Pertemuan 14a. Program RKE ISH MED
IS-H*MED Overview and News SAP Healthcare Sales Partner Summit th Feb 27 , 2002
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Modules and Integration Overview
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Roll-based Concept of Workplace and Authorization
Authorized activity sets for - Managers - Admission and billing - Physicians - Nurses - Medical controlling - Maintenance, procurement - Acountants, Controllers
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Application-specific Modules
Surgery Nursing Radiology Patient Transport Doctor‘s Round Vital Parameters Guidelines Mobile Internet
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Selected Modules Radiology
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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)
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
- Radiology workflow
- Clinical Workflow • Business partner´s workflow
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Radiology
An integrated solution for radiology must support
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 Transferring Findings Archiving Findings
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Radiology - Clinical Workflow
Integrated IS-H/IS-H*MED with- ADT-Management
Clinical Workplace
- Request communication
Service-Request
- Appointment planning
Appointment Planning
- Findings communication
Finding
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Radiology - Business Partners
General PractitionerHospital Internet Service
DOK-BAPI Request SAP R3 Findings/ Image Transfer
AE
XML, PDF mySAP.com Workplace
Image Connector DICOM Archive Historical Findings Images / Cineframes (CD) ... Other
Patient
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Radiology Workplace
Patient-based Navigation-Bar Service- and Workplace-related (Computerized Medical Record) Hierarchical Finding-DocumentationUser- 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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
- 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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Radiology - Technical Features
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Current Developments Doctor‘s Round Vital Parameters
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Doctor‘s Round
- Vital Parameters: integrated in clinical workplace
- Grid
- Graphics
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8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
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6
5
4
3
1
39
RR Pulse Temp 0
40 39,6 40,0 ***
08.11.2001
75
12:00 120 38,0
15:00 13506:00 115 37,6 130
Date Time Pulse Temp RR Sys RR Dia ... ... ...
38 140 120 100
Tick patient(s)
40 100 120 140
80 41 160
80 160
36
37
IS-H*MED Overview and News
90
Vital parameters - Kirsten, Gulliver (m/27) Toolbar27.09.2001
80 17:00 115 37,6 135 75 18:00
60
Pulse Max 92
Temperature 105
92 80 115 40,4
Clinical Workplace
H. Bartl, T-Systems; F. König, GSD, th
60
IS-H*MED Doctor‘s Round
- Medication
- – Support the Workflows relating to Drug Therapy – Documentation of Prescribed and Administered Medications
Clinical Workplace Clinical Workplace Medication & Vital Parameters
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Current Developments Guidelines
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Guidelines
What are 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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Guidelines
- Example
chest trauma clinically instable clinically instable cardiopulmonary findings chest deformation
CT scan 4 chest xray pa 4 chest xray pa if n/a 4 rib xray ao/po 4
? cardiac tamponade accurate visualization spine xray studies of morphology pericardiocentesis 4 CT scan 4
CT scan 4 MRI 3
Suitability of diagnostic test:
1 indicated, rare additional findings 3 indicated, usually conclusive 2 indicated, often additional findings 4 absolutely indicated
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Guidelines: Informative Clinical Work Station (CWS) Patient Organizer (PO) Internet
Intranet (i.e. Concern-Wide Guidelines)
...
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Guidelines: Dedicated Application
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Miller, Max * 01.01.1920 Guideline: Myocardial Infarction Level: 1 Day: 3 / 5 Time Diagnostic Lab non invas invasiv Therapy conservative operative Nursing Procedures Activity Diet Procedure Day 1 EKG check weight
Other Heparin ß-Blocker Pat.-Info CK CK-MB PTT
Consultation low K + CH worker Day 2 bedrest sit in bed
TOP
^
Text
EKGEKG EKG check weight Aspirin Dietician Check BP Back Day 3 Day 4
Change On/Off sit up cont. NOK walk 20m walk 100m Aspirin Aspirin ß-Blocker ß-Blocker ß-Blocker Letter Misc. PTT
IS-H*MED Guidelines: Dedicated Application Back
TOP
Change Guideline: Myocardial Infarction Miller, Max
^
On/Off Level: 1 Day: 3 / 5 * 01.01.1900
Text
Diagnostic Therapy Nursing Procedures OtherTime Lab non invas invasiv conservative operative Activity Diet Procedure Pat.-Info Consultation Misc. CK EKG check weight bedrest low K sit up CH worker + Day 1 CK-MB EKG Heparin PTT EKG ß-Blocker
Work Organizer Nursing Documentation / Charts Charts Service Request Lab Request
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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.
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Current Developments Mobile Solutions
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Mobile Solutions Technology an mobile devices are on-hand
- Wireless LAN • Laptop • SAP ITS
- Webpads • SAP Web Server • Organizer • Handheld • WAP-Handy
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Mobile Solutions Personal Digital Assistant Palm-PC
Laptop WAP-Handy Web-Pad
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Mobile Solutions
LaptopTALK / DATA TALK RS CS TR RD TD CD Accesspoint
Computer Computer Computer Computer ApplicationServer ApplicationServer ApplicationServer R/3 DB
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
- – Good mobility
- – Familiar usage of IS-H*MED
- – Optimised for usage of keyboard and mouse
- – Easy implementation
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Mobile Solutions
The Laptop as a complete mobile Client with
IS-H*MED Mobile Solutions
LaptopComputer Computer Computer TALK / DATA TALK RS C S TR RD TD CD Accesspoint
Computer PDA
ApplicationServer ApplicationServer ApplicationServer
ITS
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
- – Very good mobility
- – Webbased User Interface of IS-H*MED
- – Optimized for usage of touch-screens
- – Easy to implement und easy to extend
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
The Handheld or Webpad as a special mobile device
withIS-H*MED Mobile Solutions
- Worklists
- Requests
- Patient Information •Findings
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Mobile Solutions
Personal and secure access to IS-H*MED Small Medical Record showing e.g
IS-H*MED Mobile Solutions Healthcare Information Systems have to become mobile and
IS-H*MED is mobile!
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Current Developments
IS-H*MED @web
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED @web: Communication GP Hospital Hospital Service Facility, e.g. Radiology Leistungsstelle im KH GP‘s Workplace @ @ @ @
Book Services @ @ Book Appointment View Finding
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Reachable via internet
departments, locations, opening hours, ....
Register patients Book services Book appointments Access findings for requested Restricted access, agreement necessary
Tool: mySAP Enterprise Portals
IS-H*MED @web: The Portal
Hospital’s central access point
Offers services for everybody
Offers services for external doctors
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
From one ore more service facilities defined by the hospital On service ranges offered by service facilities Multiple selections possible
Based on a suggestion
Short anamnesis, diagnosis For new patient: Enter patient’s data, only name is mandatory
IS-H*MED @web: Requesting Services
Select desired services
Book appointments
Enter additional information
Booking Services@web (1): Select services Service Units Services provided
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Booking Services@web (2): Book Appointments
Enter Appointment Preferences (optional) Enter Appointment Preferences (optional) Select and book suitable Appointments
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Booking Services@web (3): Patient‘s Data & Details
Check Selected Appointments Add Details Add Patient‘s data Confirm
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Booking Services@web (4): Confirmation Patient‘s data and details Booked Appointments
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
Appointment already assigned
patients are listed together with internally booked requests
First visit: identify and admit the patient Subsequent visit: register the patient
New or existing case is assigned to the booked services
Create results report
IS-H*MED@web: Steps for the Hospital
View services in service facility’s work-pool
Patient shows up
Render services
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
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED@web: Access to Findings Hospital Service Facility, e.g. Radiology GP‘s Workplace
Web Browser: Request services @ @ View finding
Web Browser: Web Browser: booked appointments
Book appointments
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Application-specific Modules
Surgery Nursing Radiology Patient Transport Doctor‘s Round Vital Parameters Guidelines Mobile Internet
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th
IS-H*MED Overview and News Thank you! Harald Bartl, T-Systems Austria harald.bartl@t-systems.at Friedrich König, GSD Berlin fkoenig@gsd-berlin.de
IS-H*MED Overview and News
H. Bartl, T-Systems; F. König, GSD, th