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

2. IS-H*MED Modules and Integration Overview

3. Roll-based Concept of Workplace and Authorization
Authorized activity sets for - Managers - Admission and billing - Physicians - Nurses - Medical controlling - Maintenance, procurement - Acountants, Controllers

4. 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
Patient‘s EMR
Structured Medical Documentation
Hospital- and department specific
Freely defineable

5. 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
Patient‘s history, EMR

6. 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

7. 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

8. IS-H*MED Standard Modules - Patient Organizer
Aspects offer various views on patient‘s clinical history
Cases, Movements
Requests, Appointments
Diagnoses, Documents
Services
Customer-specifics
Quick navigation
Personalization
Integrated object viewer
e.g. Acrobat Reader

9. IS-H*MED Application-specific Modules
Surgery
Nursing
Radiology
Patient Transport
Doctor‘s Round
Vital Parameters
Guidelines
Mobile
Internet

10. IS-H*MED Selected Modules
Radiology

11. 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)

12. An integrated solution for radiology must support
IS-H*MED Radiology
An integrated solution for radiology must support
Radiology workflow
Clinical Workflow
Business partner´s workflow

13. 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

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

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

16. IS-H*MED Radiology Workplace
Patient-based Navigation-Bar (Computerized Medical Record)
Service- and Workplace-related
Hierarchical Finding-Documentation
User- and/or Profession-specific Worklist
Technical Navigation-Bar (PACS-Study)
Direct Dictation and Speach-Recognition
Detailed Image Information concerning selected items of the worklist
Application-Controled
Viewer Integration

17. 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

18. 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

19. 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

20. IS-H*MED Current Developments
Doctor‘s Round
Vital Parameters

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

22. IS-H*MED Doctor‘s Round
Vital Parameters: integrated in clinical workplace
Clinical Workplace
Grid
Graphics
Tick patient(s)

23. IS-H*MED Doctor‘s Round
Medication
Support the Workflows relating to Drug Therapy
Documentation of Prescribed and Administered Medications
Medication & Vital Parameters
Clinical Workplace
Clinical Workplace

24. IS-H*MED Current Developments
Guidelines

25. IS-H*MED Guidelines What are guidelines? Using Guidelines
Systematically developed conclusions aimed at supporting physician and patient’s 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

26. IS-H*MED Guidelines Example chest trauma
clinically instable
clinically instable
cardiopulmonary findings
chest deformation
CT scan 4
chest xray pa if n/a 4
chest xray pa 4
rib xray ao/po 4
accurate visualization
of morphology
? cardiac tamponade
spine xray studies
CT scan 4
MRI 3
pericardiocentesis 4
CT scan 4
Suitability of diagnostic test:
1 indicated, rare additional findings
3 indicated, usually conclusive
2 indicated, often additional findings
4 absolutely indicated

27. 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

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

29. IS-H*MED Guidelines: Dedicated Application
Miller, Max *
Back
Guideline: Myocardial Infarction
Level: 1 Day: 3 / 5
TOP
Change ^
On/Off
Text
Time
Diagnostic
Therapy
Nursing Procedures
Other
Lab
non invas
invasiv
conservative
operative
Activity
Diet
Procedure
Pat.-Info
Consultation
Misc.
Day 1 CK
EKG
check weight
bedrest
low K+
sit up
CH worker
CK-MB
EKG
Heparin
PTT
EKG
ß-Blocker
Day 2
PTT
EKG
check weight
sit in bed
Check BP
Dietician
Aspirin
ß-Blocker
Day 3
Aspirin
walk 20m
ß-Blocker
Day 4
Aspirin
walk 100m
cont. NOK
ß-Blocker
Letter

30. IS-H*MED Guidelines: Dedicated Application
Back
Miller, Max *
TOP
Guideline: Myocardial Infarction
Level: 1 Day: 3 / 5
Change ^
On/Off
Text
Time
Diagnostic
Therapy
Nursing Procedures
Other
Lab
non invas
invasiv
conservative
operative
Activity
Diet
Procedure
Pat.-Info
Consultation
Misc.
Day 1 CK
EKG
check weight
bedrest
low K+
sit up
CH worker
CK-MB
EKG
Heparin
PTT
EKG
ß-Blocker
Work Organizer
Nursing Documentation / Charts
Charts
Service Request
Lab Request

31. 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.

32. IS-H*MED Current Developments
Mobile Solutions

33. 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

34. IS-H*MED Mobile Solutions
Technology an mobile devices are on-hand
Wireless LAN
SAP ITS
SAP Web Server
Laptop
Webpads
Organizer
Handheld
WAP-Handy

35. IS-H*MED Mobile Solutions
Palm-PC
Personal Digital Assistant
Laptop
WAP-Handy
Web-Pad

36. IS-H*MED Mobile Solutions
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

37. IS-H*MED Mobile Solutions

38. IS-H*MED Mobile Solutions
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

39. IS-H*MED Mobile Solutions

40. IS-H*MED Mobile Solutions
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

41. IS-H*MED Mobile Solutions
Personal and secure
access to IS-H*MED
Small Medical Record
showing e.g.
Worklists
Requests
Patient Information
Findings

42. IS-H*MED Mobile Solutions
Healthcare Information Systems have to become mobile
IS-H*MED is mobile!
and

43. IS-H*MED Current Developments

44. 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 @ @

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

46. IS-H*MED @web: The Portal
Hospital’s 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

47. 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 patient’s data, only name is mandatory

48. Booking Services@web (1): Select services
Service Units
Services provided

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

50. Booking Services@web (3): Patient‘s Data & Details
Check Selected Appointments
Add Details
Add Patient‘s data
Confirm

51. Booking Services@web (4): Confirmation
Patient‘s data and details
Booked Appointments

52. IS-H*MED@web: Steps for the Hospital
View services in service facility’s 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

53. 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 GP´s patients via hospital’s portal
Viewing the document, printing the document
Following up the state of the document

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

55. IS-H*MED Application-specific Modules
Surgery
Nursing
Radiology
Patient Transport
Doctor‘s Round
Vital Parameters
Guidelines
Mobile
Internet

56. IS-H*MED Overview and News
Thank you!
Harald Bartl, T-Systems Austria
Friedrich König, GSD Berlin

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