SAP is-H Functions in Detail - R3 System - Hospital Information System

8/10/2019 SAP is-H Functions in Detail - R3 System - Hospital Information System

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The hospital of today faces dramatic structural changes in the healthcare field. Asa result, there are numerous requirements as well as new opportunities for suc-cessfully managing the hospital of the future, such as:

Competition between hospitals and the burden of financial risk shift frominsurance companies to healthcare provider leading to the need for better in-ternal controlling of hospital processes.

Constant change of legislative requirements regarding charges leading to shortpossible 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-mission and post-discharge treatment, outpatient surgery) and clinical andadministrative tasks in hospitals.

Outdated technology infrastructure leading to high maintenance effort, redu-ced scalability and slow changes in the information infrastructure.

A critical component for meeting these requirements is the use of a hospital-wideinformation and communications system which consistently reflects and offersintegrated support for the processes involved in providing support for all admi-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 developedsuch a leading-edge hospital information system which meets these modern re-quirements and which has demonstrated its capabilities and reliability in numerouscustomer installations. This system will be presented in the following chapters.
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This brochure describes the architecture and performance features of the IndustrySpecific 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


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The standard SAP business systems included in the healthcare industry solutionoffer the following functions (for more detailed information see the brochuresdescribing the functions of the individual modules). If you want direct informati-on on the patient management and accounting part, please proceed to Chapter 3.

The financial accounting applications use a uniform database for general ledgerand sub-ledger accounting which is also an important prerequisite for integratingfinancial accounting and controlling.

At the core of this database is the shared chart of accounts which is flexible andcan easily be adapted to the needs of individual hospitals. Single documents areused to enter and store all posting transactions in financial accounting. Thesedocuments contain both the data for general ledger and sub-ledger accountingand account assignment information for controlling and allow integrated and in-teractive processing by simultaneously updating all financial accounting and con-trolling data. You can display the latest financial accounting data such as account

balances, profitability analyses, or key figures. In addition, you can retroactivelydisplay any document with all document lines and additional account assign-ments or key data for interactive review of business transactions. In addition togeneral ledger accounting, financial accounting offers the following functions:

The Accounts Receivable module handles the traditional tasks of accounts re-ceivable management (open items, incoming payments, dunning, etc.). Anaccounts receivable master record is created from Patient Management for eachpatient 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.

The Accounts payable module maintains and manages the accounting datafor all vendors and integrates them with the purchasing functions of the Ma-terials Management System.

Financial Controlling is a tool for short-, medium- and long-term liquidityplanning with electronic banking support.

Management of financial assets and inputs. Funds Management for planning and controlling budgeting and funds utili-

zation with active availability control.

Consolidation to generate consolidated financial statements.


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A look at balance sheets and capital spending lists confirms the importance offixed assets for todays hospitals: medical equipment and devices, physical plantand technical equipment represent a steadily increasing percentage of a hospitalsphysical and liquid assets.

The SAP Asset Management System covers the complete life cycle of fixed assetitems and contains all functions necessary to comply with government regulations:

The Investment Management module integrates planning and control of capi-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 acquisitionsand 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. Theseinclude preliminary invoicing and interactive simulation to analyze theeffects of parameter changes in such areas as depreciation methods. TheReporting module allows controlling-oriented evaluation of key figures andrankings of relevant objects in addition to government mandated reporting.

In the overall model, Asset Accounting is the sub-ledger accounting part ofthe Financial Accounting System and is also fully interactive. The Asset Ac-

counting System is integrated not only with Financial Accounting, but alsowith the Cost Accounting and Materials Management Systems.

The options available in the system provide appropriate support for handlinghospital-specific financing problems.

Technical Assets Management is used to administer and manage maintenanceorders. 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 partof Asset Accounting and provides advanced resource planning functions.


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The Materials Management System facilitates fully integrated processing of alllogistic transactions in the central warehouse and pharmacy utilizing the follo-wing functions:

Consumption-based materials planning according to the reorder point proce-dure or based on forecasts.

Purchase processing from requests for bids to vendor selection and monito-ring of order placement.

Stock and warehouse management with online display of the processes affec-ting stock (goods received, stock removal, stock transfers, stock corrections,

etc.) with the option of managing various warehousing structures as well asinventory management.

Largely automated invoice verification.

Inventory Controlling with variable evaluation options.

The components of Materials Management are fully integrated into Financial Ac-counting and Controlling. This means that value-based stock is updated at thesame time as quantity-based stock. In addition, material consumption data andthe corresponding account assignment (e.g. to a cost center or to an order which isrelated to a cost object) are transferred directly to Cost Accounting. Based on thisdata, you can perform detailed analyses of medication utilization, either for eachnursing station (ward) or cost center and, if the controlling system is configuredaccordingly, also for each cost object.

Maintenance has gained in importance with the increasingly high-tech nature ofhospitals. The (Plant) Maintenance System (PM) provides extensive tools which

enable you to meet all requirements in this area, from management of non-patienttechnical and medical equipment to maintenance planning and processing andclosing of maintenance work orders. The system also includes extensive analysiscapabilities that provide up-to-date overviews of the status and history of techni-cal objects. This module is an integral part of the SAP system, which means thatdata regarding the cost of maintenance work orders flows directly to Controllingand Asset Management.


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The SAP Human Resources System covers all aspects of human resources mana-gement, from the selection of applications to master data administration, shiftplanning, time management and payroll procedures and further education andtraining planning. The system is flexible and can easily be adapted to legal andpay scale requirements and to specific situations such as internal company agree-ments. Like all SAP systems, it is completely interactive: all functions are availa-

ble online and fully integrated with other SAP modules. Payroll as well as travelexpense data is transferred automatically to Financial Accounting and Cost Ac-counting. Specifically, the Human Resources System covers the following areas:

Personnel planning (organization and position descriptions, qualifications and

requirements, planning and management of further education and trainingmeasures, etc.)

Applicant management and selection

Personnel data management (flexible definition of subject matter and functio-nal processes)

Work schedule and shift planning

Time recording and evaluation

Flexible payroll accounting

Travel expense accounting

Statements and numerous evaluations and statistics

The system is suitable both for private enterprises and the public sector.
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The hospital-specific IS-H system supports all aspects of patient management. Asthe 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:

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 ispart of the central R/3 data model and ensures full integration with the other SAPstandard systems.

The SAP Hospital Information System utilizes a hospital-wide data model. Thesystem formally maps all relevant data structures within the hospital, such aspatients, cases, diagnoses, services, invoices, etc. and the relationships betweenthem. For data modeling, an advanced version of the classical entity relationshipmodel (ERM) which increases the transparency of large data models as they arerequired for comprehensive, integrated information systems is used.

Modeling of the data structures within a hospital is an important step in the de-velopment of a hospital information system, because it forms the basis for a logi-cally designed, flexible, fully integrated, and fully functional system. In addition,the availability of a data model with open data structures facilitates the subse-quent implementation of the system and any necessary enhancements.

Excluding the partial-data business models of the complete SAP Hospital Infor-mation System, the IS-H data model consists of approximately 150 entities whichensures 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, observation patient) can be assigned to a patient, and correspondingmovements (admission, transfer, discharge, leave of absence, outpatient vi-sits) can be assigned to these cases, which provides a comprehensive pictureof the patient including all relevant data.


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Integrated

The IS-H data model takes account of the integration requirements of a hospi-tal information system with regard to:

Integration between outpatient and inpatient areas to ensure transparencybetween these treatment types.

Integration of administrative, medical and nursing requirements byproviding a patient-oriented data model with all relevant data to avoidduplicate data entries and redundancies.

Integration of patient-related and business-related aspects to utilizepatient-related information as a basis for charge determination and hospi-

tal controlling.

Realistically structured

The hospital structures are depicted in a flexible and realistic manner; the buil-ding structure and cost center structures are represented and linked togetheras different views of a hospital rather than combined in an unstructured re-presentation.

Implemented in a relational database

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 ineach R/3 system delivered to the customer.

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 Movement

Movement-related processing of patient, case and movement data for inpati-ent or outpatient admissions, outpatient visits, pre-admission and post-dischar-ge treatment, transfer or discharge and for the admission of companions andnewborns.


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Patient Master Data

Processing the specific, system-wide patient master data for each patient. Thispatient master record is the basis for all further patient-related inpatient andoutpatient information.

Case Data

Isolated data processing for a specific case such as case information, move-ments, insurance relationships, services or medical information.

Nursing Station Management

Planning of beds in an organizational unit which supports beds (such as anursing station) with the purpose of allocating a bed to a patient, recordingnursing categories as a basis for determining nursing acuities and performingadditional nursing station-related functions.

Outpatient Department Management

Scheduling appointments for outpatient visits based on the availability of re-quired resources (e.g. physician, treatment room) and different types of visits,status management for visits.

Patient Inquiry

Providing patient- or case-related information (such as master and movementdata) for one or several specifically selected patients as work lists (e.g. patientlist, admission list, nursing station overview).

Forms and Work OrganizersEvent-driven output of forms (such as admission forms) and work organizers(e.g. labels, magnetic cards) for a patient based on a preset number and onfreely 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 librarymanagement.

Mandatory Patient Medical Information

Standardized patient-related documentation of treatment data, in particulardiagnoses, risk factors and surgical procedures.

Information Retrieval and Reporting

Statistical evaluation of patient and structural data for internal purposes (busi-ness policy) and external reporting.


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Insurance Relationships

Patient- and case-related entry of multiple insurance relationships of a patientwith insurance providers, administration of self-pay patients and patientsrequired to make copayment.

Treatment Certificates

For outpatient case billing, different types of treatment certificates can be en-tered and the services performed can be assigned to them.

Service Entry

Case-dependent and case-independent documentation of services for servicebilling, service planning, and service allocation in cost center accounting andcost object controlling. Use of a hospital-specific service catalog to representthe range of services for outpatient and inpatient cases.

Insurance Verification

Highly automated determination of a customers payment obligation (insuran-ce provider, self-pay patient) for case-related, billable services. Managing com-munication with insurance provider and insurance verification monitoring.

Copayment

Managing copayments integrated into Financial Accounting based on recei-

vable or collection procedures.

Down Payment

Entering case-related down payment requests and down payments integra-ted with Financial Accounting.

Billing

Billing for billable services related to outpatient and inpatient cases, indivi-dually or as a collective invoice for many cases which are determined by caseselection (e.g. by case type, patient name, admission and discharge dates, bil-ling status). The module fully supports new charge methods such as flat ratesper case, procedures surcharges, basic nursing charges and departmental perdiems, outpatient surgery, etc.

Copayments and down payments made by the patient are taken into account,posting records are generated and transferred to Financial Accounting andCost Accounting. Reversal management and accruals and deferrals are sup-ported.

Information Retrieval and Reporting

Numerous evaluations of the billing and service data for internal purposes(business policy) and external reporting.


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Controlling - Master Data

Linking organizational units with cost centers, posting rules for assigning hos-pital services from the services catalog to activity types under Controlling andassignment of preliminary costing to hospital services.

Cost Center Accounting

Posting hospital services performed to the cost centers involved with the opti-on of posting additional statistical orders. Posting profits to profit centers.

Cost Object Controlling

Posting the costs of case-related, documented hospital services to case-relatedorders. Extended services such as nursing charges are assigned to the respec-tive time periods. Revenues from a case are also posted to the related order.Order summaries for analysis.

Asynchronous transmission of patient data to subsystems. Event-driven trans-

mission of patient, case, and movement data to authorized subsystems. Ex-amples of events are the admission, transfer, or discharge of a patient. Profileoptions determine which subsystems receive which data at what time and thestructure of the messages to be transmitted. A protocol converter allows theuse of SAP message formats and supports individual communication struc-tures and the use of HL7.

Asynchronous transfer of service and diagnostic data from subsystems.

Automatic transfer of service data and diagnoses from non-SAP systems or ahospital-specific format is supported.

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 IS-H Data such as patients, cases, or services via remo-te function calls.

External communication with insurance providers

Providing data for transmission or receipt.
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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.

To present the hospital structure in a flexible and realistic manner and to take into

account the various informational requirements, IS-H provides the following viewsof the hospital structure:

Organizational Structure

Building Structure

Cost Center Structure

These structures and the relationships between them are represented in the IS-HSystem based on each hospital situation. Using different views has the importantadvantage that the various aspects of the hospital structure can be representedand changed without regard to the other views. When a structure is changed, youonly need to adapt the affected links to other structures.


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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 storemultiple 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 fordiagnoses, surgical procedures, risk factors, postal codes, geographical areas, etc.

The following figure shows an example of how basic data is used in operationalfunctions.

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).


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The building structure is organized in a hierarchy similar to the organizational struc-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 thetop hierarchy level it can be assigned to exactly one higher-level organizational unit; ahospital room, for instance, is at a higher hierarchy level than a bed location. While theorganizational structure is defined within a specific institution, the building structureincludes all institutions so that building units can be shared by several institutions.

Each building unit is assigned a category which in turn specifies its purpose. Forexample, building units must be assigned the types hospital room and bedlocation so that a room or bed can be assigned to a patient during his/her stay.Equipment features (room with bathroom, oxygen supply, telephone) as well as

planning data (maximum room occupancy, non-availability due to disinfection orconstruction) can be stored on a time-dependent basis.

The cost centers and their relationships are defined in the SAP Controlling System

CO, which is integrated with IS-H. An assignment to organizational units andcost centers, as described above, is necessary so that the account assignment infor-mation (for instance, services of a sending to a receiving cost center) required forControlling 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).

In the simplest case, one organizational unit is assigned to exactly one cost center. Incase 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 toone 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 ofthe respective structures match.


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The business partner concept allows you to centrally manage the various func-tions of persons and institutions that have a business relationship with the hospi-tal. The system distinguishes between various functions of business partners basedon the type of business relationship. For example, a physician can be both thereferring 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-pendent) data (names, address, communication data) and 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:

Hospital

All hospitals having contact with your hospital, for example, referringhospitals.

Employers

Employers whose names frequently appear can be stored as business part-ners. The patients master record can refer to this employer.

Insurance Providers

All insurance providers with which patients have an insurance relationshipand their respective data must be entered as business partners. Insuranceproviders 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 bemaintained for billing purposes.

Employees/External Physician

Indicators are used to distinguish between employees and external persons,physicians, members of the nursing staff, and other areas. External physiciansare marked with an additional indicator.

Customer

IS-H Customer provides a link to Financial Accounting where all customer-specific information is managed.


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The charge masters which can be stored in the system are the basis of the completeservice documentation in IS-H.

A maximum of 99 different charge masters can be stored simultaneously in theIS-H System. The most important charge masters are provided by SAP. The SAPuser can change or expand existing charge masters or create completely new chargemasters. One charge master should be defined as the internal service catalog to beused for service entry. Services in the service catalog may be converted to one ormore services of other charge masters for billing or statistical purposes.

Charge masters are basically structured as follows:

Charge Master Columns

Each charge master has one or more columns in which the data required forthe 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-

ber of columns is specified for each charge master and may be defined basedon 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 oradapt them to hospital-specific needs.


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Services

Multiple services can be stored in each defined charge master. Each service isdescribed by general information and by the respective entries in the columnsof this charge master. General data include:

Service and DPnumber

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-ter histories allow retroactive billing runs and convenient maintenance ofcharge 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.

Immediate services such as laboratory or radiology services, or extendedservices 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 flatrates per case, or services which are not objects of Cost Object Controlling.

The service catalog can be designed to represent all services provided through-out the hospital so that the entered services can be used in all required areas,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 definedepartment-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 definedfor different purposes.


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Price Information

In addition to charge factor values or cost information for a service, price mod-ifications (e.g. surcharges and discounts) can be stored as conditions whichneed to be taken into account when billing this service.

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 enteringthe service.

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 andcode catalogs stored in the system. Rather than having to make manual entriesinto fields, you can call a dialog box containing possible entries for input from apredefined catalog, from which you can make your selection. When data is en-tered manually, the entered value is checked against the corresponding catalog toavoid 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-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.
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The system contains one master data record for each patient. This record is thecentral element linking all administrative, medical, and nursing care data. As aresult, both outpatient and inpatient procedures are made available via a singleview.

A patient is identified in the IS-H System by a unique 10-digit patient identificati-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

An externally (manually) assigned number to which you add a check digit

An externally assigned alphanumeric patient number

Together with the identifying patient number, another number can be assignedwhich can be defined, for instance, as an I-number. This allows you to switch fromthe I-number method to a nonmnemonic patient number when IS-H is imple-mented.


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Every case for a patient is assigned to the corresponding master data record andreceives a case number unique for the corresponding healthcare institution. Thecase number as well as the patient number can be assigned manually or automa-tically.

In a patient-oriented system it is essential to maintain a consistent patient data-base. To do this, you need to determine the correct patient master record bothwhen admitting previous patients whose master records are already in the sys-tem, and when processing other patient-related data. Usually, the patient masterrecord 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):

Last name

First name

Birth name

Date of birth

Gender

Or using movement lists, such as patients admitted during a certain period to aselected organizational unit.


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This search using patient attributes allows you to search for a name by enteringonly part of the name (generic entry). Due to name standardization, the searchfunction 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 selectablephonetic method is also supported.

Depending on the parameters set for your system, you perform a search using allpatients 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 displayedin 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).

As an alternative to entering the search criteria manually, you can import datafrom 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.Using this approach, you search for patients by movement and case-related at-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 areparticularly important for selecting quick and emergency admissions for furtherprocessing.


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As stated earlier, a consistent patient database requires that exactly one patientseveral features which can be activated by the user:

Convenient patient search options

Mandatory search for any existing patient master record when creating a newrecord

Interactive verification to ensure that no duplicates are present before the newpatient master record is saved.

If a second patient master record was created for a particular patient, this newrecord can be merged with the existing record. Related information (such as cases,movements) will be retained.

Patient movement refers to any change affecting the patient stay with respect tolocation or organization, such as admission, transfer, or outpatient departmentvisits. These different movement categories may be processed in separate systemfunctions. To provide optimum support of work processes, you can manage theactual movement data and also the patient and case data depending on the cate-gory of movement. IS-H documents different categories of patient movementsfor inpatient and outpatient cases. Companions and newborns are also taken intoaccount and assigned movements accordingly.

Admission is the main function for entering patients in the IS-H System. You usethe function to enter all data required for administrative, medical, and nursingpurposes during the patients hospital stay.

During patient admission, both patient- and case-related data are processed. Theamount of data depends on the admission method selected (standard, quick, oremergency admission). Outpatient, observation patient, and inpatient admission

are basically structured in the same way, but differ somewhat with regard to thetype and amount of information to be entered.

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


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When admitting the case, all data relevant to the patients current hospital visit isentered (see Fig. 5-5).

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 organizational unit such as a nursing station.

Specialty organizational unit such as the department involved.

Room and/or a bed. 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-leveladmission procedures where the patient is first assigned to organizational unitsonly, then later to a bed, for instance, on the nursing station.


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Admission data such as the referring physician, referring hospital or the refer-ral diagnosis.

Multiple insurance relationships between patient and insurance providers;when self-pay patients are admitted, open items can be displayed fromAccounts 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.

Various catalogs and overviews (e.g. postal data, physicians, hospitals, diagnosiscode catalogs, etc.) are available in the admission procedure to simplify input. Thesystem 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. Thisnursing station overview may be displayed as a table or in a graphical format (seesection Nursing Station Management).

Admission is further facilitated by automatic input functions such as geographi-cal areas. Parameters can be set for automatically generating service and billingdata 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 organizerscan be created, such as patient master sheets, labels, or admitting release forms.


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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 datawhen the patient actually arrives. This reduces the workload during peak admis-sion periods and greatly increases the quality of the admission process.

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 admissionwith the exception of the data which pertains specifically to the outpatient area.

In addition to patient master data, outpatient admission requires the entry of datasuch as:

Visits

Patient assignment

Referral data

Treatment certificates Services

As an alternative, outpatient department planning can be used for outpatient ad-mission by simply scheduling an appointment for a free time slot. Both physiciansand treatment rooms can be scheduled (for more information see the chapter Out-patient Department Management).


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If treatment for an outpatient is to be continued in the hospital, the outpatient casecan easily be converted to an inpatient case. This supports the required transpar-ency between outpatient and inpatient treatment areas.

A complete patient admission requires you to enter extensive data on the patientand 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 anabbreviated admission function with only the minimum amount of data requiredfor 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-up lists can be called up to remind you of such patients. This follow-up procedurealso applies to emergency admissions. If the admissions office is not staffed on theweekend, 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

admission is available both for inpatient and outpatient cases.

The emergency admission function is used to register patients who cannot be im-mediately identified or for whom a complete admission procedure is not per-

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 andsubsequently completed using the standard admission function. Should you dis-cover that the patient had already been entered in the system, functions are availa-

ble enabling you to merge patient master records.


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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

case of a documented stillbirth, or if the newborn is not admitted after an outpatientdelivery, the admission process can be terminated at this point - the delivery data isstored, but no case is created for the newborn. When you enter the master data andadmission 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 tothe mother in one procedure.

The assignment between mother and newborn(s) does not depend on the admis-sion method, so that outpatient and inpatient assignments are possible. Whetherthe newborn is healthy or sick, which is important information for patient billing,is stored as period-dependent status information together with the newborn case.

Persons who accompany a patient and benefit from services are admitted as aseparate inpatient or outpatient case. The case is assigned to the related patient ona time-dependent basis. One person can be the companion for several patientsand vice versa.

The companions case is assigned to the patient who is accompanied either whenthe companion is admitted or at a later date, if necessary.

The planned or completed treatment of a patient in an outpatient department or amedical service facility is entered as an outpatient visit. Such visits are possible foroutpatient cases, but also in the course of inpatient treatment or for an observationpatient. Both visits before and after an inpatient hospital stay (pre-admission and

post-discharge treatment) and during an inpatient stay (e.g. for a second opinion)can be represented.


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To enter and process an outpatient visit requires correct patient identification. Us-ing the patient index search described previously, you may determine whetherthe patient is returning or needs to be entered as a new patient. The respectivevisit is then logged indicating the place and time and assigned either a WaitingList, Planned, or Actual status. In addition, the outpatient department or medicalservice facility providing treatment is specified.

If a visit has already been documented via preregistration, it only needs to beconfirmed upon the patients arrival. The visit status changes from Planned toActual.

When a patient is transferred, the patients location is changed at organizationaland/or building unit level (departmental, nursing station, room, or bed locationtransfers). Like all movements, transfers can also be performed in planning. Whena 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.

Pre-admission or post-discharge treatments are entered as visits and are assignedto the inpatient case as movements. These visits are identified as special visit typeswith specific plausibility checks (e.g. maximum number of pre-admission treat-ments, maximum time interval between pre-admission treatments and inpatientadmission, etc.). The services billable for pre-admission and post-discharge treat-ments can also be assigned to the case and invoiced as such.


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Assignments to other related cases are also checked. A companion has to be dis-charged together with the respective patient, unless the person is a companion forother patients as well. The assigned cases may be discharged immediately afterthe patient.

IS-H also supports planned discharges.

Every patient movement, from admission to discharge, may be entered in plan-ning. For example, an admission can be entered for a future date. In this case, thepatients 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-larly important when performing resource or capacity planning.

For planned admissions in particular, it is sometimes not possible to specify theexact date of the actual admission. In this case, the patient master data and knowncase and admission data such as assignment to the departmental organizationalunit 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 aplanned or actual admission.


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This option of entering movements in planning enables the admission personnelto 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 mandatory data which describes a case and is maintained in theIS-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 classificationYou 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.

Nursing Station Management offers an approach to processing patient-related datawhich is different from the patient management functions described so far. It looksat the nursing station and the patients assigned to this station. Nursing StationManagement provides the IS-H functions required on the nursing stations in auser-friendly environment which takes into consideration the workplace require-ments on the nursing stations. The general IS-H menus with all IS-H functions arealso available on the nursing stations.


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An important administrative function of Nursing Station Management is bedassignment planning, i.e. the planning and administration of bed assignmentswithin organizational units supporting beds. The room and bed listing serves as astarting 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-definedtime. This summary shows the accumulated bed assignment numbers for thisorganizational unit. The display includes information such as the number of free

bed locations, assignable bed locations, planned beds, etc. In addition, the arrivalsand departures planned for a definable period may be displayed. Starting withthe selected organizational unit, this information can be called up in detail for alllower-level organizational units down to the lowest level, the units supporting

beds (see Fig. 5-10).

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 orin 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


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Outpatient Department Management provides a user interface similar to that ofNursing Station Management. It allows you to plan outpatient department visitsand offers those IS-H functions which are required in outpatient departments.

Visit Planning

Resources considered relevant for outpatient visits are the attending physici-ans and the available treatment rooms. Available time slots are stored on adaily and weekly basis for these resources and for the outpatient departmentsthemselves. The planning types are user-definable, such as initial visits, fol-

low-up examination, etc. For instance, it is possible to specify that follow-upvisits by a specific physician may only be scheduled at pre-defined times on

selected weekdays. Based on these available time slots, on-screen appoint-ment schedules are generated for the resources which need to be planned. Thepatient visits are entered into these appointment schedules and are assignedto 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-ment function allows you to easily control patient treatment including visit

planning, making the appointment, and actual treatment. You may also sched-ule an appointment without having to create a patient master record or case.


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Additional outpatient department functions:

Outpatient Department Management provides all IS-H functions required inan outpatient department, such as:

Patient Master Data

Service entry

Medical documentation (diagnoses, etc.)

Administration of certificates

Administration of medical records

Printing of 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

can customize these forms using a forms editor or define additional forms. It isalso possible to define any type of bar code for labels. Bar codes and labels aregenerated automatically after certain functions have been performed (e.g. duringpatient admission) or upon request. Tables can be set up which specify where theitem will be printed, how many copies will be printed, etc.

To determine the professional staff needed for adult and pediatric patient care inrelation to nursing acuities the system supports the following processes:

Definition of nursing acuity for determining the nursing effort as well as theassignment of nursing care minutes per day. Storing minimum requirementsfor patient care and case weights to determine the staff required for adult andpediatric patient care.

Assignment of inpatient cases to nursing acuity.

Case-related nursing acuity management by selecting a case (case view) ormanaging 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).

A comprehensive reporting system is offered to ensure a complete databasefor determining staff requirements and analyzing data for internal purposes.


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Because of the many organizational models in the hospital with respect to filing,the file system, and archive management, individual medical records for eachpatient are created with varying frequency and in varying numbers. The systemtherefore supports the following record creation strategies:

Creation of a new medical record upon initial admission to the hospital; norecord 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 amedical record. It also contains information on who borrowed a record, when itwas borrowed, and why.

Medical Record Administration provides the following 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 saidrecords

Create reminders for borrowed medical records

Administration of borrowed medical records (request, lend, transfer, returnmedical records)

Evaluations

current medical records (for example, to obtain an overview of archiveoccupancy 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 tomedical records.
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To bill for services you must enter the patients insurance data in the system. Thisis performed by processing the insurance relationships on a patient- and case-related basis. Multiple insurance relationships can be defined for each patient,each of which is assigned to either an insurance provider (usually an insurancecompany) or is processed as an insurance relationship for self-pay patients if thepatient pays him-/herself or is required to make copayments.

The insurance provider relationship establishes a link with the insurance provid-er who is entered into the system as a business partner. For self-pay patients, thepatient is assigned a customer in Financial Accounting to process his/her openitems, payments, dunning letters, etc. In addition, a different invoice recipientmay be entered for self-pay patients. It is important that all insurance relation-ships are assigned to the patient and that those insurance relationships applicableto 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 casesand need not be re-entered for future inpatient or outpatient cases. The data willonly be verified and updated as required.

Insurance relationships are managed on a time-dependent basis so that the insur-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


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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.

In addition to assigning the patient to an insurance provider, the patient-relatedinsurance relationship specifies the type of insurance coverage. In the case of de-pendent coverage for family members, for example, data for the insured familymember and optionally for their employer can be entered. You may also defineyour own types of coverage.

Healthcare smart card data can be included in the related insurance relationship.

Ranking and copayment information are important data for case-related insur-ance relationships. When requests for insurance verification are generated auto-matically, the ranking of the insurance relationship determines the order in whichthe insurance relationships are used to request insurance verification for the case-related services. For insurance providers requiring copayments, copayment infor-mation specifies either the copayment obligation with the respective copaymentamount or provides a reason why the copayment obligation is waived.

Service entry is a key function of all hospital information systems. It is used todocument planned and performed services for inpatient and outpatient cases. Thedocumented services are used for managing the insurance verification process,

billing, hospital-specific controlling (cost center accounting, cost object control-ling), medical documentation and statistical evaluations (legally mandated and

internal). In addition, services are frequently entered into subsystems, and thisdata can be imported into IS-H using the communications module IS-HCM orspecial data transfer programs.


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The service catalog (internal charge master) is usually the basis for service entry.Services entered using this catalog are medical, nursing, and operational services,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 bedocumented for a specific organizational unit as service recipient and transferredto Controlling. They may also be documented on a case basis which is necessaryto set up cost object controlling.

You can enter many different types of information for each entered service. Thisinformation 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.

Service entry is facilitated by the hierarchy structure of the service catalog; in ad-dition, default values are stored for many entry fields so that most of the time nomanual entry is necessary. Filter functions are available for processing services


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In addition, a verification program can be used to compare days spent in the hos-pital and days billed based on flat rates per case (and their maximum allowablestay) and procedures surcharges.

Services are entered locally or centrally. For central service entry, a quick entryfunction 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 isassigned based on assignment tables when insurance verification is requested orduring billing. Service input is therefore independent of such charge masters. Asa result, the patients insurance situation can be ignored when entering services.This also applies to any services in the patients insurance data during inpatienttreatment (e.g. workers compensation instead of legal health insurance). Thesechanges do not affect services already entered.

The insurance verification process is essential for billing for inpatient case servic-es in the IS-H System. The insurance verification process is used to assign billableservices 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 andautomatic functions to facilitate this process.

A billable service in an insurance verification item may be assigned to one insur-ance provider or split among several providers directly from the service entryfunction. You can split the price of a service among multiple insurance providerswith 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

patients. It is possible also to assign groups of services to an insurance provider.


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Based on pre-approved insurance and default values which are defined by eachhospital, 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 generatedautomatically for selected cases, e.g. for all patients admitted during a specifictime period. As a result, with fully maintained insurance verification items anddefault values, insurance verification requests and benefits approvals are largelyautomated.

You can, of course store insurance verification information in the system withoutfirst having entered services.

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.

Depending on the response received from the insurance provider, insurance ver-ification requests or their items can be marked as confirmed or rejected. Anintegrated reminder procedure enables you to send reminders for outstandinginsurance verification requests to the insurance provider after the predefined wait-ing period has elapsed.

To monitor insurance verification, a function is available which monitors the insur-

ance verification situation for inpatient cases. You can check, for instance, whether arequested or confirmed insurance verification is available for all billable services,whether the insurance verification for extended services covers the whole periodup to the evaluation key date, or whether the diagnoses required by the insuranceprovider are available. A checklist is generated so that the activities required forinsurance verification can be performed directly. Any necessary extensions for in-surance verification requests with a time limit are generated automatically.

The system automatically generates billing proposals based on stored pre-approvedinsurance rates and default values. Pre-approved insurance rates may be stored foreach insurance provider separately or for all insurance providers of an insuranceprovider type. This pre-approved insurance is usually covered by the insuranceprovider. In addition, you can specify whether a charge will be covered in full, inpart 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 ischanged immediately to confirmed and billing can subsequently take place.

Default values are stored in the same system structure as pre-approved insurance,however the generated insurance verification proposals receive the requestedstatus, rather than the confirmed status, and benefits coverage usually has to berequested from and approved by the insurance provider before an invoice can beissued. With the default values, you can also store information regarding the ser-vices usually not approved by an insurance provider, such as personal items notcovered by legal insurance providers. This prevents the system from generatingsuch insurance verification defaults.


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Copayments can be managed in two different ways:

Receivable Procedure

The insurance provider assigns the copayment receivable to the hospital. As aresult, the receivable amount billed to the insurance provider is reduced bythe amount of copayment, regardless of whether the patient actually madethe copayment or not.

Collection Procedure

The invoice sent to the insurance provider takes into account only copaymentsactually made. Copayments received later are sent to the insurance providercollectively 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 arefully integrated. As a result, the relevant copayment postings in FI can be madeconveniently from IS-H.

If the patient pays him-/herself, a down payment is required (down payment

request). Outstanding down payment amounts are dunned.Down payments which have been made are displayed by the system and takeninto account when billing. The SAP standard Financial Accounting module pro-cesses down payments.

Every hospital performs a variety of services, which in turn must be billed in var-ious ways in accordance with government regulations, contractual obligations,

organizational rules, etc.

IS-H supports you in billing inpatient, observation patient, and outpatientservices.

Together with the SAP Financial Accounting module and SAP Controlling, IS-Hensures safe control of receivables and cash flow and detailed controlling includ-ing cost object controlling and profitability accounting which supports hospitalliquidity and profitability.


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Particular features of IS-H Patient Accounting are:

Using services as the only basis for accounting

A highly modular accounting approach using combinable modules to sup-port different organizational processes

A highly flexible system with numerous profile options which can be speci-fied individually by each institution and which ensure that IS-H will remain astate-of-the-art system in particular in view of the impending structural changesin the healthcare system.

In the inpatient area, the system supports all types of charge, such as flat rates percase, procedure surcharges, departmental per diems, and base nursing charges,pre-admission and post-discharge treatments, as well as general nursing charges,

personal items, etc. Charge determination is facilitated by a case monitor whichdisplays an overview of all billing data, by flexible rules to determine potentiallybillable flat rates per case and procedure surcharges from entered diagnoses andICPM 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 completeand accurate billing such as automatic generation of billable services from avail-able information are being developed.

Direct patient billing for inpatient cases and billing for observation patient servic-es such as dialysis treatments is performed very easily.

The following billing methods are supported for outpatient cases:

Billing for outpatient surgery

Self-pay patient billing


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Direct patient billing (including calculation and evaluation of physician reim-bursement, also for direct inpatient billing)

Workers compensation billing

As a first billing step, you have to select the cases to be billed. For individualbilling this is exactly one case, for collective billing it is a large number of caseswhich are determined by a selection function and are saved collectively under aspecific name. Selection criteria are general attributes such as the type of case, lastname of the patient, discharged/not discharged, the presence of a discharge diag-nosis, the insurance verification status, or other visit-related criteria such as anyoutpatient visits during a certain time period or certain types of visits. The latteritem is particularly useful for outpatient cases.

To prevent billing, a billing block can be set for certain cases.


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The system determines the billing type (such as direct inpatient billing) basedon the case type, insurance provider and billing organizational unit. The bill-ing type affects the billing charge master and pricing.

The billable services entered from the service catalog may be converted tobilling master services based on grouping categories stored in the system. Asa result, a service catalog service is converted to different billing chargemaster services based on the various billing conditions.

The charge mater used for billing is selected based on the insurance provider,billing type, service master and, if necessary, the billable service.

The system generates a pricing procedure based on the case type and billingtype. You use this procedure to enter types of conditions which determinewhich price elements (e.g. basic price, surcharges/discounts) are to be used inpricing.

To access the basic price of a service, a mandatory formula is assigned to therespective condition type which is used to determine the price for a servicefrom the appropriate column of the billing charge master. For other conditiontypes (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 specificdiscount 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 theservice, etc.).

Conditions allow you to take into account different criteria when determiningregular and graduated prices.


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Down payments made can be deducted from self-pay invoices. Down paymentsare managed as special transactions in customer accounts. A special down pay-ment account is maintained in the main Financial Accounting module.

You may specify whether the balance of the payer invoice should be reduced onlywhen a copayment is made by the patient (collection procedure), or generally(receivable procedure). Comments may be entered on the invoice in cases wherea patient does not make a copayment. You can list the paid and settled copaymentamounts either from the SAP Financial Accounting module or from Patient Man-

agement.

IS-H allows you to reverse all invoices or one invoice of a case completely or par-tially by referring to the original invoice. The system always tracks the processingvia a reference to the source document (invoice). Reversals are also posted auto-matically to Financial Accounting.

Using special evaluations, accrued services which have been performed but notyet 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 shownin the year-end closing. Accruals and deferrals are reversed when the accrual ser-vices are billed.


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Government regulations and hospital information needs are making statisticalevaluations necessary on a regular basis. Evaluations derived from service andpatient census data under Patient Management are offered as standard reportssuch 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 costand service listings (e.g. personnel, revenues) are generated in the respective SAPstandard systems.

Diagnostic statistics according to hospital statistics regulations and geographicdata can also be provided. The standard system also compiles inpatient censusstatistics based on the midnight patient census.

During billing in IS-H, posting records for the Financial Accounting and Control-ling modules are generated automatically. The Financial Accounting module mon-itors payment receipt and issues dunning letters for unpaid items.

Instead of transferring invoices directly, first use the invoice posting block. Bylifting the block you release the invoice for posting in Financial Accounting. Blockedinvoices are listed and processed separately.

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 foreach service and all surcharges and discounts to a separate G/L account. The

various flat rates per case, procedures surcharges, departmental per diems (with afurther 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.

For controlling purposes, revenues and revenue reductions are assigned to costcenters or profit centers or case-based orders. The latter is required if you want toimplement 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.

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.


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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, forexample, to compare days spent in the hospital and days billed, to analyze thehospital stay for flat rates per case, to analyze billed services by insurance provid-er type or regulator, to determine the billing status of discharged cases, etc.

The healthcare institution is able to easily generate individual evaluations usingthe tools provided.
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Efficient Controlling functions are an increasingly important tool for controllingthe service processes. The ultimate goal is to implement a cost object controllingsystem which makes it possible to determine the planned and actual costs andrevenues for each cost object and compare them via variance analyses. These anal-yses can be case- or period-related, and implemented as multi-level contributionmargin accounting. Cost objects include any hospital services which are provid-ed to the patient, such as flat rates per case, procedures surcharges, departmentalper diems, or outpatient surgical procedures.

To implement cost object controlling you need to set up a meaningful cost centeraccounting system as a tool for allocating (cost object) overhead to the variouscost objects based on the cost origin.


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As a first step, profit center accounting is used to make the revenue structures ofthe hospital transparent.

The SAP Standard Controlling System CO provides all the tools required for costelement, cost center, and cost object accounting. For effective controlling, the Con-trolling System has to be provided with the controlling-relevant data such as costsand 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, documentsand bills for patient-related service processes. In doing so, it provides the dataessential for Controlling regarding the services performed by the hospital organi-zational units and the revenue derived from them.

The components of IS-HCO provide the necessary integration between IS-H andCO. In particular, IS-HCO comprises the following functional areas:

Linking CO with corresponding IS-H objects (e.g. cost centers with organiza-tional units, activity types with service catalog services)

Transferring and posting the services performed from IS-H to CO for inter-nal activity allocation


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Assigning preliminary costing to a cost object:

A preliminary costing from CO can be assigned to IS-H services which aredesignated as cost objects. If such a service is performed for a patient, an orderis created for the respective case, and the costs from preliminary costing areentered on the order as planned costs. This allows a comparison between theseplanned costs and the actual costs for cost analysis purposes.

Assigning IS-H key figures to statistical key figures under CO:

IS-H allows you to determine the nursing days, billing days, and the numberof outpatient visits for a certain period as key figures for each organizationalunit. For posting to the cost center assigned to the organizational unit, thecorresponding statistical key figures in CO must be assigned to the IS-H keyfigures.

Based on the assignments defined in the IS-HCO master data you determine the

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-Hand then make the appropriate postings in CO. Revenues are treated similarly.

Services are transferred to the CO modu

SAP is-H Functions in Detail - R3 System - Hospital Information System

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