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SAP MDM: A Healthcare Use case

Recently, the stork visited one of my friend and his wife. After the initial well wishing, I posed a question to him: what was the most nerve-wrecking moment? I was expecting the routine answer: the wait outside the OT, as the child had been delivered via surgery. Instead, he said, it was the seemingly endless wait for his cashless insurance claim to materialize. It seems, his employer had taken a cashless health insurance cover for all its employees and their families. It covers hospitalization too and he can avail cashless treatment, subject to a co-pay. 

 

He narrated the entire process: His wife has a bar-coded identity card issued by the hospital and her health policy details are on a separate e-card issued by his insurer. Upon hospitalization, her cashless-claim request form was faxed to the TPA, who in turn verified the policy details with the insurer. The insurance firm requested some past medical data. So the relevant info was retrieved from the medical records at the hospital and then faxed back. Finally, an authorization was faxed to the hospital by the TPA after a gap of many hours. During this period, his wife could not be operated upon as the hospital insisted on either a deposit or an insurance authorization, before proceeding with the surgery. All this happened while his wife was in labour.

 

Suddenly, it struck me, why was this process so time-consuming and error-prone? The employer, TPA, insurer and hospital were all maintaining information about my friend and his wife as the insurance policy was taken a year back and they were regular visitors to the hospital for routine checkups. Although data about them was used for different purposes by different parties involved, it contained some common data elements like: name, age, insurance policy id etc… Then why were these entities playing a game of u-fax-me-I-fax-u? These firms could work together to accurately identify a patient across multiple systems and databases to create a meaningful, trusted system of record. This would not only enable speedier claims settlement but also prevent frauds.

 

To-be state

SAP MDM can definitely play a role here. It can provide the community of hospitals, insurers and TPAs, access to a consolidated view of patient data across participating organizations thus enabling community-wide workflows and messaging. It can serve as a critical foundation for accurate matching and linking of patient information across widely dispersed systems.

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Once a SAP MDM solution is in place supplemented with a health information exchange, the patient can simple check into the hospital in a planned or unplanned visit. The hospital identity card can be swiped on a bar-code/RFID reader and immediately the patient’s employer, hospital, insurance firm, TPA would be notified and seamless information exchange could take place. The attending doctor’s diagnosis and other details contained in the medical records could be sent to the TPA and insurance firm as and when requested. SAP MDM would form the backbone of such a system feeding accurate master data on patients to all the relevant systems.

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12 Comments

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  1. Former Member
    I found this blog very interesting and realistic. This is a real time scenario occurring in daily life. People actually suffer this kind of harassments daily. MDM can really help a lot in the this type of situations like described in the blog.

    Regards,
    Dheeraj.

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  2. Former Member
    I think that what the blog explains is a scenario that most of us have gone through, condition where one of out family member is being hospitalized and we are running after the Insurance policies.

    I think that the MDM solution suggested would be really helpful and would really help to reduce the chaos that do arise in such situations.

    Really an Excellent piece of work!!!!!!!!

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  3. Former Member
    This is really a nice blog showing the real life scenario and how SAP MDM can play a vital role in maitaining Master Data and hence showing that SAP MDM can go far in implementing it in HealthCare also.

    Great Idea.
    Thank You

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  4. The blog is an excellent work which has opened new dimensions to think and worked upon.It make us to think beyond product,material customer…. data management. Also,it channelize the thinking towards the new business and social needs.
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  5. Former Member
    Hi ,
    This is a very good blog , uniqueness is in bringing the realtime business case . We can also extend MDM data model to maintain prescriptions & drug history for a patient .

    Regards
    Yogesh

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  6. Former Member
    Really, it’s a very good article which shows us the reality where MDM plays a vital Role. MDM would be very helpful in solving our problems to a greater extent.
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  7. Marilyn Pratt
    Enjoyed the context in which you framed the benefits of MDM.  A good story, well told is an engaging technique.  What needs be done is illustrate with more technical depth now that you have our attention. You might also want to look at this entry in the wiki that popped into my radar today: Collaborative Healthcare Wiki
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  8. Dear Sukant Pandey,

    very good blog, and as Marilyn Pratt already discovered, you described a real CHN scenario! Please check following two blogs:

    1. The need for collaboration in the Healthcare ecosystem from Miguel Coelho at https://www.sdn.sap.com/irj/sdn/weblogs?blog=/pub/wlg/8398 [original link is broken] [original link is broken]

    2. Experience Enterprise Service in a real healthcare application – demo scenarios for CHN by Martin Burger at Experience Enterprise Service in a real healthcare application – demo scenarios for CHN

    We would be very interested in your feedback o those blog and continue a vital discussion around eHealth with you!

    Kind regards, Martin Burger

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  9. Arpita Biswas

    I found this blog very interesting and informative. This blog gives a good insight into how Mobile Device Management is benefiting and getting useful for healthcare sector. Healthcare is one of the area where multiple mobile devices like smartphones, tablets, mPOS, IOTS are deployed across varied OS platforms. Mobile Device Management Solutions have simplified the way how these several mobile devices can be easily managed and secured through an Unified and remote end point.

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