B6 Koenig

IS-H*MED
Overview and News
SAP Healthcare
Sales Partner Summit
Feb 27th, 2002
IS-H*MED Overview and News

H. Bartl, T-Systems; F. Knig,
GSD,
IS-H*MED Modules and Integration Overview

GSD,
Roll-based Concept of Workplace and Authorization
Authorized
SAP Banking Solution activity
Map, sets
Edition 1999 for
Enterprise Management - Managers
Strategic
StrategicEEnterpr
nterprise
ise Business
BusinessIIntelligence
ntelligence&
& Managerial
Managerial Financial
FinancialAccounting
Accounting
Management
Management Data
DataWarehousing
Warehousing Accounting
Accounting
Patient Management - Admission and billing

Patient
Patient
PatientAccounting
Accounting&
& Patient
PatientService
Service Marketing
Marketing&&Health
Health
PatientAdministration
Administration Billing
Patient
PatientScheduling
Scheduling Management Promotion
Billing Management Promotion
Diagnostics & Therapy - Physicians

Diagnostic
DiagnosticSu pport &
Support & Clinical
ClinicalOrder
Order Medical
Medical&&Clinical
Clinical Treatment
Treatment&& Research
Research&&
Ancillaries
Ancillaries Management
Management Documentation
Documentation Operation
Operation Education
Education
Care Management
- Nurses
Car
CareePlanning
Planning Clinical
ClinicalCare
Care Car
CareeDocumentation
Documentation After
AfterCar
CareeManagement
Management
Enterprise Communication- Medical controlling Communication

Inter Communicationwith
with Communication
Communicationw
with
ith Communication
Communicationw
with
ith Communication
Communicationw ith
with
Internal
nalComm unication
Communication Provid ers Payers Patients Supplier
Providers Payers Patients Supplierss
Support Services
- Maintenance, procurement Hygiene
BioMedical HygieneServices
Services &
&Risk
Risk
BioMedicalTechnology
Technology Management
Transportation
Transportation Cater
Catering
ing&
&Facility
FacilityServices
Services
Management
Business Support
- Acountants, Controllers
Human
HumanResource
Resource Financial
FinancialA
Asset
sset Fixed
FixedAsset
Asset
Procurement
Procurement Equipment
EquipmentMaintenance
Maintenance
Management
Management Management
Management Management
Management

GSD,
IS-H*MED Standard Modules
Clinical Workprocess Support

Out- and Inpatient Departments Workplaces
Service Request Workflow
Scheduling for Patients and Services
Work Organizers
Clinical Documentation
Patients EMR
Structured Medical Documentation
Hospital- and department specific
Freely defineable

GSD,
IS-H*MED Standard Modules: Recent Developments
Clinical Workplace
For outpatients departments
For functional units
Scheduling
Admission scheduling
Multiappointment
e.g. Preoperative Planning
Waiting List Management
Patient Organizer
Patients history, EMR

GSD,
IS-H*MED Standard Modules - Clinical Workplace
Unified Workplace Look&Feel

Shows
Service Requests
Appointments
Visits
Freely defineable
Displays
Set of functions
Functionality
Outpatients management
Service request processing

GSD,
IS-H*MED Standard Modules - Scheduling
Multiappointment Planning
Caseless registry of patients for intended operations/treatments
Optional admission planning
Requesting services for clearing up
Coordinated planning of accompanying visits
Progress check of e.g. preoperative phase
Waiting List Mgmt

Based on preregistration
In clinical workplace
Service Requests, Visits Coordinated Planning

GSD,
IS-H*MED Standard Modules - Patient Organizer
Aspects offer various views on patients clinical history

Cases, Movements
Requests, Appointments
Diagnoses, Documents
Services
Customer-specifics
Quick navigation
Personalization
Integrated object viewer
e.g. Acrobat Reader

GSD,
IS-H*MED Application-specific Modules
Surgery
Nursing
Radiology
Patient Transport
Doctors Round
Vital Parameters
Guidelines
Mobile Internet
GSD,
IS-H*MED Selected Modules
Radiology

GSD,
IS-H*MED Radiology
The Situation
Increasing DICOM Application Entities
Evolving PACS Implementations
Development of DICOM-capable Endoscopes
and Ultrasound Devices
Increasing need for Telemedicine Applications
Report and Image Access (Workplace Solutions)
Clinic wide
General Practicioners
Patients
Report and Image Delivery
Transaction to other provider (hospital)
Delivery to Patient (CD)

GSD,
IS-H*MED Radiology
An integrated solution for radiology must support
Radiology workflow
Clinical Workflow
Business partners workflow

GSD,
IS-H*MED Radiology Workflow
Request
Scheduling Worklist Management
Prefetching Planning
Pat. Arrival
Single Pat.
Preparation
Work Organizer
ID-Stamping, Labels
Execution
Ex-Docu
Autoroute
Perf.Proc.Step
Deriving Findings
Query/Retrieve Writing Findings
Findings Transferring Findings Archiving

GSD,
IS-H*MED Radiology - Clinical Workflow
Integrated IS-H/IS-H*MED with
ADT-Management
Request communication Clinical Workplace
Service-Request
Appointment planning
Findings communication Appointment Planning
Finding

GSD,
IS-H*MED Radiology - Business Partners
General Practitioner
Internet Hospital
Service
Request DOK-BAPI
SAP R3
Findings/
Image
mySAP.com Transfer XML, PDF AE
Workplace
Image
Connector
DICOM
Archive
Historical Findings
Images / Cineframes (CD)
...
Other
Patient

GSD,
IS-H*MED Radiology Workplace
Patient-based Navigation-Bar Service- and Workplace-related
(Computerized Medical Record) Hierarchical Finding-Documentation
User- and/or
Profession-
specific
Worklist
Technical Direct Dictation and

Navigation- Speach-Recognition
Bar (PACS-
Study)
Detailed Application-Controled
Image Viewer Integration
Information
concerning
selected
items of the
worklist

GSD,
IS-H*MED Radiology Reports and Evaluation
Device and Service Related

X-Ray Register
Service Statistics
Person-Related
Experience History,
Radiation Dosage
Open
Studies
Scientific Evaluations

GSD,
IS-H*MED Radiology - Technical Features
Worklist-Server
Event-based generation of worklist entries in the MSI-Format (Customizing)
Patient Management
Generation of ADT-information in the MSI-Format, for admissions,,
discharges, transfers, etc. in IS-H, IS-H*MED (HCM)
Study Management
Overview of the entire examination flow
PACS-IDs in the Study Document
DICOM Study Status in the Examination Document
Integrated Radiological Image Findings Work Station
Calling the Load Study Servers Including Viewer-Interface Using RIS-
Communication Client (RCC)
Report Management
Transfer of the Report Text and Status to the PACS-Broker in the MSI-Format

GSD,
IS-H*MED Radiology Summary
Institution-wide Image & Cineframe Access

Access of Findings and their related Images
Standard Programming Architecture (BAPI) allows easy
transfer of findings via Internet-technology (PDF, XML).
New applications as the mySAP Enterprise Portals allow
direct access to findings and related pictures for GPs or even
patients.
The media integration in IS-H*MED concludes the efforts for a
multimedial patient record

GSD,
IS-H*MED Current Developments
Doctors Round
Vital Parameters

GSD,
IS-H*MED Doctors Round
Objective
Support of doctors round via online-connected mobile device
All needed patient-related information at his fingertip
Vital parameters
Blood pressure, temperature, pulse, ...
1st step to doctors round support
Presentation in grid or graphics
Entry for one or more patients
Integrated in clinical workplaces for in- and outpatient departments

GSD,
Vital Parameters: integrated in clinical workplace
Grid
Graphics
Vital parameters 08.11.2001
RR Pulse Temp 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
160 160 41
Vital parameters - Kirsten, Gulliver (m/27)
140 140 40 Date 27.09.2001
Toolbar
120 120 39
Time Pulse Temp RR Sys RR Dia ... ... ...
100 100 38 06:00 115 37,6 130 75
12:00 120 38,0
80 Tick
80 patient(s)
37 15:00 135 80
60 60 36
17:00 115 37,6 135 75
18:00 90
40 40
Temperature 40,4 39,6 40,0 ***
Pulse 105 92 80 115 Max 92
Clinical Workplace

GSD,
Medication
Support the Workflows relating to Drug Therapy
Documentation of Prescribed and Administered Medications
Clinical Workplace
Medication & Vital Parameters

GSD,
Guidelines

GSD,
IS-H*MED Guidelines
What are guidelines?

Systematically developed conclusions aimed at supporting
physician and patients decisions concerning appropriate health
care for specific clinical situations.
Reproduce the status of the knowledge and the methodology
comprehensively although simply for a detailed problem
Using Guidelines
Improves the quality of medical and non-medical services.
Improves the quality of the execution and results of clinical
research.
Fundamentally better acceptance and therefore also a permanent
behavioral change.
Cost savings due to reduction in unprofitable diagnostic and
therapeutic processes.
Medium-term improvement of knowledge
GSD,
IS-H*MED Guidelines
Example
chest trauma
clinically instable clinically instable
chest deformation cardiopulmonary findings

CT scan 4
chest xray pa 4 chest xray pa if n/a 4
rib xray ao/po 4
accurate visualization ? cardiac tamponade

spine xray studies
of morphology
CT scan 4 pericardiocentesis 4
MRI 3 CT scan 4
Suitability of diagnostic test:
1 indicated, rare additional findings 3 indicated, usually conclusive
2 indicated, often additional findings 4 absolutely indicated

GSD,
Implementation of 4.63 B
Informative (Can be implemented immediately)

Case-related, linked information, here in user-defined textual format or
via external applications.
Simple Rules (Project Solution)
Simple, parametrizable service rules that check the time reference of
services and their relations to diagnoses.
Rule Interpreter (more as Application)
Layout of an interpreter that checks the rules of a certain syntax using
two-valued logic.
Dedicated Application (Concept)
Interface for creating and managing processes with link to each of the
relevant objects in IS-H*MED

GSD,
IS-H*MED Guidelines: Informative
Clinical Work Station (CWS)
Patient Organizer (PO)
Internet
Intranet (i.e. Concern-Wide Guidelines)
...

GSD,
IS-H*MED Guidelines: Dedicated Application
Back TOP Change

Miller, Max Guideline: Myocardial Infarction
^ On/Off
* 01.01.1920 Level: 1 Day: 3 / 5
Text
Diagnostic Therapy Nursing Procedures Other
Time
Lab non invas invasiv conservative operative Activity Diet Procedure Pat.-Info ConsultationMisc.
CK EKG check weight bedrest low K+ sit up CH worker
Day 1 CK-MB EKG Heparin
PTT EKG -Blocker
PTT EKG check weight sit in bed Check BP Dietician
Day 2 Aspirin
-Blocker
Aspirin walk 20m
Day 3 -Blocker
Aspirin walk 100m cont. NOK

Day 4 -Blocker
Letter

GSD,
IS-H*MED Guidelines: Dedicated Application
Back TOP Change

Miller, Max Guideline: Myocardial Infarction
^ On/Off
* 01.01.1900 Level: 1 Day: 3 / 5
Text
Diagnostic Therapy Nursing Procedures Other
Time
Lab non invas invasiv conservative operative Activity Diet Procedure Pat.-Info ConsultationMisc.
CK EKG check weight bedrest low K+ sit up CH worker
Day 1 CK-MB EKG Heparin
PTT EKG -Blocker
Work Organizer
Nursing Documentation / Charts

Charts
Service Request
Lab Request

GSD,
IS-H*MED Guidelines: Relevance
Demand for approx. 10 guidelines per year as provided for in SGB V

137 (German Social Insurance Code).
Existing discussions concerning financial incentives in remuneration
system if guidelines are used.
Current discussion concerning financing for the development of
guidelines by self-governing partners.
Important basis for labor and process controlling in the new,

completely consolidated pay system.

GSD,
Mobile Solutions

GSD,
IS-H*MED Mobile Solutions
The situation in healthcare:

Computer workplace is fixed on a desktop
Medical stuff has more and more rotative workplaces
Medical data lacks where it is needed
Paper documentation is further on widespread
Much time for documentation and information retrieval means
less time for the patient
Conclusion:
Healthcare Information Systems have to become mobile

GSD,
Technology an mobile devices are on-hand
Wireless LAN Laptop

SAP ITS Webpads
SAP Web Server Organizer
Handheld
WAP-Handy

GSD,
Palm-PC Personal Digital Assistant
Laptop
WAP-Handy
Web-Pad

GSD,
Mobile solutions are

an extension of the existing system
Using
IS-H*MED with RFC und BAPI
Existing network infrastructure
Extending with
SAP Portal
Wireless LAN Devices

GSD,
Laptop
T
A
L
K
/D
A
A
T
L
KRS
C
S
T
RR
D
T
DC
DAccesspoint
Computer Computer Computer
Computer
ApplicationServer ApplicationServer ApplicationServer
R/3 DB

GSD,
The Laptop as a complete mobile Client with

Good mobility
Familiar usage of IS-H*MED
Optimised for usage of keyboard and mouse
Easy implementation

GSD,
Laptop
Computer Computer Computer TA

LK/D
A
TLA
KR
SC
STRD
TDC
DAccesspoint
Computer
PDA
ApplicationServer ApplicationServer ApplicationServer
ITS
R/3 DB

GSD,
The Handheld or Webpad as a special mobile device

with
Very good mobility
Webbased User Interface of IS-H*MED
Optimized for usage of touch-screens
Easy to implement und easy to extend

GSD,
Personal and secure

access to IS-H*MED
Small Medical Record

showing e.g.
Worklists
Requests
Patient Information
Findings

GSD,
Healthcare Information Systems have to become mobile
and
IS-H*MED is mobile!

GSD,
IS-H*MED @web

GSD,
IS-H*MED @web: Development Initiation
Hospitals have new policies

See themselves as service providers
Want to strengthen the links with general practitioners and patients
Give better support to patients and external doctors
Aspects
Extended processes and patient logistics
Increased transmural communication
@ @
Improved standards and efficiency in communication
Needed Tools
Portal with services offered by the hospital
For patients, for everybody
For external doctors

GSD,
IS-H*MED @web: Communication GP Hospital
Hospital
Service Facility, e.g. Radiology
@
Leistungsstelle im KH
GPs Workplace
@ Book
Services
@
Book Appointment
View Finding

GSD,
IS-H*MED @web: The Portal
Hospitals central access point

Reachable via internet
Offers services for everybody
departments, locations, opening hours, ....
Offers services for external doctors
Register patients
Book services
Book appointments
Access findings for requested
Restricted access, agreement necessary
Tool: mySAP Enterprise Portals
GSD,
IS-H*MED @web: Requesting Services
Select desired services

From one ore more service facilities defined by the hospital
On service ranges offered by service facilities
Multiple selections possible
Book appointments
Based on a suggestion
Enter additional information

Short anamnesis, diagnosis
For new patient: Enter patients data, only name is mandatory

GSD,
Booking Services@web (1): Select services
Service Units
Services provided

GSD,
Booking Services@web (2): Book Appointments
Enter Appointment Preferences (optional)
Select and book suitable Appointments

GSD,
Booking Services@web (3): Patients Data & Details
Check Selected Appointments
Add Details
Add Patients data
Confirm

GSD,
Booking Services@web (4): Confirmation
Patients data and details
Booked Appointments

GSD,
IS-H*MED@web: Steps for the Hospital
View services in service facilitys work-pool

Appointment already assigned
patients are listed together with internally booked requests
Patient shows up
First visit: identify and admit the patient
Subsequent visit: register the patient
New or existing case is assigned to the booked services
Render services
Create results report
GSD,
IS-H*MED@web: Access to Findings
Clinicside
Encryption of documents
Publishing documents for external access
Logging the access of external users
No physical transfer of findings
GP side
Access to findings for GPs patients via hospitals portal
Viewing the document, printing the document
Following up the state of the document

GSD,
IS-H*MED@web: Access to Findings
Hospital
Service Facility, e.g. Radiology
GPs Workplace
@ Web Browser:
Request services
View finding
Web Browser:
Web Browser: booked appointments Book appointments

GSD,
IS-H*MED Application-specific Modules
Surgery
Nursing
Radiology
Patient Transport
Doctors Round
Vital Parameters
Guidelines
Mobile Internet
GSD,
Thank you!
Harald Bartl, T-Systems Austria

harald.bartl@t-systems.at
Friedrich Knig, GSD Berlin

fkoenig@gsd-berlin.de

GSD,

B6 Koenig

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IS-H*MED

Overview and News

IS-H*MED Overview and News

IS-H*MED Overview and News

Patient Management - Admission and billing

Diagnostics & Therapy - Physicians

Enterprise Communication- Medical controlling Communication

IS-H*MED Overview and News

Clinical Workprocess Support

IS-H*MED Overview and News

IS-H*MED Overview and News

Unified Workplace Look&Feel

IS-H*MED Overview and News

Waiting List Mgmt

IS-H*MED Overview and News

Aspects offer various views on patients clinical history

IS-H*MED Overview and News

IS-H*MED Overview and News

IS-H*MED Overview and News

An integrated solution for radiology must support

Business partners workflow

IS-H*MED Overview and News

Scheduling Worklist Management

Findings Transferring Findings Archiving

IS-H*MED Overview and News

Integrated IS-H/IS-H*MED with

Request communication Clinical Workplace

Findings communication Appointment Planning

IS-H*MED Overview and News

IS-H*MED Overview and News

Technical Direct Dictation and

IS-H*MED Overview and News

Device and Service Related

IS-H*MED Overview and News

IS-H*MED Overview and News

Institution-wide Image & Cineframe Access

IS-H*MED Overview and News

IS-H*MED Overview and News

IS-H*MED Overview and News

Vital Parameters: integrated in clinical workplace

IS-H*MED Overview and News

Medication & Vital Parameters

IS-H*MED Overview and News

What are guidelines?

clinically instable clinically instable

chest deformation cardiopulmonary findings

accurate visualization ? cardiac tamponade

IS-H*MED Overview and News

Informative (Can be implemented immediately)

IS-H*MED Overview and News

Patient Organizer (PO)

IS-H*MED Overview and News

Back TOP Change

Aspirin walk 100m cont. NOK

IS-H*MED Overview and News

Back TOP Change

Nursing Documentation / Charts

IS-H*MED Overview and News

Demand for approx. 10 guidelines per year as provided for in SGB V

Important basis for labor and process controlling in the new,

IS-H*MED Overview and News

IS-H*MED Overview and News

The situation in healthcare: