurance Verification ce provider, self-pay patient) for case-related, billable services. Managing com-
Process munication with insurance provider and insurance verification monitoring.
Copayment
Copayment Management Managing copayments integrated into Financial Accounting based on recei-
vable or collection procedures.
Down Payment
Managing Case-Related Entering case-related down payment requests and down payments integra-
Down Payments ted with Financial Accounting.
Billing
Outpatient and Billing for billable services related to outpatient and inpatient cases, indivi-
Inpatient Accounting dually or as a collective invoice for many cases which are determined by case
selection (e.g. by case type, patient name, admission and discharge dates, bil-
ling status). The module fully supports new charge methods such as flat rates
per case, procedures surcharges, basic nursing charges and departmental per
diems, outpatient surgery, etc.
Integration with Accounting Copayments and down payments made by the patient are taken into account,
Accrual and Deferral posting records are generated and transferred to Financial Accounting and
Cost Accounting. Reversal management and accruals and deferrals are sup-
ported.
Internal and Numerous evaluations of the billing and service data for internal purposes
External Reports (business policy) and external reporting.
IS-HPA provides comprehensive support for entering and billing services performed for
outpatient and inpatient cases and their statistical analysis.
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The IS-H Architecture 3
Hospital Controlling (IS-HCO)

Controlling - Master Data
Linking organizational units with cost centers, posting rules for assigning hos- Linking IS-H with
pital services from the services catalog to activity types under Controlling and Controlling Objects
assignment of preliminary costing to hospital services.
Cost Center Accounting
Posting hospital services performed to the cost centers involved with the opti- Integration of
on of posting additional statistical orders. Posting profits to profit centers. Cost Center Accounting
Cost Object Controlling
Posting the costs of case-related, documented hospital services to case-related Integrated Cost Object
orders. Extended services such as nursing charges are assigned to the respec- Controlling
tive time periods. Revenues from a case are also posted to the related order.
Order summaries for analysis.
IS-HCO provides a link between IS-H and the SAP Controlling System to implement me-
aningful cost and profitability controlling.
IS-HCM Communication
Asynchronous transmission of patient data to subsystems. Event-driven trans- Patient Data Transmission
mission of patient, case, and movement data to authorized subsystems. Ex-
amples of events are the admission, transfer, or discharge of a patient. Profile
options determine which subsystems receive which data at what time and the
structure of the messages to be transmitted. A protocol converter allows the
use of SAP message formats and supports individual communication struc-
tures and the use of HL7.
Asynchronous transfer of service and diagnostic data from subsystems. Transfer of Service and
Automatic transfer of service data and diagnoses from non-SAP systems or a Diagnostic Data
hospital-specific format is supported. from Subsystems
Synchronous admission reporting to subsystems.
Express dispatch of data on admitted patients to authorized subsystems.
Synchronous access to IS-H data from subsystems. Synchronous Access to
Synchronous access to IS-H Data such as patients, cases, or services via remo- IS-H Data
te function calls.
External communication with insurance providers Insurance provider
Providing data for transmission or receipt.
IS-HCM supports communication between IS-H and subsystems and insurance providers.
3-5
Chapter 4
Basic Data
Basic Data
IS-H Basic Data Structure
To be able to use the operational functions in IS-H for patient management, bill-
ing, etc., you first need to enter the basic data for the hospital in the IS-H System.
This data includes firstly information on the hospital structure. Hospital Structure
To present the hospital structure in a flexible and realistic manner and to take into Hospital Structure Views
account the various informational requirements, IS-H provides the following views
of the hospital structure:
Organizational Structure
Building Structure
Cost Center Structure
Fig. 4-1: Hospital Structures
These structures and the relationships between them are represented in the IS-H Flexible Representation of
System based on each hospital situation. Using different views has the important Structures
advantage that the various aspects of the hospital structure can be represented
and changed without regard to the other views. When a structure is changed, you
only need to adapt the affected links to other structures.
4-1
4 Basic Data
Business Partners The basic data further includes the business partners, i.e. the persons or institu-
tions which have a business relationship with the hospital, such as insurance pro-
viders or external physicians. Moreover, the IS-H System enables you to store
Charge Masters multiple charge masters for service entry and billing as well as many other cata-
logs. This makes data entry simple and safe (error-free). Examples are catalogs for
Catalogs for Diagnoses, diagnoses, surgical procedures, risk factors, postal codes, geographical areas, etc.
Surgical Procedures, etc. The following figure shows an example of how basic data is used in operational
functions.
Fig. 4-2: Basic Data and Operational Functions

As a simple check, a subset of the basic data entered can also be represented graph-
ically (e.g. the organizational structure in an organizational chart).
4-2
Basic Data 4
Hospital Structures
Organizational Structure
The organizational structure considers an institution strictly under organizational Organizational Hierarchy
aspects. It defines the various structural units (organizational units) and presents
them in a hospital-specific hierarchy.
Each organizational unit can be above other organizational units in the hierarchy. User-Definable
With the exception of the top hierarchy level, each organizational unit can be as- Hierarchy Levels
signed to exactly one higher-level organizational unit. For example, certain nurs-
ing stations are under a department which in turn belongs to a clinic. The number
of hierarchy levels is freely definable and is usually based on factors such as hos-
pital size.
In case of multi-specialty bed assignment to an organizational unit such as a nurs- Multi-Specialty Bed
ing station, both the higher-level department and the departments assigning beds Assignment
are recorded. With this procedure, bed assignment to organizational units can be
precisely controlled during admission and transfer.
The user-definable organizational category (OE category) which is part of each User-Definable Organizational
organizational unit specifies the particular tasks of each organizational unit. It Unit Categories
determines the basic functions of organizational units of a specific category, such
as outpatient treatment or nursing care of patients assigned to an organizational
unit. This provides maximum flexibility for representing the organizational struc-
ture in IS-H.
Cost centers and building elements can be assigned to defined organizational struc- Assignment of Cost Centers
tures. Cost centers are required for hospital controlling, building elements for the and Building Elements
assignment of beds or rooms to the patients of an organizational unit (e.g. a nurs-
ing station). These links - and those of the organizational hierarchy - can be limit-
ed to specific time periods so that structural changes can be tracked. The time
periods are checked for overlaps and periods when no assignments were made, to
the extent this is necessary for data structure consistency.
The organizational structure is used to represent the hospitals organization with as much
detail as necessary, independent of all other structures.
Building Structure
User-definable building units such as bed locations or rooms, their equipment, User-Definable Building Units
availability, position in the hierarchy, and time-based relationships to the organi-
zational structure constitute the building structure of the hospital operation. This
is particularly important when planning the use of space (e.g. bed assignment, Planning Basis
scheduling of treatment rooms in outpatient departments) based on the assign-
ment of patients to specific rooms.
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4 Basic Data
User-Definable The building structure is organized in a hierarchy similar to the organizational struc-
Hierarchy Structure ture. The specific hierarchy of building units in a hospital is user-definable. A build-
ing unit can be at a higher level than other building units. With the exception of the
top hierarchy level it can be assigned to exactly one higher-level organizational unit; a
Concept Includes All hospital room, for instance, is at a higher hierarchy level than a bed location. While the
Institutions organizational structure is defined within a specific institution, the building structure
includes all institutions so that building units can be shared by several institutions.
User-Definable Building Each building unit is assigned a category which in turn specifies its purpose. For
Unit Categories example, building units must be assigned the types hospital room and bed
location so that a room or bed can be assigned to a patient during his/her stay.
Equipment Features and Equipment features (room with bathroom, oxygen supply, telephone) as well as
Planning Data planning data (maximum room occupancy, non-availability due to disinfection or
construction) can be stored on a time-dependent basis.
Building units, their features and hierarchy, and their assignment to organizational units,
are all defined under building structure.
Cost Center Structure

Assignment to The cost centers and their relationships are defined in the SAP Controlling System
Organizational Units and CO, which is integrated with IS-H. An assignment to organizational units and
cost centers, as described above, is necessary so that the account assignment infor-
Cost Centers
mation (for instance, services of a sending to a receiving cost center) required for
Controlling can be derived from the data available in IS-H regarding services pro-
vided for a case or an (ordering) organizational unit. (For more detailed informa-
tion, see the description of the Hospital Controlling module IS-HCO).
One or Several Cost Centers In the simplest case, one organizational unit is assigned to exactly one cost center. In
For Each Organizational Unit case of multi-specialty organizational units (e.g. nursing stations), several cost cen-
ters, such as a separate cost center for each assigning department, can be assigned to
one organizational unit.
Cost accounting and organizational data or analysis views can be defined inde-
pendently of one another, but are fully integrated provided that the contents of
the respective structures match.
The cost center structure is linked with the organizational structure for controlling
purposes.
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Basic Data 4
Business Partners
The business partner concept allows you to centrally manage the various func- Central Business Partner
tions of persons and institutions that have a business relationship with the hospi-
tal. The system distinguishes between various functions of business partners based
on the type of business relationship. For example, a physician can be both the
referring physician and (with respect to financial accounting) the customer. An-
other hospital may act both as a customer and an employer.
Information stored for a business partner is divided into general (function-inde- General and
pendent) data (names, address, communication data) and function-specific data. Function-Specific Data
The function-independent data for a business partner is stored centrally and only
once.
IS-H manages the following business partner functions: Functions of a
Hospital Business Partner
All hospitals having contact with your hospital, for example, referring Hospitals
hospitals.
Employers
Employers whose names frequently appear can be stored as business part- Employers
ners. The patients master record can refer to this employer.
Insurance Providers
All insurance providers with which patients have an insurance relationship Insurance Providers
and their respective data must be entered as business partners. Insurance
providers of specific types can be grouped together (e.g. local health insur-
ance fund, employer-specific insurance fund of a district, workers compensa-
tion associations, welfare agencies). In addition, a central provider can be
maintained for billing purposes.
Employees/External Physician
Indicators are used to distinguish between employees and external persons, Employees/External
physicians, members of the nursing staff, and other areas. External physicians Physicians
are marked with an additional indicator.
Customer
IS-H Customer provides a link to Financial Accounting where all customer- Customers
specific information is managed.
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4 Basic Data
Charge Masters
The charge masters which can be stored in the system are the basis of the complete
service documentation in IS-H.
99 Different Charge Masters A maximum of 99 different charge masters can be stored simultaneously in the
IS-H System. The most important charge masters are provided by SAP. The SAP
user can change or expand existing charge masters or create completely new charge
Internal Service Catalog masters. One charge master should be defined as the internal service catalog to be
for Service Entry used for service entry. Services in the service catalog may be converted to one or
Conversion more services of other charge masters for billing or statistical purposes.
Flexible Basic Structure Charge masters are basically structured as follows:

Charge Master Columns
User-Definable Charge Each charge master has one or more columns in which the data required for
Master Columns the services of this catalog can be entered. Examples of entries into these col-
umns are charge factors, prices and different cost values. The type and num-
Allows Structural Changes ber of columns is specified for each charge master and may be defined based
on hospital-specific needs. You can also add columns to existing charge mas-
ters. This open system allows you to change the structure of charge masters or
adapt them to hospital-specific needs.
Fig. 4-3: Charge Master Structure
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Basic Data 4
Services
Multiple services can be stored in each defined charge master. Each service is Multiple Services
described by general information and by the respective entries in the columns
of this charge master. General data include:
Service and DP number
Name of service
Valuation formula
Charge type
Value-added tax indicator
Maximum length of stay (normal, intensive)
Regular length of stay
The column entries may be related to specific time periods so that charge mas- Time-Related Column Entries
ter histories allow retroactive billing runs and convenient maintenance of
charge maters. In addition, each service is only valid for a certain time period.
The charge master can contain a great number of heterogeneous services, in-
cluding:
Nursing, medical or basic services in the outpatient and inpatient area. Different Types of Services
Immediate services such as laboratory or radiology services, or extended
services such as nursing services.
Billable or non-billable services.
Controlling-relevant services or services only needed for other purposes.
Objects of Cost Object Controlling such as procedures surcharges or flat
rates per case, or services which are not objects of Cost Object Controlling.
The service catalog can be designed to represent all services provided through- Service Catalog as Hospital-
out the hospital so that the entered services can be used in all required areas, Wide Charge Master
such as billing for inpatient and outpatient services, service communication,
Cost Object Controlling , or documentation.
Service Groups
Services can be combined in service groups (see Fig. 4-4). This helps define Different Groupings
department-related service profiles, simplify the management of the insur-
ance verification process, or define service exclusions or service combinations.
This significantly increases user friendliness. Different groups can be defined
for different purposes.
4-7
4 Basic Data
Fig. 4-4: Service Groups
Price Information
Price Modifications In addition to charge factor values or cost information for a service, price mod-
as Conditions ifications (e.g. surcharges and discounts) can be stored as conditions which
need to be taken into account when billing this service.
Conversion Rules
Conversion Rules In addition to the actual charge masters, it is possible to store rules for con-
verting the services of one charge master to those of another charge master.
This is particularly important for billing purposes, if billing is based on a bill-
ing charge master which is different from the charge master used for entering
the service.
Code Catalogs
Possible Entries Facility To allow the simple, fast, and error-free entry of information such as patient, case,
or service data, IS-H offers many input facilities based on charge masters and
code catalogs stored in the system. Rather than having to make manual entries
into fields, you can call a dialog box containing possible entries for input from a
predefined catalog, from which you can make your selection. When data is en-
Checking the Input Value tered manually, the entered value is checked against the corresponding catalog to
avoid incorrect entries. Examples of such catalogs are postal codes, forms of ad-
dress, admission types, etc. Other data such as geographical areas can be deter-
Automatic Data Entry mined automatically from catalogs and does not have to be entered manually. IS-
H can also manage national or international medical code catalogs such ICD-9,
ICD-10, or ICPM.
Major catalogs are already included in IS-H and will be supplied with the
system.
4-8
Chapter 5
Patient Management
Patient Management
Patient Master Data
The system contains one master data record for each patient. This record is the Central Patient Master
central element linking all administrative, medical, and nursing care data. As a Record
result, both outpatient and inpatient procedures are made available via a single
view.
Fig. 5-1: Patient Master Record and Related Information
A patient is identified in the IS-H System by a unique 10-digit patient identificati- Unique Patient Number
on number which is valid throughout the life cycle of the system. The system
requires no specific semantics; the patient identification can be designed accor-
ding to your requirements and can be established, for example, as an:
An internally assigned consecutive number with a check digit Internal and External
An externally (manually) assigned number to which you add a check digit Number Assignment
An externally assigned alphanumeric patient number
Together with the identifying patient number, another number can be assigned I-Number
which can be defined, for instance, as an I-number. This allows you to switch from
the I-number method to a nonmnemonic patient number when IS-H is imple-
mented.
5-1
5 Patient Management
Case Assignment Every case for a patient is assigned to the corresponding master data record and
receives a case number unique for the corresponding healthcare institution. The
case number as well as the patient number can be assigned manually or automa-
tically.
Patient Search Using In a patient-oriented system it is essential to maintain a consistent patient data-
Combined Attributes base. To do this, you need to determine the correct patient master record both
when admitting previous patients whose master records are already in the sys-
tem, and when processing other patient-related data. Usually, the patient master
record is not selected by entering the patient number, but by using descriptive,
patient-related information. There are two possible ways to search for a patient:
either by entering combinations of patient-specific attributes (see Fig. 5-2):
Search Attributes Last name
First name
Birth name
Date of birth
Gender
Search by Movements Or using movement lists, such as patients admitted during a certain period to a
selected organizational unit.
Fig. 5-2: Patient Index Search
5-2
Patient Management 5
This search using patient attributes allows you to search for a name by entering NameStandardization
only part of the name (generic entry). Due to name standardization, the search
function is not case sensitive. You may also search for compound names and for-
mer names. For last names, the phonetic search according to a freely selectable Change of Case Type
phonetic method is also supported.
Depending on the parameters set for your system, you perform a search using all Phonetic Search
patients or - if this is not desirable, or if you are restricted by data security consid-
erations - a limited search for a specific institution is possible.
If the search attributes apply to several patients, the patients found are displayed Selection Lists
in a list for subsequent selection. If it is not possible to identify a patient using the
specifications in the list, additional data is available via a dialog box (see Fig. 5-3).
Fig. 5-3: Selection List of Patients found in the Database
As an alternative to entering the search criteria manually, you can import data Healthcare Smart Card
from a healthcare smart card into the IS-H System and use it for the patient search.
One common way to search for patient master records is to use movement lists. Patient Search Using
Using this approach, you search for patients by movement and case-related at- Movement Lists
tributes. Examples are lists of all patients who were admitted, transferred, or dis-
charged during a certain period or who made outpatient visits or were registered
through quick or emergency admission during that period. These latter lists are
particularly important for selecting quick and emergency admissions for further
processing.
5-3
Unique Patient Master As stated earlier, a consistent patient database requires that exactly one patient
several features which can be activated by the user:
Convenient patient search options
Mandatory search for any existing patient master record when creating a new
record
Interactive verification to ensure that no duplicates are present before the new
patient master record is saved.
Patient Record Merging If a second patient master record was created for a particular patient, this new
record can be merged with the existing record. Related information (such as cases,
movements) will be retained.
Patient Movement
Different Movement Patient movement refers to any change affecting the patient stay with respect to
Categories location or organization, such as admission, transfer, or outpatient department
visits. These different movement categories may be processed in separate system
functions. To provide optimum support of work processes, you can manage the
Optimum Support of actual movement data and also the patient and case data depending on the cate-
Work Processes gory of movement. IS-H documents different categories of patient movements
for inpatient and outpatient cases. Companions and newborns are also taken into
account and assigned movements accordingly.
Patient Admission
Admission is the main function for entering patients in the IS-H System. You use
the function to enter all data required for administrative, medical, and nursing
purposes during the patients hospital stay.
Patient and Case Data During patient admission, both patient- and case-related data are processed. The
amount of data depends on the admission method selected (standard, quick, or
emergency admission). Outpatient, observation patient, and inpatient admission
Outpatient and Inpatient are basically structured in the same way, but differ somewhat with regard to the
Admission Method type and amount of information to be entered.
Sub-Functions Admission basically includes the following sub-functions:

Patient index search
Patient master data
Admission/referral data
Diagnostic data
Accident data
Insurance relationships/treatment certificates
Services
5-4
All functions also allow you to display or suppress fields from the screen. You also Flexible User Interface
control which sub-functions to carry out and in what order.
Patient Admission offers functions which are suitable for the hospital work processes
involved in the admission of inpatient and outpatient cases.
Standard Inpatient Admission

The standard admission screen contains all functions and fields to be completed
for patient admission.
The interactive admitting process begins with the patient search; you have to de- Patient Index Search
termine whether the patient is new to the system and a record has to be created or
whether he/she is a previous patient whose master data has only to be verified
and updated, if necessary.
The patient master data contains all attributes applicable to the patient regardless
of each individual case.
Once the patient master data has been entered or verified, the actual case is pro- Case List
cessed. If the patient is a previous patient, his/her case list will be called up (see
Fig. 5-4). At this point, you can decide whether to continue an existing case or
create a new one. A case would be continued if, for example, a scheduled patient
is admitted.
Fig. 5-4: Case List of a Patient
5-5
When admitting the case, all data relevant to the patients current hospital visit is
entered (see Fig. 5-5).
Fig. 5-5: Case with Related Information
Admission Data Admission data such as date and time of admission, admission type, reason
for the admission, planned length of stay, accident data, emergency indicator,
admission status (waiting list/planned/actual), etc.
Patient assignment: Each patient can be assigned to a:
Nursing Care and Specialty Nursing organizational unit such as a nursing station.
Assignment Specialty organizational unit such as the department involved.
Room Assignment Room and/or a bed.
Multi-specialty Assignment All system functions including Controlling support the distinction between
specialty and nursing responsibilities. This allows an easy and correct repre-
sentation of multi-specialty assignments. The system also supports two-level
admission procedures where the patient is first assigned to organizational units
only, then later to a bed, for instance, on the nursing station.
5-6
Admission data such as the referring physician, referring hospital or the refer- Admission Data
ral diagnosis.
Multiple insurance relationships between patient and insurance providers; Insurance Relationships
when self-pay patients are admitted, open items can be displayed from
Accounts Receivable.
Services to be provided to the patient such as nursing charges, personal items,
but also individual services such as laboratory tests or a flat rate per case.
Requests for insurance verification directed to the respective insurance pro-
viders can be generated directly for the billable services entered.
Fig. 5-6: Admission Data for Inpatient Case
Various catalogs and overviews (e.g. postal data, physicians, hospitals, diagnosis Patient Census Overview
code catalogs, etc.) are available in the admission procedure to simplify input. The
system also contains a patient census indicating available rooms and beds as well
as current bed assignments for specific patients. This allows optimum distribu-
tion of available bed resources as well as the most suitable room assignment. This
nursing station overview may be displayed as a table or in a graphical format (see
section Nursing Station Management).
Admission is further facilitated by automatic input functions such as geographi- Automatic Input Functions
cal areas. Parameters can be set for automatically generating service and billing
data by entering the treatment category (e.g. generating the basic nursing charge,
semi-private room surcharge and chief physician choice for private patient, semi-
private room).
During or after completing the admission procedure, definable work organizers Work Organizers
can be created, such as patient master sheets, labels, or admitting release forms.
5-7
Planned Admissions The entire admission process may be performed on the planning level or by wait-
ing lists. In this case, you only need to check and/or supplement the planned data
when the patient actually arrives. This reduces the workload during peak admis-
sion periods and greatly increases the quality of the admission process.
Standard admission enables you to enter all required patient and case data, including bed
assignment if necessary.
Standard Outpatient Admission
Outpatient Case During standard outpatient admission, patient data is processed and an outpa-
tient case with a first visit is created. The process is similar to inpatient admission
with the exception of the data which pertains specifically to the outpatient area.
Data Required for In addition to patient master data, outpatient admission requires the entry of data
Outpatient Admission such as:
Visits
Patient assignment
Referral data
Treatment certificates
Services
Outpatient Department As an alternative, outpatient department planning can be used for outpatient ad-
Planning mission by simply scheduling an appointment for a free time slot. Both physicians
and treatment rooms can be scheduled (for more information see the chapter Out-
patient Department Management).
Fig. 5-7: Outpatient Case
5-8
If treatment for an outpatient is to be continued in the hospital, the outpatient case

can easily be converted to an inpatient case. This supports the required transpar-
ency between outpatient and inpatient treatment areas.
Outpatient emergency admission enables you to enter all patient and case information
pertaining to outpatient cases.
Quick Admission (inpatient and outpatient)

A complete patient admission requires you to enter extensive data on the patient
and his/her case. The dialog for this procedure consists of several screens. In cas-
es where there is a high workload, shortage of departmental staff, or missing data,
the admission should still be performed as quickly as possible. IS-H provides an Quick Admission with
abbreviated admission function with only the minimum amount of data required Minimum Data
for proper case processing at a later time. Patients admitted via quick admission
are marked as such and their complete data can be entered at a later date. Follow- Follow-Up
up lists can be called up to remind you of such patients. This follow-up procedure
also applies to emergency admissions. If the admissions office is not staffed on the
weekend, the patient can easily be admitted to the respective nursing station, and
the missing data can be entered by the admissions office at a later time. Quick Inpatient and Outpatient
admission is available both for inpatient and outpatient cases. Quick Admissions
Quick admission allows you to quickly enter a case and add the missing data at a
later time.
Emergency Admission (inpatient and outpatient)

The emergency admission function is used to register patients who cannot be im- Incomplete Admission if
mediately identified or for whom a complete admission procedure is not per- Identification Impossible
formed. A prior patient index search is not mandatory for emergency admissions.
This form of admission is even more limited in scope than quick admission. Emer-
gency admissions are marked as such in the system and must be checked and
subsequently completed using the standard admission function. Should you dis- Complete at a Later Date
cover that the patient had already been entered in the system, functions are availa-
ble enabling you to merge patient master records.
Emergency admission enables you to quickly admit patients who cannot be identified.
5-9
Newborn Admission
Newborns as Patients With few exceptions, newborns are entered as patients after birth and are man-
aged in the system as a patient master record with an outpatient or inpatient case.
The newborns case is assigned to the mothers case.
When admitting a newborn, all statistically relevant delivery data is entered first,
such as the delivery method and time as well as the birth data of the newborn(s). In
Delivery Data/ case of a documented stillbirth, or if the newborn is not admitted after an outpatient
Birth Data delivery, the admission process can be terminated at this point - the delivery data is
stored, but no case is created for the newborn. When you enter the master data and
admission data for the newborn, certain information is transferred from the moth-
ers data record or the delivery data to make admission as simple as possible.
In the case of multiple births, all the newborns may be admitted and assigned to
the mother in one procedure.
Time-Dependent Status The assignment between mother and newborn(s) does not depend on the admis-
Information sion method, so that outpatient and inpatient assignments are possible. Whether
the newborn is healthy or sick, which is important information for patient billing,
is stored as period-dependent status information together with the newborn case.
Newborns are normally entered into the system as patients with a related case, and
assigned to the mothers case.
Admission of Companions
Separate Cases for Persons who accompany a patient and benefit from services are admitted as a
Companions separate inpatient or outpatient case. The case is assigned to the related patient on
a time-dependent basis. One person can be the companion for several patients
and vice versa.
Assigning the Companion The companions case is assigned to the patient who is accompanied either when
to the Patient the companion is admitted or at a later date, if necessary.
Companions are also entered and their cases are assigned to the respective patient (s).
Outpatient Visit
Visit in the Outpatient The planned or completed treatment of a patient in an outpatient department or a
Department/Medical Service medical service facility is entered as an outpatient visit. Such visits are possible for
outpatient cases, but also in the course of inpatient treatment or for an observation
Facility
patient. Both visits before and after an inpatient hospital stay (pre-admission and
Visits for Inpatient and post-discharge treatment) and during an inpatient stay (e.g. for a second opinion)
Outpatient Cases can be represented.
5-10
To enter and process an outpatient visit requires correct patient identification. Us- Patient Identification
ing the patient index search described previously, you may determine whether
the patient is returning or needs to be entered as a new patient. The respective
visit is then logged indicating the place and time and assigned either a Waiting
List, Planned, or Actual status. In addition, the outpatient department or medical
service facility providing treatment is specified.
If a visit has already been documented via preregistration, it only needs to be Scheduled Visits
confirmed upon the patients arrival. The visit status changes from Planned to
Actual.
Pre-admission or post-discharge treatments are entered as visits and are assigned Plausibility Checks
to the inpatient case as movements. These visits are identified as special visit types
with specific plausibility checks (e.g. maximum number of pre-admission treat-
ments, maximum time interval between pre-admission treatments and inpatient Pre-Admission and
admission, etc.). The services billable for pre-admission and post-discharge treat- Post-Discharge Treatments
ments can also be assigned to the case and invoiced as such.
Outpatient visits are used to enter treatments in outpatient departments and medical
service facilities and can be assigned to outpatient and inpatient cases.
Transfer
When a patient is transferred, the patients location is changed at organizational Changes of Organizational/
and/or building unit level (departmental, nursing station, room, or bed location Building Units
transfers). Like all movements, transfers can also be performed in planning. When
Planned Transfers
a patient is transferred, other related information such as nursing category, diag-
noses, case classification (e.g. chief physician choice), attending physician, com-
panion have also be maintained if necessary.
Fig. 5-8: Transfer
5-11
Service Documentation Since services performed for a case (for example, personal items, departmental
per diems) are always linked to specific organizational units , the extended servic-
es entered for the previous movement are automatically delimited (service split).
Services can also be processed manually to document added or deleted services.
Transfers are changes in the patients location at organizational and/or building

unit level; service data, diagnoses, etc., must also be processed.
Leave of Absence
Documenting Leave of The periods of time during which a patient has temporarily left the hospital have
Absence often to be tracked. This enables you to monitor the patients location and organi-
zational assignment, calculate the care and operational services rendered, and re-
act to changes (such as reduced nursing charges) within the accounting system.
Planned Leave of Absence Leave of absence may also be entered in planning for a future time period by
specifying the leave of absence start and end dates in advance. In this case, the
data must be confirmed and modified (if necessary) when the actual absence oc-
curs. In addition to the time frame, you also maintain the reason for the absence,
the approval, and the approving physicians, if necessary.
Periods of absence can be entered as planned or actual data, and are taken into account
for staffing, accounting, etc.
Discharge
Related Activities When you discharge a patient, discharge data such as discharge type, date and
status, post-discharge physician or hospital have be entered. In addition, certain
Entering Discharge Data activities related to the discharge are included in the processing flow, similar to
transfer processing. These activities include entering the discharge diagnosis, de-
termining the hospital main diagnosis, or checking the nursing categories of the
case for completeness. IS-H provides these processing functions when the patient
is being discharged.
Planned transfers, absence periods, and other planned movements may be can-
celed or changed.
Final Check of Services and Extended services such as nursing care charges and personal items are ended au-
Insurance Verifications tomatically. You can double-check whether benefits coverage has been confirmed
by an insurance provider for every service performed. If necessary, the case can be
billed at discharge so that private patients receive the invoice upon discharge.
5-12
Assignments to other related cases are also checked. A companion has to be dis- Assignment to Other Cases
charged together with the respective patient, unless the person is a companion for
other patients as well. The assigned cases may be discharged immediately after
the patient.
IS-H also supports planned discharges. Planned Discharges
Fig. 5-9: Discharge
Discharges can be processed together with the corresponding sub-activities.
Pre-Registration
Every patient movement, from admission to discharge, may be entered in plan- Planned Movements
ning. For example, an admission can be entered for a future date. In this case, the
patients master data and admission data such as assignment to a specific depart-
ment or applicable insurance relationships can be entered in advance.
Entering planned movements, including the services involved, becomes particu- Resource Planning
larly important when performing resource or capacity planning.
For planned admissions in particular, it is sometimes not possible to specify the Prioritized Entries in
exact date of the actual admission. In this case, the patient master data and known Waiting Lists
case and admission data such as assignment to the departmental organizational
unit or planned services are entered. These time-independent entries are given a
priority status. Based on this status, such a waiting list entry can be changed to a
planned or actual admission.
5-13
Easing the Workload of This option of entering movements in planning enables the admission personnel
Admission Personnel to enter data outside periods of maximum work load. When the movement actu-
ally occurs, the amount of data to be entered and work load peaks are reduced.
In addition to scheduling all movements, you can create a prioritized waiting list.
Variable Case Information

Hospital-Specific In addition to mandatory data which describes a case and is maintained in the
Additional Information IS-H operational functions, each hospital can define and document additional at-
tributes as additional information.
This information covers the following areas:
Case-to-person assignment
Persons may be assigned to a case with user-definable functions.
Examples: Attending nurse, attending physical therapist
Case-to-case-assignment
Cases can be assigned to each other with freely definable functions.
Examples: Organ donor/organ recipient, parents/child
Case classification
You have the option to define and maintain user-definable case attributes inclu-
ding authorized characteristics.
Examples: Treatment type: somatic/psychiatric, diet: Regular/body building/
bland/diet.
Hospital-specific additional information can be maintained in addition to mandatory case

data.
Nursing Station Management

Nursing Station-Specific Nursing Station Management offers an approach to processing patient-related data
User Interface which is different from the patient management functions described so far. It looks
at the nursing station and the patients assigned to this station. Nursing Station
Management provides the IS-H functions required on the nursing stations in a
user-friendly environment which takes into consideration the workplace require-
All IS-H Functions Available ments on the nursing stations. The general IS-H menus with all IS-H functions are
also available on the nursing stations.
5-14
An important administrative function of Nursing Station Management is bed Bed Assignment Planning
assignment planning, i.e. the planning and administration of bed assignments
within organizational units supporting beds. The room and bed listing serves as a Room and Bed Listing
starting point for bed assignment planning. It offers a summary of bed assign-
ments for each organizational unit at any level of the hierarchy at a user-defined
time. This summary shows the accumulated bed assignment numbers for this
organizational unit. The display includes information such as the number of free
bed locations, assignable bed locations, planned beds, etc. In addition, the arrivals
and departures planned for a definable period may be displayed. Starting with
the selected organizational unit, this information can be called up in detail for all
lower-level organizational units down to the lowest level, the units supporting
beds (see Fig. 5-10).
Fig. 5-10: Summarized Room and Bed Listing

The nursing station overview illustrates the beds assigned to patients at a select-
able time for an organizational unit supporting beds. The screen shows the as-
signment of patients to rooms and bed locations and can be displayed as a list or
in graphic form. From the nursing station overview, further functions may be per-
formed such as:
Processing patient, case, or movement data for a patient
Maintaining diagnoses or nursing categories
Requesting medical records
Entering services
Entering surgical procedures
Generating work organizers
5-15
Fig. 5-11: Graphical Nursing Station Overview
Planning in the Nursing Actual planning is another important function of the nursing station overview.
Station Overview The screen displays the assignment of each bed location during a selectable plan-
ning period and a list of all patients assigned to the nursing station, but not to a
specific bed (arrival list), and all patients transferred or discharged during this
period (departure list). Special planning functions such as assigning a patient to a
bed location within the nursing station, the swapping of beds among patients or
Replacing the Patient the transfer or discharge of a patient may be performed so that the nursing staff
Traffic List can enter patient movements into the system very easily. A patient traffic list for
the nursing station linked to IS-H is not necessary.
Access to Central In addition to the functions described in the nursing station overview, Nursing
Patient Database Station Management provides all additional important functions required on the
nursing station. Since the nursing station has direct access to the central IS-H da-
tabase, the latest data is always available.
Additional Nursing Additional Nursing Station Management functions include:

Station Functions Information functions, such as listings of standard, quick, or emergency ad-
missions, outpatient visits, waiting lists, etc.
Patient admission
Admission of newborns and companions
Managing diagnoses and nursing categories for the patients on the nursing
station
Requesting medication and material from the central warehouse
5-16
Outpatient Department Management

Outpatient Department Management provides a user interface similar to that of Outpatient Dept Mgmt
Nursing Station Management. It allows you to plan outpatient department visits as User Interface
and offers those IS-H functions which are required in outpatient departments.
Visit Planning
Visit Planning
Resources considered relevant for outpatient visits are the attending physici- Phys./Rooms as Resources
ans and the available treatment rooms. Available time slots are stored on a Available Time Slots for
daily and weekly basis for these resources and for the outpatient departments
Different Planning Type
themselves. The planning types are user-definable, such as initial visits, fol-
low-up examination, etc. For instance, it is possible to specify that follow-up
visits by a specific physician may only be scheduled at pre-defined times on
selected weekdays. Based on these available time slots, on-screen appoint- On-Screen Appointment
ment schedules are generated for the resources which need to be planned. The Schedules
patient visits are entered into these appointment schedules and are assigned
to the respective physician or treatment room. New cases and/or patients can
be scheduled and admitted at the same time. A detailed visit status manage- Visit Status Management
ment function allows you to easily control patient treatment including visit
planning, making the appointment, and actual treatment. You may also sched- Provisional Appointments
ule an appointment without having to create a patient master record or case.
Fig. 5-12 Appointment Schedule
5-17
All IS-H Functions are Additional outpatient department functions:

Available Outpatient Department Management provides all IS-H functions required in
an outpatient department, such as:
Patient Master Data
Service entry
Medical documentation (diagnoses, etc.)
Administration of certificates
Administration of medical records
Printing of forms
Forms Management and Work Organizers

Standard Forms The standard system includes a number of forms such as patient status reports,
patient labels, admitting release forms for patient and insurance provider, etc. You
Forms Editor can customize these forms using a forms editor or define additional forms. It is
Bar Codes also possible to define any type of bar code for labels. Bar codes and labels are
generated automatically after certain functions have been performed (e.g. during
patient admission) or upon request. Tables can be set up which specify where the
item will be printed, how many copies will be printed, etc.
Medical/Nursing Documentation
Nursing acuities
Nursing Acuities To determine the professional staff needed for adult and pediatric patient care in
relation to nursing acuities the system supports the following processes:
Nursing Effort per Definition of nursing acuity for determining the nursing effort as well as the
Nursing Acuity assignment of nursing care minutes per day. Storing minimum requirements
for patient care and case weights to determine the staff required for adult and
pediatric patient care.
Assignment to Nursing Acuity Assignment of inpatient cases to nursing acuity.

Case-related nursing acuity management by selecting a case (case view) or
managing the nursing acuity for all patients of a nursing station (nursing or-
ganizational unit) at a certain key date (nursing station view of Nursing Sta-
tion Management).
Reports A comprehensive reporting system is offered to ensure a complete database

for determining staff requirements and analyzing data for internal purposes.
The system supports the assignment of patients to nursing acuities and the determinati-
on of staff requirements based on this assignment.
5-18
Diagnoses
IS-H manages diagnoses for each case and departmental stay and makes them Diagnoses for Each Case and
available both for medical documentation and for statistical purposes. Department Stay
The system distinguishes between two types of diagnoses: Diagnosis Types
Admission or transfer diagnoses
Treatment diagnoses made while the patient was treated in the medical facility.
Treatment diagnoses are definable as: Classification of Diagnoses
Admission diagnosis
Surgery diagnosis
Discharge diagnosis
Departmental main diagnosis
Hospital main diagnosis
Multiple diagnoses can be maintained for each case or departmental stay. Each Multiple Diagnoses
diagnosis is entered as free text or as a code using a combination of two diagnosis Parallel Coding
code catalogs (e.g. ICD-9, ICD-10). The diagnosis code catalogs are user-defina-
ble. Available input facilities take the form of the text search in diagnosis code Possible Entry Facilities
catalogs, hit lists, hierarchy search in hierarchic catalogs, and automatic conversi-
on using connectable special systems.
Fig. 5-13: Diagnoses
5-19
Post-Discharge The diagnosis is entered as part of the work process so that you may edit the
Documentation information when processing admissions, transfers and discharges. As an alter-
native, diagnoses are processed separately from movements, for instance, as post-
discharge documentation. The diagnoses can be maintained on a case-related ba-
sis for a specific case or collectively, for instance for all cases of an organizational
unit.
Reports as Work Tools Various reports (for example, a list of all cases without a discharge diagnosis)
support you in maintaining a complete database.
IS-H allows you to enter multiple case- and department-related diagnoses which can be
coded based on different catalogs and assigned to several classifications.
Surgery
Legally Mandated Surgery IS-H offers a surgery documentation function which complies with legal require-
Documentation ments. For each surgery performed, you can enter administrative data such as
time of surgery, organizational unit in charge, operating surgeon, operating room,
ICPM Coding etc. and the services performed (in the service catalog), surgery codes according to
Surgery Diagnosis the ICPM catalog, and a surgery diagnosis for each ICPM code.
IS-H supports surgery documentation which is legally mandated for determining charges.
Risk Factors
Risk Factors at Patient Level While the medical/nursing information described above is maintained on a case
level, risk factors are maintained on a patient level and apply to all cases.
Hospital-Specific Catalog The possible risk factors are stored in a catalog which is maintained based on
Maintenance specific hospital needs. Possible factors are:
Allergies to antibiotics
Hypertension
Diabetes
Risk factors are documented at patient level.
5-20
Medical Record Administration

Because of the many organizational models in the hospital with respect to filing, Different Record
the file system, and archive management, individual medical records for each Creation Strategies
patient are created with varying frequency and in varying numbers. The system
therefore supports the following record creation strategies:
Creation of a new medical record upon initial admission to the hospital; no
record created upon re-admission
Creation of a new medical record upon every admission to the hospital
Creation of a medical record per department
Creation of a medical record per case and department
Creation of a medical record per patient movement (e.g. transfer)
The system manages data regarding the existence, location, and movements of a Medical Record List
medical record. It also contains information on who borrowed a record, when it
was borrowed, and why.
Medical Record Administration provides the following functions: Processing Functions

Display, input, and change of medical records
Information on:
newly created medical records
lists of patients admitted after the date you specify, nursing station loca-
tion, whether medical records exist for the patient, and the location of said
records
Create reminders for borrowed medical records
Administration of borrowed medical records (request, lend, transfer, return
medical records)
Evaluations
current medical records (for example, to obtain an overview of archive
occupancy and reorganize the archives where necessary)
borrowed medical records; selection criteria include:
- medical records for which a reminder was created
- borrowed records by borrower
- borrowed records by date, etc.
externally-stored old medical records
A detailed data security concept ensures that only authorized users have access to Authorized Access
medical records.
5-21
Chapter66
Patient Accounting
Patient Accounting
Insurance Relationship
To bill for services you must enter the patients insurance data in the system. This Multiple Insurance
is performed by processing the insurance relationships on a patient- and case- Relationships
related basis. Multiple insurance relationships can be defined for each patient,
each of which is assigned to either an insurance provider (usually an insurance
company) or is processed as an insurance relationship for self-pay patients if the
patient pays him-/herself or is required to make copayments.
The insurance provider relationship establishes a link with the insurance provid- Insurance Provider
er who is entered into the system as a business partner. For self-pay patients, the Self-Pay Patients
patient is assigned a customer in Financial Accounting to process his/her open
items, payments, dunning letters, etc. In addition, a different invoice recipient
may be entered for self-pay patients. It is important that all insurance relation- Patient- and Case-Related
ships are assigned to the patient and that those insurance relationships applicable Insurance Relationships
to a specific case are selected and assigned to it (see Fig. 6-1). An insurance rela-
tionship that has been entered for a patient will be available for all future cases
and need not be re-entered for future inpatient or outpatient cases. The data will
only be verified and updated as required.
Fig. 6-1: Insurance Relationships
Insurance relationships are managed on a time-dependent basis so that the insur- Time-Dependent
ance situation of a patient is represented accurately and a history can be generat-
ed. Each insurance relationship is assigned a start and an end date, and there may
6-1
6 Patient Accounting
Cancellation be several insurance relationships with the same insurance provider over time.
Incorrectly entered insurance relationships are canceled, so that the history is re-
traced in such cases as well.
Patient-Related Insurance In addition to assigning the patient to an insurance provider, the patient-related
Relationship insurance relationship specifies the type of insurance coverage. In the case of de-
pendent coverage for family members, for example, data for the insured family
Customer-Defined Types of member and optionally for their employer can be entered. You may also define
Coverage your own types of coverage.
Healthcare Smart Card Healthcare smart card data can be included in the related insurance relationship.
Ranking of Case-Related Ranking and copayment information are important data for case-related insur-
Insurance Relationships ance relationships. When requests for insurance verification are generated auto-
matically, the ranking of the insurance relationship determines the order in which
the insurance relationships are used to request insurance verification for the case-
Copayment Information related services. For insurance providers requiring copayments, copayment infor-
mation specifies either the copayment obligation with the respective copayment
amount or provides a reason why the copayment obligation is waived.
Fig. 6-2: Overview of the Insurance Data of a Case
Service Entry
Central Function Service entry is a key function of all hospital information systems. It is used to
document planned and performed services for inpatient and outpatient cases. The
Services for Inpatient and documented services are used for managing the insurance verification process,
Outpatient Cases billing, hospital-specific controlling (cost center accounting, cost object control-
ling), medical documentation and statistical evaluations (legally mandated and
Import From Subsystems internal). In addition, services are frequently entered into subsystems, and this
data can be imported into IS-H using the communications module IS-HCM or
special data transfer programs.
6-2
Patient Accounting 6
The service catalog (internal charge master) is usually the basis for service entry. Internal Charge Master as a
Services entered using this catalog are medical, nursing, and operational services, Basis for Service Entry
or services of functional areas such as the laboratory or radiology department.
Services are usually entered on a case basis and may also be assigned to the move-
ments, treatment certificates, or insurance verification requests of the case.
Both billable and non-billable services are definable. Non-billable services can be Billable and Non-Billable
documented for a specific organizational unit as service recipient and transferred Services
to Controlling. They may also be documented on a case basis which is necessary
to set up cost object controlling.
You can enter many different types of information for each entered service. This Service Information
information is necessary for subsequent functions and includes:
Time or time interval when the service was performed (planning or actual)
Service quantity
Departmental and nursing organizational unit ordering the service
Organizational unit performing the service
Billing information such as assessment rate or different price including reasons
Service number in the billing charge master, etc.
Fig. 6-3: Case-Related Service Entry
Service entry is facilitated by the hierarchy structure of the service catalog; in ad- Service Catalog Hierarchy
dition, default values are stored for many entry fields so that most of the time no Structure
manual entry is necessary. Filter functions are available for processing services
Filter Functions
6-3
which have already been entered. These filters select certain services to avoid con-
fusion, particularly for cases with many services. For extended services involving
Automatic Service Splits transfers and discharges, the system automatically splits the services. In case of a
transfer, the services are ended, and corresponding services are generated for the
newly assigned organizational unit.
Services can be entered manually or transferred from subsystems; they can be
Generating Services generated automatically, such as departmental per diems by the attending de-
partments or other services by treatment categories.
Automatically Generated Service entries may be used for automatically generating most of the requests for
Requests for Insurance insurance verification. For services already billed, the billing information is dis-
Verification played for each service directly from service processing.
Plausibility Checks Plausibility checks for service exclusions, combinations, and limits may be per-
formed during service entry or at a later date.
Another important group of service entry functions ensures the complete entry of
Billable Services and Specific billable services as specific forms of charging. For instance, services may be billed
Forms of Charging as flat rates per case, procedures surcharges, departmental per diems and base
nursing charges. To determine billable services, a special function proposes po-
Rule-Based Charge tentially billable flat rates per case and/or procedures surcharges for the combi-
Determination nation of diagnoses and surgical procedures entered (based on user-expandable
rules). You may select the appropriate form of charging from this list.
Case Monitor The case monitor is another tool for determining charges. It allows you to display
billing-related case information in compressed form, such as insurance relation-
ships, insurance verification requests, treatment certificates, services performed,
diagnoses and movements. (see Fig. 6-4).
Fig. 6-4: Case Monitor
6-4
In addition, a verification program can be used to compare days spent in the hos- Comparing Days in Hospital
pital and days billed based on flat rates per case (and their maximum allowable and Billed Days
stay) and procedures surcharges.
Services are entered locally or centrally. For central service entry, a quick entry Integrated Service Entry
function is available. To enter services, you can use the function specifically de-
signed for service entry, or you enter services from one of the many other functions.
The appropriate charge master for the insurance verification process and billing is Service Entry independent
assigned based on assignment tables when insurance verification is requested or of Billing Charge Master
during billing. Service input is therefore independent of such charge masters. As
a result, the patients insurance situation can be ignored when entering services.
This also applies to any services in the patients insurance data during inpatient
treatment (e.g. workers compensation instead of legal health insurance). These
changes do not affect services already entered.
Insurance Verification Process

The insurance verification process is essential for billing for inpatient case servic- Assigning Billable Services to
es in the IS-H System. The insurance verification process is used to assign billable Insurance Providers
services to the case-related insurance relationships and to insurance providers,
which will be billed for some or all of the services involved.
IS-H provides comprehensive support for the insurance verification process and Comprehensive Support
automatic functions to facilitate this process.
Fig. 6-5: Insurance Verification Process
A billable service in an insurance verification item may be assigned to one insur- Insurance Verification
ance provider or split among several providers directly from the service entry Integrated with Service Entry
function. You can split the price of a service among multiple insurance providers
Apportioning Among Several
with which the hospital has a case-related insurance relationship either as a per-
centage or as an absolute value.The price can also be assigned to self-pay Insurance Providers
patients. It is possible also to assign groups of services to an insurance provider.
6-5
Pre-Approved Insurance The system automatically generates billing proposals based on stored pre-approved
insurance rates and default values. Pre-approved insurance rates may be stored for
each insurance provider separately or for all insurance providers of an insurance
provider type. This pre-approved insurance is usually covered by the insurance
provider. In addition, you can specify whether a charge will be covered in full, in
part or up to a specified limit. For such pre-approved insurance no insurance verifi-
cation request has to be issued; the status of the related insurance verification is
changed immediately to confirmed and billing can subsequently take place.
Default Values Default values are stored in the same system structure as pre-approved insurance,
however the generated insurance verification proposals receive the requested
status, rather than the confirmed status, and benefits coverage usually has to be
requested from and approved by the insurance provider before an invoice can be
issued. With the default values, you can also store information regarding the ser-
vices usually not approved by an insurance provider, such as personal items not
covered by legal insurance providers. This prevents the system from generating
such insurance verification defaults.
Insurance Verification Based on pre-approved insurance and default values which are defined by each
Proposals hospital, IS-H generates insurance verification proposals. In this process, insur-
ance providers are selected for insurance verification in the order of the case-relat-
ed insurance relationships. In addition, insurance verification items are generated
automatically for selected cases, e.g. for all patients admitted during a specific
time period. As a result, with fully maintained insurance verification items and
default values, insurance verification requests and benefits approvals are largely
automated.
Automated Processes You can, of course store insurance verification information in the system without
first having entered services.
Print Functions Insurance verification requests can be printed individually or in a batch mode.
Different forms are used based on the insurance provider or the insurance provid-
er type and the respective organizational unit.
Status Management Depending on the response received from the insurance provider, insurance ver-
ification requests or their items can be marked as confirmed or rejected. An
Integrated Reminder integrated reminder procedure enables you to send reminders for outstanding
insurance verification requests to the insurance provider after the predefined wait-
Procedure
ing period has elapsed.
Monitoring the Insurance To monitor insurance verification, a function is available which monitors the insur-
Verification Situation ance verification situation for inpatient cases. You can check, for instance, whether a
requested or confirmed insurance verification is available for all billable services,
Automatic Extension whether the insurance verification for extended services covers the whole period
up to the evaluation key date, or whether the diagnoses required by the insurance
provider are available. A checklist is generated so that the activities required for
insurance verification can be performed directly. Any necessary extensions for in-
surance verification requests with a time limit are generated automatically.
6-6
Copayments
Copayments can be managed in two different ways:
Receivable Procedure
The insurance provider assigns the copayment receivable to the hospital. As a Receivable Procedure
result, the receivable amount billed to the insurance provider is reduced by
the amount of copayment, regardless of whether the patient actually made
the copayment or not.
Collection Procedure
The invoice sent to the insurance provider takes into account only copayments Collection Procedure
actually made. Copayments received later are sent to the insurance provider
collectively for several cases.
Both procedures rely heavily on Financial Accounting for administering copay-
ment requests and open items, reminders, machine payments, etc. IS-H and FI are
fully integrated. As a result, the relevant copayment postings in FI can be made
conveniently from IS-H.
Down Payments
If the patient pays him-/herself, a down payment is required (down payment Down Payment Request
request). Outstanding down payment amounts are dunned.
Down payments which have been made are displayed by the system and taken Down Payment Accounting
into account when billing. The SAP standard Financial Accounting module pro-
cesses down payments.
Billing
Billing Methods
Every hospital performs a variety of services, which in turn must be billed in var- Different Billing Methods
ious ways in accordance with government regulations, contractual obligations,
organizational rules, etc.
IS-H supports you in billing inpatient, observation patient, and outpatient Inpatient and Outpatient
services. Billing
Together with the SAP Financial Accounting module and SAP Controlling, IS-H Effective Controlling
ensures safe control of receivables and cash flow and detailed controlling includ-
ing cost object controlling and profitability accounting which supports hospital
liquidity and profitability.
6-7
Particular features of IS-H Patient Accounting are:

Service-Based Accounting Using services as the only basis for accounting
Modular Accounting A highly modular accounting approach using combinable modules to sup-
Approach port different organizational processes
Great Flexibility with A highly flexible system with numerous profile options which can be speci-
Numerous Profile Options fied individually by each institution and which ensure that IS-H will remain a
state-of-the-art system in particular in view of the impending structural changes
in the healthcare system.
Fig . 6-6: Supported Billing Methods
Support for In the inpatient area, the system supports all types of charge, such as flat rates per
Inpatient Charge Types case, procedure surcharges, departmental per diems, and base nursing charges,
pre-admission and post-discharge treatments, as well as general nursing charges,
Case Monitor personal items, etc. Charge determination is facilitated by a case monitor which
displays an overview of all billing data, by flexible rules to determine potentially
Flexible Rules for billable flat rates per case and procedure surcharges from entered diagnoses and
Determining Charge ICPM codes as default values as well as by functions which check for complete-
ness of billable services for a case. Other automatic functions to ensure complete
Completeness Check and accurate billing such as automatic generation of billable services from avail-
able information are being developed.
Direct Patient Billing/Billing for Direct patient billing for inpatient cases and billing for observation patient servic-
Observation Patient Services es such as dialysis treatments is performed very easily.
Outpatient Billing The following billing methods are supported for outpatient cases:
Billing for outpatient surgery
Self-pay patient billing
6-8
Direct patient billing (including calculation and evaluation of physician reim-

bursement, also for direct inpatient billing)
Workers compensation billing
IS-H billing provides for inpatient, observation patient, and outpatient billing, and offers
maximum flexibility to make for a safe investment.
Billing Procedure
As a first billing step, you have to select the cases to be billed. For individual Individual Billing
billing this is exactly one case, for collective billing it is a large number of cases Collective Billing
which are determined by a selection function and are saved collectively under a
specific name. Selection criteria are general attributes such as the type of case, last
name of the patient, discharged/not discharged, the presence of a discharge diag-
nosis, the insurance verification status, or other visit-related criteria such as any
outpatient visits during a certain time period or certain types of visits. The latter
item is particularly useful for outpatient cases.
To prevent billing, a billing block can be set for certain cases. Billing Block
Fig. 6-7: Billing
6-9
Billing Parameters Subsequent billing is determined by user-definable parameters. The most impor-
tant are:
Final or Interim Billing Final or interim billing?
Interim billings allow billing by period.
Test or Production Billing Test or production billing. Test billing allows you to perform plausibility checks
only without actually generating an invoice or a financial accounting docu-
ment. This function is particularly important for collective billing, since any
errors are logged and corrected interactively from the error log prior to pro-
duction billing.
Billing Date Billing date as the date up to which the services of a case are included in the
invoice. The billing date serves as the posting date for financial accounting.
Posting Block Optional posting block imposed on Financial Accounting to prevent direct
posting of the invoice document in Financial Accounting. The invoice is post-
ed later after an explicit invoice release.
Billing Scope Determining the billing scope by selecting the billable services(s) and insur-
ance provider(s).
Plausibility Checks After the billing parameters have been specified, you start billing. First, a number
of plausibility checks are performed. They check, for instance, whether the re-
quired insurance verification documents have the confirmed status, if this is
required by the insurance provider, whether the patient was actually discharged,
when you want to do final billing, whether a discharge diagnosis is available, etc.
Highly Flexible With If the plausibility checks have been successful, a number of rules are applied and
Definable Rules processed which will finally result in an invoice. Since each hospital can adjust these
rules according to its specific needs, IS-H provides for extremely flexible billing
simply by adjusting the parameters and without having to modify the program.
The billing process is basically as follows (see Fig. 6-8)
Fig. 6-8: Billing Process
6-10
The system determines the billing type (such as direct inpatient billing) based Billing Type Determination
on the case type, insurance provider and billing organizational unit. The bill-
ing type affects the billing charge master and pricing.
The charge mater used for billing is selected based on the insurance provider, Billing Charge Master
billing type, service master and, if necessary, the billable service. Determination
The billable services entered from the service catalog may be converted to Service Conversion
billing master services based on grouping categories stored in the system. As
a result, a service catalog service is converted to different billing charge
master services based on the various billing conditions.
Fig. 6-9: Service Conversion
The system generates a pricing procedure based on the case type and billing Pricing Procedure
type. You use this procedure to enter types of conditions which determine
which price elements (e.g. basic price, surcharges/discounts) are to be used in
pricing.
To access the basic price of a service, a mandatory formula is assigned to the Basic Service Price
respective condition type which is used to determine the price for a service
from the appropriate column of the billing charge master. For other condition
types (surcharges or discounts), the system uses a search strategy (access se-
quence) to determine in which order condition records pertaining to a condi-
tion type are to be read (for instance, do you want to search for a specific
discount for a combination of insurance provider and service, and, if this can-
not be found, do you want to search for a value which only depends on the
service, etc.).
Conditions allow you to take into account different criteria when determining Conditions
regular and graduated prices.
6-11
Invoice These steps produce the invoice which is created based on the billing parameters.
If necessary, it can be processed with the many functions which are available cen-
trally (Fig. 6-10).
Fig. 6-10: Invoice Processing Functions
Invoice Processing As an example, you may display all invoices for the selected case as well as related
documents in financial accounting, if the invoice was released for posting; invoice
documents which have not been posted in financial accounting can be processed
to a limited extent, invoices blocked for financial accounting can be released, open
items for self-pay patients displayed, etc. In addition, the case monitor provides
an overview of all data pertaining to billing such as insurance relationships, in-
surance verification requests and approvals, certificates, services, diagnoses, sur-
gical procedures, movements.
Service Entry After You can still enter and bill for services, even after final billing has been completed
Final Billing for a case.
Printing the Invoice As a last billing step the invoice is printed, either immediately during billing or at
a later time. The necessary forms can be designed according to hospital-specific
requirements using a forms editor which is integrated in the system. You can call
up various forms depending on factors such as billing type or insurance provider
type.
Collective Invoice A collective invoice (invoice list) with invoices selected for an insurance provider
can be generated in addition to the individual invoice.
The system allows individual or collective billing with different parameters. Billing is
determined by adjustable rules offering maximum flexibility.
6-12
Reversal
IS-H allows you to reverse all invoices or one invoice of a case completely or par- Complete/Partial Reversal
tially by referring to the original invoice. The system always tracks the processing Integration with Financial
via a reference to the source document (invoice). Reversals are also posted auto-
Accounting
matically to Financial Accounting.
Complete and partial reversals are processed as special billing types in addition to the
actual invoice.
Reduction of Balance via Down Payment and Copayment

Down payments made can be deducted from self-pay invoices. Down payments Reduction of Balance via
are managed as special transactions in customer accounts. A special down pay- Down Payment
ment account is maintained in the main Financial Accounting module.
You may specify whether the balance of the payer invoice should be reduced only Reduction of Balance via
when a copayment is made by the patient (collection procedure), or generally Copayment
(receivable procedure). Comments may be entered on the invoice in cases where
a patient does not make a copayment. You can list the paid and settled copayment
amounts either from the SAP Financial Accounting module or from Patient Man-
agement.
Copayments and down payments are taken into account during invoicing.
Accruals and Deferrals

Using special evaluations, accrued services which have been performed but not Complete Year-End Closing
yet billed are displayed; that is, the services are valued for internal purposes only.
Accruals and deferrals are updated in special accounts using the Financial Ac-
counting module. As a result, all sales revenues from hospital services are shown
in the year-end closing. Accruals and deferrals are reversed when the accrual ser-
vices are billed.
For accurate accounting, services performed but not yet billed can be valued and posted.
6-13
Accounting Integration
Posting Records for Financial During billing in IS-H, posting records for the Financial Accounting and Control-
Accounting and Controlling ling modules are generated automatically. The Financial Accounting module mon-
itors payment receipt and issues dunning letters for unpaid items.
Posting Block Instead of transferring invoices directly, first use the invoice posting block. By
lifting the block you release the invoice for posting in Financial Accounting. Blocked
invoices are listed and processed separately.
Flexible Cost Determination The accounts used for posting revenues and sales reductions are generated auto-
matically based on rules set by the hospital. This allows you to post the charge for
each service and all surcharges and discounts to a separate G/L account. The
various flat rates per case, procedures surcharges, departmental per diems (with a
further breakdown by reduced and full departmental per diems, if desired), de-
partmental per diem discounts, etc. may be posted to multiple revenue accounts.
Additional differentiating attributes are used for account assignment, such as in-
stitution, insurance provider, insurance provider type, or case type.
Cost Center Accounting For controlling purposes, revenues and revenue reductions are assigned to cost
centers or profit centers or case-based orders. The latter is required if you want to
implement cost object controlling. The exact relationship and the processes be-
tween IS-H and Controlling are described in the chapter IS-HCO Hospital Con-
trolling.
Revenues and revenue reduction flow from IS-H Accounting directly to Financial Accoun-
ting and Controlling.

Statistical Evaluations Government regulations and hospital information needs are making statistical
evaluations necessary on a regular basis. Evaluations derived from service and
patient census data under Patient Management are offered as standard reports
such as diagnostic statistics, service statistics, occupancy data, and departmental
key figures. The system supports the legally required breakdown of data by inpa-
tient, observation patient, and outpatient cases. Other statistical data such as cost
and service listings (e.g. personnel, revenues) are generated in the respective SAP
standard systems.
Diagnoses Diagnostic statistics according to hospital statistics regulations and geographic

Geographical Areas Midnight data can also be provided. The standard system also compiles inpatient census
Patient Census statistics based on the midnight patient census.
Detailed Patient Overview Overviews of the current patient count including scheduled or performed treat-
ments for a defined period are accessible in list format or via online display. Pa-
tient inquiry restrictions and display authorizations are also taken into account.
6-14
Various evaluations are available to monitor insurance verification; for example,

insurance verification requests needing reminders and missing referral certificates.
A large number of evaluations is also available for service entry and billing, for
example, to compare days spent in the hospital and days billed, to analyze the Insurance Verification
hospital stay for flat rates per case, to analyze billed services by insurance provid- Service Entry and Billing
er type or regulator, to determine the billing status of discharged cases, etc.
The healthcare institution is able to easily generate individual evaluations using Individual
the tools provided. Evaluations
6-15
Chapter 7
Hospital Controlling
Hospital Controlling
Integrating IS-H with CO

Efficient Controlling functions are an increasingly important tool for controlling Controlling Services
the service processes. The ultimate goal is to implement a cost object controlling Processes
system which makes it possible to determine the planned and actual costs and
revenues for each cost object and compare them via variance analyses. These anal-
yses can be case- or period-related, and implemented as multi-level contribution Multi-Level Coverage
margin accounting. Cost objects include any hospital services which are provid- Contribution Margin
ed to the patient, such as flat rates per case, procedures surcharges, departmental Accounting
per diems, or outpatient surgical procedures. Multiple Cost Objects
Fig. 7-1: Cost Object Controlling
To implement cost object controlling you need to set up a meaningful cost center Cost Center Accounting
accounting system as a tool for allocating (cost object) overhead to the various
cost objects based on the cost origin.
7-1
7 Hospital Controlling
Fig. 7-2: Data Flow in the Cost Center System
Profit Center Accounting As a first step, profit center accounting is used to make the revenue structures of
the hospital transparent.
CO Tools The SAP Standard Controlling System CO provides all the tools required for cost
element, cost center, and cost object accounting. For effective controlling, the Con-
trolling System has to be provided with the controlling-relevant data such as costs
and services from the (quantity-based) operational systems in an appropriate form.
This affects Financial and Assets Accounting, Human Resources and Material Man-
agement, and in particular IS-H, since this module centrally plans, documents
Patient-Related Service and bills for patient-related service processes. In doing so, it provides the data
Processes essential for Controlling regarding the services performed by the hospital organi-
zational units and the revenue derived from them.
Integration Between The components of IS-HCO provide the necessary integration between IS-H and
IS-H and CO CO. In particular, IS-HCO comprises the following functional areas:
Linking CO q Linking CO with corresponding IS-H objects (e.g. cost centers with organiza-
with IS-H Objects tional units, activity types with service catalog services)
Service Transfer q Transferring and posting the services performed from IS-H to CO for inter-
nal activity allocation
7-2
Hospital Controlling 7
q Determining and transferring statistical key figures from IS-H to CO Statistical Key Figures
q Transferring and posting revenues from IS-H to CO Transfer of Revenues
Fig. 7-3: Data Flow in the Hospital
In Customizing, you determine whether to implement only cost center account- Cost Center Accounting or
ing or cost object controlling in CO. Depending on this decision, internal activity Cost Object Controlling
allocation is used to post the case-related services performed from the cost center
which performed the service either to the receiving cost center (or to a statistical
order) or to case-based orders. Similarly, revenues are posted to cost centers or
profit centers, but also to case-based orders.
Master Data
To be able to use the operational functions of IS-HCO, you have to manage master Assigning CO to
data which is primarily used to assign CO objects to the corresponding IS-H ob- IS-H Objects
jects.
q Assigning organizational units (IS-H) to cost centers (CO) Organizational Units/
One or several cost centers from CO are assigned to each organizational unit Cost Centers
in IS-H. The latter is possible, so that a separate nursing station cost center can
be defined for each assigning department when multi-specialty nursing sta- Multi-Specialty Nursing
tions are used. This assignment is necessary to determine the cost centers to Stations
which services are to be posted, based on the organizational units ordering
and performing the services. The organizational units are specified together
with the services performed.
7-3
Fig. 7-4: Cost Centers and Activity Types
IS-H Services/ Assignment of IS-H services to CO activity types:

CO Activity Types When services were performed with regard to a case or an organizational unit,
the case-based order or the receiving cost center should be debited with the
costs of the performing cost center in CO. Therefore, you have to specify how
the CO-relevant IS-H services of the service catalog will be assigned to CO
activity types. The following options are available:
Single Account Assignment m Single account assignment: Exactly one CO activity type is assigned to a
service in IS-H and vice versa (1:1 assignment).
Summarization m Summarization: One CO activity type is assigned to several IS-H services

(1:n assignment, for instance, to summarize all radiology services in one
CO activity type Charge factors).
Multiple Account Assignment m Multiple account assignment: Several CO activity types are assigned to one
IS-H service (n:1 assignment, for instance, account assignment of Nursing
care minutes and Physician minutes from the IS-H service Nursing
charge).
For each assignment you must also store information on how to determine the
quantity of the CO activity type from the IS-H service. To determine the Nurs-
ing care minutes quantity, for instance, you can use the patient classification
in nursing care categories; to determine Charge factor, you may use the charge
factor from the appropriate column of a charge master.
7-4
q Assigning preliminary costing to a cost object:

A preliminary costing from CO can be assigned to IS-H services which are Preliminary Costing/
designated as cost objects. If such a service is performed for a patient, an order Cost Objects
is created for the respective case, and the costs from preliminary costing are
entered on the order as planned costs. This allows a comparison between these
planned costs and the actual costs for cost analysis purposes.
Fig. 7-5: Preliminary Costing
q Assigning IS-H key figures to statistical key figures under CO:

IS-H allows you to determine the nursing days, billing days, and the number IS-H Key Figures/
of outpatient visits for a certain period as key figures for each organizational Statistical Key Figures
unit. For posting to the cost center assigned to the organizational unit, the
corresponding statistical key figures in CO must be assigned to the IS-H key
figures.
Cost Center Accounting

Based on the assignments defined in the IS-HCO master data you determine the Activity Allocation
activity relationships between sending and receiving cost centers from the servic-
es which were performed for a case or an organizational unit and entered in IS-H
and then make the appropriate postings in CO. Revenues are treated similarly.
Services are transferred to the CO module periodically, or when the patient is Transfer Log
discharged. It is also planned to support transfer immediately the performed Automatic Correction of CO
service is entered into IS-H. To avoid duplicate postings in CO, the IS-H module Postings
logs which and how many services have been transferred. As a result, CO post-
ings are automatically corrected when the IS-H service is changed or canceled.
Extended services are posted in the CO module by period. The service quantity Period-Based Service Posting
provided is divided among the posting periods according to the service period.
As a result, the extended service quantities and costs are available on the cost
centers for analysis purposes.
7-5
Services From Subsystems Services from subsystems which enter IS-H via IS-HCM or by other means are
transferred to CO the same way as services directly entered into IS-H.
Statistical Key Figures As mentioned above, statistical key figures are also transferred to the CO module
Costs and Revenues To implement hospital-specific cost object controlling, you have to be able to de-
Profitability Analyses termine and analyze the planned and actual costs and revenues from market-ori-
ented hospital services (products) and perform period-based profitability anal-
yses.
Case-Related Cost and At present, IS-H supports case-related cost and revenue determination: as a next
Revenue Determination step their will also be support when several cost objects are involved in a case.
Cost Object Accounting Case-related cost-object controlling requires the following procedure:
Procedure q Create a CO order for each inpatient case (automatically during patient ad-
mission or periodically).
Preliminary Costing q If a service is entered for the case in IS-H which was designated a cost object
and if a preliminary costing is assigned to it, this preliminary costing is in-
cluded in the order to establish the planned costs.
q Post actual costs from case-related IS-H services performed. This is similar to
the cost center accounting procedure.
q Post case-related revenues from IS-H accounting.
Classifying Characteristics q Classify case-related orders:
To classify and describe a case-based order in CO, IS-H provides the following
characteristics:
m Patient age
m Patient age group
m Patient gender
m Admission diagnosis
m Discharge diagnosis
m Hospital main diagnosis
m Length of stay
m Procedures surcharge
m Flat rate per case
m Number of surgeries
m Number of surgical procedures
Hierarchical Order Analyses Each case-based order can then be described by the values of the selected charac-
teristics. These characteristics and their values can be used to search for orders
and for reporting. This allows you to perform order analyses, as illustrated in the
figure below.
7-6
Fig. 7-6: Cost Objects in Profitability Analysis
7-7
Chapter 8
Communication
Communication
The Hospital Communications module IS-HCM supports the following internal Internal and External
and external communication possibilities: Communication Possibilities
q Event-controlled, asynchronous transmission and receipt of information to
and from subsystems
q Synchronous admission notification of subsystems
q Synchronous access to IS-H data from subsystems (queries)
q Data exchange between hospital and health insurance companies
Asynchronous Communication with Subsystems

IS-H provides integrated support for linking medical subsystems (such as labora- Linking Subsystems
tory, radiology, etc.). This linkage is essential for implementing a uniform, inte-
grated information system for hospitals.
Currently, the most popular communication mode is asynchronous, message-ori- Asynchronous,
ented communication which is supported by most subsystems. IS-HCM offers Message-Oriented
this communication possibility. At present, IS-HCM sends messages regarding
Communication
defined events to subsystems, such as for inpatient admission, outpatient admis-
sion, outpatient visit, discharge, merging of patient master records or orders.
For movement-related events, a distinction is made between creating, changing, Movement-Related Events
and canceling a movement.
Services, surgical procedures, and diagnoses performed are supported as incom- Messages Received from
ing messages. The range of message types supported by IS-HCM is constantly Subsystems
being expanded (e.g. transfer of findings is planned).
The interface between IS-HCM and the non-SAP application is provided by sev- Message Standard
eral files in a mandatory directory of the non-SAP computer. The message stan-
dards supported are the HCM format and HL7 in the ADT area. In addition, HCM
message types are adaptable to create hospital-specific message types.
Various parameters are used to control the transfer of data from IS-H to autho- Parameter Control
rized subsystems. When a communication-relevant activity is performed, the de-
fined message is sent asynchronously to the corresponding system. This requires
several steps which can be automated:
q A communication-relevant event generates a transmit order for the correspond- Steps in Sending a Message
ing message type.
q Transmittable messages are generated from the transmit orders in a format
which the subsystem expects for this message type.
q The messages are transmitted periodically to the subsystem. A trace of the
transmission is created for documentation purposes.
8-1
8 Communication
Fig. 8-1: Patient Data Transmission
Interface File On the receiver side, the IS-HCM Transceiver receives the message and stores it in
the interface file messages received from IS-H. The application running in this
system has to read this file at regular intervals to enter new IS-H data into its own
database as soon as possible. When processing has been successfully completed,
the corresponding record can be deleted from the interface file.
If a communication-relevant event occurs in IS-H, the corresponding message is

transmitted asynchronously to the authorized subsystems.
Communication Flow: Transferring Data

Steps in Receiving Messages When data is transferred to IS-H from the non-SAP system, the non-SAP applica-
tion places the messages in the interface file messages to be transmitted to IS-H
using the specified format. Then, the sequence of steps is as follows:
q IS-HCM retrieves the messages at regular intervals, or the subsystem sends
the messages.
q IS-H immediately writes the message to its database or generates batch input
folders, and logs the received message.
q IS-HCM acknowledges receipt of the message file to the subsystem or reports
an error if reception was faulty with appropriate error handling.
8-2
Communication 8
Fig. 8-2: Buffered Data Transfer
Non-SAP Systems transmit Messages to IS-H via IS-HCM .
Synchronous Admission Notification of Subsystems

In addition to the asynchronous, message-oriented communication described Synchronous Notification of
above, Patient Admission also provides for the synchronous notification of the Subsystems
subsystems. This method is based on RFC technology (RFC = Remote Function
Call) and enables you to transmit patient and case data to subsystems immediate-
ly after patient admission.
This interface has to be activated for individual subsystems. During the admis-
sion procedure, IS-H calls up a customer- or system-specific function outside
IS-H. This call is specified in IS-H Customizing. The most important patient and
case data is transmitted in a special format. With this data, the patient is simulta-
neously admitted in the subsystem.
Patient and case data is immediately available in the subsystem, and data is not
entered in duplicate. The waiting periods of asynchronous data transmission are
avoided.
In addition to the communication options between IS-H and subsystems described Synchronous Access to IS-H
above, subsystems may also access IS-H data synchronously by Remote Function Data (Queries)
Call. IS-HCM provides object-oriented function modules with which data such
as patient master data or case data can be read. This allows the object-oriented Object-Oriented Integration
integration between IS-H and subsystems, provided the subsystem satisfies the
necessary technical prerequisites.
8-3
Chapter99
General IS-H Concepts
General IS-H Concepts

The features of the IS-H system described in the following section cover all IS-H
application components.
Hospital Operators and Institutions

A number of clients can be set up in the system, each with specific parameters and Multiple Hospital Operators
data, thereby allowing you to manage the institutions of different hospital opera-
tors within IS-H. If a hospital operator runs multiple institutions, this can be rep-
Multiple Institutions
resented in the system by assigning the institutions to the same accounting unit
(company code). If required, the variable system parameters for controlling pro-
cesses can be set specifically for each institution, enabling you to structure pro- Individual Processes
cesses on an individual basis.
Process-Oriented
IS-H functions are basically designed to meet the work process requirements of Tailored to User
users. It is our goal to provide maximum support for user tasks. Work Processes
Since the various institutions have different organizational rules for work pro-
cesses, IS-H offers maximum flexibility. An object, such as services or case diag- Processing an Object in
noses, can be processed in different functions or contexts. In this way, the services Different Contexts
for a case can be entered during the admission procedure, when the patient is
transferred or has an outpatient visit, or during the discharge procedure. Further-
more, services can be generated automatically, via a case-related service entry trans-
action, quick service entry or can be transferred automatically from subsystems. Object-Oriented Function
Object-oriented design features allow you to use functions for different purposes Design
and in different areas.
Many functions are available to support shared work processes, to determine the Planned Integration with
workload of a user and display it on screen as a work list. Examples are the Workflow Functions
listing of all quick or emergency admissions which have to be completed by the
Support for Shared Work
admission staff. The integration of workflow functions is planned for a future
release. Processes
In some functions, you can adapt the selection and sequence of screens to hospi- Customizable Screen
tal-specific requirements. Sequence
Data Security and Authorization Concept

An extensive authorization concept has been implemented in IS-H to support or- Detailed Authorization
ganizational and technical data security measures such as user, access, input, and Concept
storage control.
Use of the IS-H system is restricted to persons who have a user master data file Access to the IS-H System
and password in the respective client (hospital operator) After a specific number
of unsuccessful logon attempts, the user is locked out for the day. All logon at-
tempts are recorded by the system.
9-1
9 General IS-H Concepts
Access to Functions and Data You can only carry out functions and access objects for which you received autho-
rization in your user master file. The authorizations allow you to process general
objects such as patient master records or cases, or objects which are assigned to
specific organizational units (e.g. departments) such as movements or services.
Authorizations relating to functions allow you to protect transactions such as call-
ing up patient admission or evaluation reports.
Authorization Profiles To minimize the maintenance required for individual users and structure authori-
zations based on user operations and locations, authorizations are assigned to
User Groups groups of users in the form of profiles. These profiles contain all required authori-
zations for a group of users. The group is usually established by organizational
characteristics; for instance, the nursing staff of a specific nursing station can be
combined in a group. This authorization profile is then assigned to all users of the
group, and additional authorizations can be added as required. This means that
Low Maintenance you need to maintain only one authorization profile per group, and profile chang-
es automatically affect all assigned users.
Fig-9-1: Authorization Concept
Separate Maintenance To increase data security, user master files, authorizations, and profiles are main-
Activation tained separately and are assigned to different persons. Authorizations and pro-
files must be explicitly activated before they become effective.
To comply with input control measures, the system records your user ID and the
Entry Date date when you enter data. When you change data assigned master data status, a
Change Documentation change document is created containing your user ID, the changed fields, and the
old and new field content to document the changes. In addition, IS-H manages
Time-Dependent Objects numerous time-dependent objects with different contents for different time peri-
ods. As a result, this data is managed quite comfortably (you can specify new
prices for services starting at a future date), and older data sets can be maintained
for histories.
Cancellation Concept A cancellation concept is used in many places to increase data security even fur-
ther. This concept allows you to cancel incorrect entries, without deleting them,
thereby ensuring that user actions are always tracked.
9-2
General IS-H Concepts 9
Number Assignment
Objects assigned key values usually receive them from predefined number range Predefined Number Range
intervals. The ranges are maintained in a special table. The objects in question Intervals
include patients, cases, organizational units, and insurance providers.
The number ranges for objects are established or defined for each institution. Internal/External Number
Numbers can be assigned manually by you (external) or automatically by the sys- Assignment
tem (internal). In addition, it is possible to permit (manual) assignment of alpha-
Alphanumeric Key Values
numeric key values. You may also differentiate the number ranges within an ob-
ject using certain criteria. For example, inpatient and outpatient cases can be as- Differentiated Number
signed to different number ranges within the institution. Ranges
Number ranges are also differentiated based on mode of operation. You indicate Mode of Operation Intervals
whether the application runs in normal operation with the central database, or
whether the application runs independent of the central database. The numbers
assigned for the standalone system are outside the number range for the central
database. As a result, objects entered in the standalone system can be imported
into the central database because the numbers do not overlap. However, during
transfer the content of the objects created centrally and in the standalone system
must be compared.
Matchcodes
You have to enter the identifying key value for an object to begin a display or Online Search Tool
change transaction for that object. Since you frequently do not know the key
value, the system must provide alternatives for finding the search object.
In addition to mandatory entry tools such as patient index search using patient Mandatory Entry Tools
attributes, matchcodes are another basis for finding key values using descriptive Matchcode Search
attributes of the object in question. An example is using a name or address data to
find a business partner. In fields where you enter a specific object such as busi-
ness partner, the search by matchcodes can be activated in two different ways:
either by entering the matchcode search term into the field or by calling the possi-
ble values for input.
The matchcode search returns a hit list from which you choose the desired object. Hit List
The key value of the selected object is then copied into the input field. The rest of
the procedure is identical to manual input of the corresponding value.
Multiple matchcodes may be assigned to an object in the IS-H system, e.g. a busi- Multiple Matchcodes per
ness partner, so that you can search by name in one case and by location in the Object
other.
The sequence of fields within a matchcode determines the sequence of fields for Generic entry
the matchcode search term. You can make generic entries for the various fields of
the search term.
In addition to working as an online search function as described above, match- Hospital-Specific Matchcodes
codes are also used as the basis for evaluations or as an index in programs. You
may add your own matchcodes based on the search preferences in your environ-
ment.
9-3
9 General IS-H Concepts
Extended Screen Modification

Modifying Screen Fields Extended screen modification is used for institution- and user group-specific mod-
ification of screen fields. The field attributes can be changed based on the follow-
ing parameters:
Institution
Screen
User groups from the SAP user master record
Function code
Processing mode (display, change, add, delete)
The following attributes can be set for each field:
Field Attributes Required entry

Optional entry
Suppress from screen
Display only
Customized IS-H Since the modification function is available for all screens, each IS-H screen layout
Screen Layout can be customized for a user group. For example, screens can be configured so
that more data is displayed for a physician than for a nurse.
Free-Form Text Processing

Free-Form Texts of Where required, IS-H allows you to save free-form texts of any length in conjunc-
Any Length tion with an object. In this case, you will only see the first few lines on-screen. You
can edit the complete text in SAPscript by simply clicking the text. If the field
length on the original screen is sufficient for the text, only the short text field is
displayed. If the system contains free-form text for the object in question, the sys-
tem will inform you of this.
Several Texts per Object Frequently, you store several texts for a single object simultaneously. For a patient
movement, for instance, you may enter a general comment on the movement and
a comment regarding the accident.
9-4
Chapter 10
Implementing IS-H
Implementing IS-H
When implementing IS-H, we pursue the following goals: Implementation Goals
Short project run time
Low implementation cost
Implementing departmental requirements
Optimizing work processes.
To reach these goals we offer various types of support: Implementation Support
The R/3 Procedure Model describes the activities required for implementing R/3 Procedure Model
an R/3 system and summarizes them in several phases.
The reference model represents data, process and organizational models. Reference Model
An implementation guide and extensive configuration options support the Implementation Guide
adaptation of IS-H to the actual hospital operation.
IS-H can be used with heterogeneous systems. Various tools are available for Linking with
linking IS-H with non-SAP systems. Non-SAP Systems
Fig. 10-1: R/3 - Implementation Strategy
Procedure Model
The success of an IS-H implementation depends to a large extent on general hos- Organizing the
pital conditions. How the project implementation is organized and how the de- Implementation Project
partmental requirements are translated into IS-H are particularly important as-
pects. General data affecting the implementation project includes type and extent General Data
of the IS-H modules to be implemented, existing system landscape to which IS-H
10-1
10 Implementing IS-H
will be added, type and number of areas and employees affected by the imple-
mentation and anticipated implementation deadlines. In addition to the project
Project Team leader, you need to assign specialists and data processing personnel who will help
implement the project.
R/3 Process Model The R/3 Procedure Model provides general basic information regarding the steps
and activities required for implementing a R/3 system. The main phases are
Main Project Phases Organization and conceptual design
Detailed design and system set-up
Preparations for going live
Productive operation
Fig. 10-2: R/3 Procedure Model
Optimum Benefit The implementation of IS-H will be of maximum benefit to the hospital if the
capabilities offered by the system are utilized to the fullest extent. To achieve this
goal, you may have to take organizational measures to complement system im-
plementation.
IS-H Reference Model

Data, Process, and Models are designed to translate real-life conditions into a representative infor-
Organization Models mation system. Primary examples are data, process, and organizational models.
All required elements, relationships, and designations are stored in the R/3 re-
pository. They provide an integrated and consistent description of the data, pro-
cesses, and the organizational structure which serves as a complete, system-wide
basis for implementing the R/3 system.
10-2
Implementing IS-H 10
Fig. 10-3: SAP Reference Model
Chapter 3 contains an overview of the content of the IS-H data model. A sample IS-H Data Model
IS-H data model excerpt is provided in the appendix.
The business processes in the Business Navigator are supported by R/3. These Process Models
process models are available for all standard R/3 systems and will be available
for IS-H in the near future. Event-driven process chains which link the individual Event-Driven Process Chains
functions of a business process via events are the basic representation tool. Events
trigger processes, and are in turn triggered by processes, thereby triggering addi-
tional processes. In addition to a simple representation of business processes you
can display the data which is used in individual processes as input and generated
as output, data flows, or function hierarchies.
The process models provided by SAP in the Reference Model facilitate implemen- Optimizing Business
tation of the R/3 system and are used to determine the planned processes so that Processes
business processes can be optimized, or to compare R/3 with other software sys-
tems during the selection process.
Customizing
IS-H was designed as a standardized software system for hospitals, with the re- Simple Adaptation to
sult that every hospital using this system works with the same programs. To tailor Hospital-Specific Needs
the system to the individual requirements of your institution without modifying
the programs, several options have been made available.
10-3
10 Implementing IS-H
System Parameter Settings Management of system parameters in tables which you can modify easily.
With these parameters you may define organizational unit types (e.g. depart-
ment, nursing station, nursing care group), specify admission and discharge
types and decide which billing method should be used for a case. SAP pro-
vides defaults for all parameters.
Integrated All system parameters are described in the IMG (Implementation Guide) pro-
Implementation Guide vided. This guide is an important tool for implementing the R/3 system. A
detailed representation of all functions allows you to decide which subfunc-
tions are currently relevant for your requirements. The hospital-specific im-
plementation guide will include only these functions. The functions for ad-
Control Parameters Can be justing the various control parameters can be called up directly from the on-
Set Directly line documentation. The IMG serves as an interactive guide which provides
the required system functions as well as explanations and detailed documen-
tation material.
Basic Data Comprehensive basic data administration
Information regarding your organizational structure, building structure, busi-
ness partners (insurance providers, external physicians, etc.), charge masters,
diagnosis code catalogs, ICPM, etc. maybe maintained and structured to your
requirements in the basic data (see Chapter 4). The standard system includes
a large set of basic data.
Variable process control
Variable Sequence of You can change the sequence of processing steps for all comprehensive pro-
Processing Steps cesses such as admissions, transfers, and discharges.
Dynamic screen modification
Screen Contents Modification Screen contents can be modified dymanically based on the user group to which
the user belongs, the actual task being performed, and the processing mode
(create/display/ change). In this way, you can set the system to display more
data for a physician than for a nurse, for example. You may delimit the data
which can be entered in the same manner.
Individual enhancements to the standard system
R/3 Development Using the R/3 development tools available, additional reports, ad hoc que-
Environment ries, or enhanced system components are created as integrated modules of the
standard system without affecting releases.
10-4
Implementing IS-H 10
Integration With Non-SAP Systems

The system supports integration of the IS-H system with non-SAP systems as fol-
lows:
Use of the IS-HCM module as described in Chapter 8. IS-HCM
Transfer of data from non-SAP systems into IS-H
. Using an SAP standard interface, you can supply IS-H transactions with in- Transfer of Data from
put data from non-SAP systems and subsequently perform the transaction. Non-SAP Systems
Manual execution of the transactions is simulated. All checks and database
updates are performed as with interactive transactions, thus ensuring the Ensuring Data Integrity
logical integrity of the database. Incorrect data is rejected by the system but
stored separately so that it may be processed once corrected. The procedure
is performed interactively or in batch mode.
Transfer of data from IS-H to non-SAP systems without IS-HCM
Besides using IS-HCM, you can read, edit and transfer data from the IS-H Data to Non-SAP Systems
database to other systems via reports and functional modules generated with
the R/3 development tools. This can be done interactively by RFC (Remote Interactive Communication
Function Call) or by CPI-C (program to program communication), via extract Data Extracts
files, etc. Since the R/3 tables are stored transparently in the relational data-
base system which is used, you are also able to access the data of the R/3 Direct Access to R/3 Tables
system directly via ODBC or SQL. To ensure data consistency, this should be
restricted to read functions only.
10-5
Chapter11
11
Fundamentals of the R/3 System
Fundamentals of the R/3 System

R/3 System Concept
Client/Server Architecture
The R/3 System is based on a software-oriented three-tier client/server architec- Three-Tier
ture. Client/Server-Architecture
Owing to this type of architecture, the central functions of an application system com- Distributed Environment
prising data management, the application logic itself and communication with the
user are implemented in separate modules which can be distributed among dedicat-
ed servers. This results in the following R/3 System implementation levels:
Central database server for managing both system- and application-related Central Database Server
data in a relational database system. Data can be distributed among R/3 Sys-
tems with ALE (Application Link Enabling).
Unlimited number of application servers on which the application programs Unlimited Number of
run. All the applications available in the R/3 System can be used on each Application Servers
application server.
A presentation server for each user which ensures communication between Presentation Server
the application and the user through the standard R/3 graphical user inter-
face.
With distribution over all three system levels, communication between the vari- TCP/IP Protocol
ous components is provided by the TCP/IP protocol. The use of this standard
network protocol also makes it possible to connect a presentation server to an
application server across a wide area network.
The client/server architecture provides R/3 customers with the freedom to up- Scalability
grade their hardware installation in line with technological innovation and indi-
vidual requirements. For instance, new PCs can simply be added if the number of
users increases. This kind of scalability allows you to install the optimum com- Suitable for Configurations
puter capacity on each of the three levels and provide for optimum load distribu- with Several Thousand Users
tion even in client/server configurations with several thousand users.
This is a major requirement for achieving shorter system response times in hospi-
tals where physicians, nursing and administrative staff work with the system and
a considerably high number of users is therefore to be expected.
11-1
11 Fundamentals of the R/3 System
Fig. 11-1: Three-Tier Client/Server R/3 Architecture
The Client/Server Architecture enables the R/3 System to adapt to hardware installati-
ons of virtually any size.
Integrated Development System

Customizing SAPs R/3 standard application software enables you to meet the demands of
your hospitals business environment by selecting the modules and setting the
parameters you require (Customizing). This requires no modification of the stan-
dard software and is upward compatible.
ABAP/4 Development To incorporate even greater detail on specific hospital characteristics, R/3 soft-
Workbench ware includes a fully integrated development system complete with the follow-
ing technological components:
ABAP/4 Repository The centralized Repository contains all development objects in the ABAP/4
Development Workbench. These objects include data model objects, ABAP/4
programs, screens and table logic, documentation.
Modeling Integrated tools for presenting and modeling data structures and business
processes.
11-2
Fundamentals of the R/3 System 11
An interpretative, platform-independent 4th generation language tailored to ABAP/4

the development of business applications.
Library of ready-made function modules which are reusable units of code. Function Library
Screen Painter and Menu Painter for the platform-independent development Graphical User Interface
of the graphical user interface.
Integrated tools for creating application documentation, including context- Documentation Tools
sensitive online user documentation.
Fig. 11-2: Integrated R/3 - Development System
All applications developed within the R/3 development environment can, analog Seamless Component
to the R/3 System itself, be used in a client/server architecture, without the devel- Integration
opers having to take care of the distribution aspect. These applications can be
seamlessly integrated in the R/3 standard System.
In addition to hospital-specific customer developments, the customer exists available Customer Exits
within the standard R/3 applications allow you to extend the functionality of your
R/3 System without changing the source code of standard SAP programs or affecting
software upgrades.
Customer-specific functionality can be simply and seamlessly added to the R/3 standard
applications using the SAP development system.
System Management
To ensure the reliable operation of a distributed application system, tools are re- Computing Center
quired for monitoring, tuning and analyzing the R/3 System. These are contained Management System
in the Computing Center Management System (CCMS) toolset which is highly
11-3
integrated with the operating, database and network management systems used
and which relies on their services.
Graphical User Interface The CCMS provides the system administrator with a user-friendly graphical in-
terface to facilitate the execution of all system tasks:
System monitoring is provided by the performance monitor, alert monitor and
Monitors the performance figures history.
System Control System control supports all system administration functions (e.g. configura-
tion, starting and stopping systems and processes), load distribution, back-
ground processing, data backup and restore.
Open Interfaces Open interfaces with management systems in the network, database and op-
erating system areas.
Integrated system management components guarantee the reliable operation of the R/3
System.
User Interface Design

Ergonomic Interface Design
Graphical User Interface Interaction between the user and the R/3 business applications is ensured by a
graphical user interface resulting from the latest findings of ergonomic research.
SAP Style Guide The design standards of the R/3 operator interfaces are documented in the SAP
Style Guide which takes account of the Windows Style Guide and the recommen-
Uniform Interface dations of CUA, OSF/Motif and Apple Macintosh. All SAP applications are de-
signed according to this guideline. This has the advantage that you are presented
with a consistent work environment. As a result, adjustments to a new application
and using all the options in an existing application are made considerably easier.
The uniformity achieved by the SAP style guide affects all sub-areas of interface
design:
Uniformly Structured Menus Menus:

All R/3 application functions can be accessed through menus. Menus are
uniformly structured throughout the system. To simplify operation, you can
also define customized menus that are adapted to your field of activity. The
Session Manager Session Manager takes simplification further. It allows you to access individ-
ual transactions directly from a user-specific menu.
Standard Tool Bars Tool bars

A standard tool bar contains symbols, known as icons, for frequently-used
navigation commands and for calling up Online Help.
11-4
Fundamentals of the R/3 System 11
Push button bars Push Buttons

The essential functions used to control an application are accessed through func-
tion keys.
Control elements Graphical Control Elements
Along with input/output fields, there are check boxes, list boxes, push but-
tons and radio buttons. Scroll bars are used wherever more information needs
to be displayed than fits on the screen.
Input values Input Values
Wherever it is practical to limit the number of possible input values for a field,
you can display this limit number and use the mouse to select an entry.
Online Help Online Help
Offers documentation on using R/3 applications. Help functions, which are
always accessible, offer various ways to access Online Help. Examples are
through the glossary or directly from an application.
Examples of the R/3 System user interface are given in chapter 5 of this booklet. Mouse or Keyboard
The interface is designed in such a way that you can work predominantly with Operation
the mouse. The keyboard is only required for entering text or figures, but can
nevertheless serve as the R/3 System input medium in its own right.
Wherever additional display options are required, SAP presentation uses special Interactive
graphics tools. Interactive SAP Business Graphics is integrated in many R/3 ap- SAP Business Graphics
plications for displaying and processing data.
The uniformity of the R/3 System graphical user interface makes use and adjustment to
new applications considerably easier.
Multi-Level User Documentation

Although the graphical user interface is largely self-explanatory, it is backed up Consistent Documentation
by consistent and clearly written documentation to assist you in implementing
and using the R/3 System.
The R/3 System provides both online and paper documentation. The docu- Implementation and
mentation is divided into implementation guides and end-user manuals, depend- End-User- Related
ing on the tasks being performed. The objective of the R/3 System is to combine Documentation
online and paper documentation to offer maximum support to the user. You can,
for instance, search for a particular documentation element online and print out
Online Display / Paper
all related texts and notes which could be of interest.
Documentation
11-5
There are various types of documentation which differ in content as outlined be-
low:
Field Documentation Context-sensitive field documentation on data elements, error and system
messages
User Manuals User manual with extensive conceptual discussions, examples and system
application functions. You can also call these manuals online from the appli-
cation screen.
Implementation Guides Online implementation guides, data and process models to assist you in im-
plementing the R/3 System (see chapter 10).
Integrated Documentation Online documentation combines all the various documentation types interactive-
Elements ly on the screen (from field descriptions, via extended conceptual notes to glossa-
ry definitions). In addition, you can access particular documentation elements
via hierarchical structures.
Online, context-sensitive and user-friendly documentation simplifies working with the

R/3 System.
11-6
Chapter12
12
Additional Features
Additional Features
Worldwide Support
Since its foundation in 1972, SAP has developed into one of the largest independent
software houses in the world. With branch offices all over Europe, North and
South America, in South Africa, South-east Asia, and Australia, the company can
guarantee uniform customer support around the globe. In addition to the sophis-
ticated data processing technology used, the comprehensive SAP software sys-
tems provide complete business application solutions.
The market for the R/3 System covers a wide spectrum of users: User Groups
q Group headquarters
q Group subsidiaries
q Medium-sized companies.
Common to all these different types of user is the demand for a wide-ranging
business functionality, as well as an expansion of the integrated, business data
processing technology and enhancement of international and multinational func-
tions.
Development and Maintenance

SAP offers the wide range of business functionality in the R/3 System in the form New Developments
of modern data processing solutions. Customer requirements, national and inter-
national regulations, and new concepts in business management, mean that the
functionality of the system must be continuously enhanced. This means recogniz-
ing new trends early, and realizing them as standard software solutions, often at
very short notice. Before new developments or enhancements are released for sale,
they are thoroughly tested in pilot installations at carefully selected sites.
SAP provides a comprehensive and reliable maintenance service which guaran-
tees the stability of the individual software modules.
Price
The installation and use of R/3 modules must also be within the bounds of eco- Uniform Price Structure
nomic feasibility. The uniform price structure, modular organization of the sys-
tem, and prices related to the size of the installation and customer concerned en-
sure that every potential R/3 customer can see the costs likely to be incurred for
the software. This allows you to plan the costs both for the initial installation and
for any subsequent enhancements fairly exactly, based on the business require-
ments of your company.
12-1
12 Additional Features
Support Services
Services SAP also offers a wide range of support services to help you decide how R/3 can
best be used to meet your particular data processing needs. These services in-
clude:
q Advice when deciding on the modules required
q Comprehensive training in all system components
q Consulting services during implementation and application
q Miscellaneous services, such as telephone hotline, written problem, and so on
These services strengthen still further the economic viability of installing and us-
ing SAP software.
Fig. 12-1: Integrated Customer Solution

You can use the various services on offer individually. The SAP support services
guarantee that price, deadlines, and content are all tailored to suit the require-
ments and budgets of your particular company.
12-2
Glossary
G
Glossary
Admission Chief Physician Contract

Process designating the beginning of a case (treat- Contract between the hospital and physician regar-
ment and/or stay) in a healthcare facility. During ding additional services provided by the physician
the admission procedure, a new case is opened and and the resulting rights and obligations of both par-
a new case number is assigned. For outpatient ca- ties.
ses, admission is equivalent to the first outpatient
visit. Discharge
Process describing the termination of a case (treat-
Admission Department ment and/or stay) in an institution. The only ex-
Organizational unit which is allowed to admit pati- ception is the outpatient case where a case is not
ents. This department must be included in the or- terminated by a discharge. The discharge releases
ganizational structure and a corresponding catego- the case for follow-up processing.
ry must be assigned to it. Example: Final billing
Admission Diagnosis Institution

Specially marked diagnosis made during the admis- Healthcare facility which is legally independent and
sion examination. It is used primarily to verify the functions as an independent organization. Enter-
referral diagnosis and as an indication for all proce- prises where physicians and the nursing staff dia-
dures performed on the patient. The admission dia- gnose, heal and alleviate illnesses and bodily inju-
gnosis is forwarded to the insurance provider as part ries and provide obstetric services and where the
of the insurance verification process. persons to be cared for can be accommodated. Le-
Benefits Coverage Rate gally mandated evaluations are made at institution
The portion of the charge billed by the hospital for level.
services performed which must be covered by the Several institutions can be set up for one client so
insurance provider. that patient management can cover several hospi-
tals simultaneously. An institution is part of a com-
Business Partner (Hospital) pany code. When preparing an internal balance
All persons or institutions having a relationship sheet and a profit and loss statement, an institution
with the hospital. The general business partner sec- can be assigned to a business area.
tion contains primarily address data. Business part-
ners have various functions: Insurance Provider Group (Hospital)
Insurance provider groups are used as a selection
Health insurance funds criterion or as a control parameter. One or several
Insurance providers insurance providers (e.g. health insurance funds)
can be assigned to an insurance provider group. The
Employees insurance provider hierarchy can have as many
Physicians levels as the user needs.
Hospitals
Employers
Insurance Verification
Through insurance verification, the insurance pro-
vider confirms to the hospital that the charge to be
Charge Factor (Hospital) billed by the hospital will be covered by the ins-
Factor specified for the relative value of a medical urance provider subject to the insurance conditions.
service.
Charge Factor Value (Hospital)

Monetary value of a charge factor.
Glossary-1
G Glossary
Leave of Absence Procedures Surcharges

Period during which treatment is suspended. It is In addition to nursing charges, the hospital can bill
defined by the two movement types leave of ab- for procedures surcharges. Procedures surcharges
sence start date and leave of absence end date. are not time-based. Special forms of charging are
During this period, a different nursing charge can available in the hospital for defined services.
be billed. Leave of absence can be documented for
the case types Inpatient, Observation Patient, and Request for Insurance Verification
Nursing Home Patient. Especially for inpatient ca- The hospital generates the request for insurance ve-
ses, leave of absence must be expressly approved rification to ask the insurance provider if and to what
by an attending physician. extent a patient is entitled to benefits coverage.
Movement Self-Pay Patient (Hospital)

Process describing a case-related change of building Patient, who is a payer or invoice recipient.
unit, organizational, and planning criteria. The ge-
neral term movement comprises the following
movement categories:
Service Catalog
Hospital-specific charge master used for entering
Admission services.
Transfer
Discharge Type of Coverage
Frequently used break-down of insured persons into
Outpatient visit billing groups for purposes of cost object controlling.
Leave of absence start date and leave of absence
end date
Movements can also be planned
Movement Category
Characterizes a movement. Movement categories
are:
Admission
Transfer
Discharge
Outpatient visit
Leave of absence start date and leave of absence
end date
These movement categories are mandatory in the
system since they are firmly linked with existing
functions.
Pre-Registration
Planned admission of a patient for a future date.
Pre-registration helps planning (beds, staff, rooms,
etc.) and shortens and optimizes the actual admis-
sion process during peak workload periods. A pre-
registered patient takes up resources and is therefo-
re included in planning.
Glossary-2

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Functions in Detail - IS-H

Current Challenges Facing Hospitals

SAP Hospital Information System

Fig. 2-1: The SAP Industry Solution for Hospitals

Overview of the Standard SAP Business Systems

Financial Assets/ -Inputs Management of financial assets and inputs.

Financial Accounting is a real-time system independent of charts of accounts which is set

Materials and Inventory Management

Recruitment Applicant management and selection

Time Recording Time recording and evaluation

Payroll Management Flexible payroll accounting

Statements Statements and numerous evaluations and statistics

The IS-H Architecture

Integration between Nursing Integration of administrative, medical and nursing requirements by

Integration between Patient Integration of patient-related and business-related aspects to utilize

Patient Accounting (IS-HPA)

Hospital Controlling (IS-HCO)

These components provide the following main functions:

Patient Management (IS-HPM)

Patient Master Data

Patient Accounting (IS-HPA)

Hospital Controlling (IS-HCO)

Fig. 4-1: Hospital Structures

Fig. 4-2: Basic Data and Operational Functions

Cost Center Structure

Flexible Basic Structure Charge masters are basically structured as follows:

Fig. 4-3: Charge Master Structure

Fig. 4-4: Service Groups

Fig. 5-1: Patient Master Record and Related Information

Fig. 5-2: Patient Index Search

Fig. 5-3: Selection List of Patients found in the Database

Sub-Functions Admission basically includes the following sub-functions:

Standard Inpatient Admission

Fig. 5-4: Case List of a Patient

Fig. 5-5: Case with Related Information

Fig. 5-6: Admission Data for Inpatient Case

Standard Outpatient Admission

Fig. 5-7: Outpatient Case

If treatment for an outpatient is to be continued in the hospital, the outpatient case

Quick Admission (inpatient and outpatient)

Emergency Admission (inpatient and outpatient)

Fig. 5-8: Transfer

Transfers are changes in the patients location at organizational and/or building

Fig. 5-9: Discharge

Discharges can be processed together with the corresponding sub-activities.

Variable Case Information

Hospital-specific additional information can be maintained in addition to mandatory case

Nursing Station Management

Fig. 5-10: Summarized Room and Bed Listing

Fig. 5-11: Graphical Nursing Station Overview

Additional Nursing Additional Nursing Station Management functions include:

Outpatient Department Management

Fig. 5-12 Appointment Schedule

All IS-H Functions are Additional outpatient department functions:

Forms Management and Work Organizers

Assignment to Nursing Acuity Assignment of inpatient cases to nursing acuity.

Reports A comprehensive reporting system is offered to ensure a complete database

Fig. 5-13: Diagnoses

Risk factors are documented at patient level.

Medical Record Administration

Medical Record Administration provides the following functions: Processing Functions

Fig. 6-1: Insurance Relationships

Fig. 6-2: Overview of the Insurance Data of a Case