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New Legal Requirements

In accordance with the Swiss Health Care Federal regulation, an new smart card will be introduced, starting Januar 2010. In a first step, this new smart card, aims to simplify administrative processes. This new electronic “health” card serves to identify a specific person and titles its legal owner as member of a basic insurance to medical treatment according. It is also prepared for storing further medical data. Next to this physical card, Swiss insurance companies also offer an online Service (VeKa) that allows healthcare providers to check the validity of this smartcard.

Our analysis showed that actual customer pains could only be solved if we seamlessly and strongly integrated the card related services in the entire process chain. Customers complained on labor intensive pre-admission and admission costs, not to mention the poor patient master data, which can lead to medical errors. Due to false case related insurance data, CFO’s of big sized healthcare providers complained on long discharge to cash processes.

SAP NetWeaver

During a pilot project with one of the biggest university hospitals in Switzerland, we decided to use SAP NetWeaver PI and existing SAP Patient Management Enterprise Services that were delivered with EHP4.

SAP NetWeaver PI was used for:

  • Service Repository (ES Repository) to centrally define, access, and manage services that are related to insurance card handling and patient identification (based on SAP Patient Management Enterprise Services), and allow decentralized access to central identification functionality. Not only did we have to integrate these services into SAP Patient Management, but had the possibility to demonstrate the reusability of enterprise services, integrating them into Adobe Interactive Forms, Webclients, 3th Party Systems and a Patient Kiosk.
  • Monitor the data exchange processes between VeKa and the SAP Patient Management System, using the Process Integration Monitoring
  • Integrate the mandatory Hardware Security Model (HSM) for a certificate based, two way encryption
  • Service Mapping and Enhancement

Proven reusability

During the last few months, I have read more blog’s and articles that spoke against the reusability aspect of SOA, which made me very eager to find use cases connected to the developed services. You normally might aspect that you define the use cases models first, and then define all relate services, but the more we dug into the customers process landscape, we found useful uses cases where we could implement our services. Which probably means that customers that are offered standard SAP enterprise services should, work the other way around, and calculate the business value of a process re-engineering around this object and their services.

 

  1. Embed smart card based patient identification services in the pre-admission processes of SAP Patient Management

    Users: referring doctors and patients

  2. Embed smart card based patient identification services in the ADT-processes of SAP Patient Management

    Users: Admission staff (SAP users)

  3. Embed smart card based patient identification services in a webclient and third Party Applications

    Users: All employees that have direct Patient interaction

  4. Embed VeKa-Services in billing related services of SAP Patient Management

    Users: Billing Office employees (SAP users)

  5. Embed smart card based patient identification services in adobe interactive forms, and integrate patient relevant information to shorten to decentralize administrative processes. Could also be used to embed patient information on Adobe interactive digital forms, to replace the old inhouse identification cards and the related printed documents.

    Users: All employees that have direct Patient interaction

  6. Embed patient information on Adobe interactive digital forms, to replace the old inhouse identification cards and the related printed documents.
  7. Create a whole new Patient Experience and embed smart card based patient identification services in a Patient Information Terminal.

    Users: Patients

  8. Re-Use of Patient Identification Services for Auto-ID processes
  9. Re-Use of Patient Identification processes for external MPI integration using IHE profiles. As already described in Bettina Lieke’s WIKI and Engineering a Business Process Platform for Healthcare Part 7 – the 2008 Year-end shipment

 

As the initial project focused on integrating the new smart card in the existing processes, and process reengineering wasn’t in scope, we did not implement all above described use cases. But we implemented the integration in SAP Patient Management & Adobe Interactive Forms. A value chain analysis that I carried out already for three Swiss hospitals, showed us that the biggest cost saving potential lies within bringing functionality direct to the patient and integrate this functionality within the pre-admission for in- and out-patients, and admission related processes for out-patients. With around 500 000 visits per year, a decrease in documentation-time of 4 minutes, an average employee cost of 1.25 CHF per minute and 50% usage costs-savings add up to 1.25 Mio. CHF. 

 

WOW – Patient Kiosk in 3 days

 

I remember me always telling our customers that the plug-and-play benefits of SOA promises to increase the pace of innovation and lower costs of development, but never could bring an example out of our industry. Until now I haven’t seen much innovation in patient management processes, and customers worldwide seem to be reluctant when it comes to innovate their existing processes. I am not even talking on the adoption of SOA here.

At this moment customers discuss the use of enteprise service to integrate with 3th party applications, but at the end still establish a replication of data.I don’t see the real value of using services to replicate data from one system to the other.

All this motivated me and our Swiss Special Expertise Partner for SAP NetWeaver, Emineo AG, to change this idiosyncrasy against SOA in healthcare.

US Hospitals demonstrated a 50 percent cut in check-in time for new patients as a 75 percent cut for existing patients through self check in scenarios. So why just not implement proven value, but re-use available services to build a patient terminal. The patient self check terminal, might also address a challenge Swiss hospitals are facing: If no smart card is used, bills will be rejected. So how do you motivate your patients to bring along this new card? Perhaps Self Check Services is part of the answer.

When Emineo and SAP Switzerland decided to build a Self-check-In Prototype for the Swiss eHealth Summit, there were still 4 four weeks left. We agreed with OKI, a Gold-level Member of SAP’s Printer Vendor Program, and also a vendor of information terminal systems with a focus on hospitals  to jointly develop a prototype that could be used during the Swiss eHealth Summit and the coming eHealthCare in Nottwil. But due to Swiss customs, there were only 3 days left to develop the first SAP Patient Management Patient Self Check-In Terminal.

Emineo did the impossible and three days later, we had a first Self-check-In Terminal, that reused all the already available services, based on SAP NetWeaver CE and Adode Flex front end technology. Our customers were amazed, and finally I could show them real life proof of that what SAO always promissed to bring.

Please look at following screenshots to get an idea of the processes and functions we implemented:

 

– display Patient Insurance Data
– update Insurance Data
– update Adress Data
– display Appointments of the Day

 

In future cases, one woold wish for “display my patient record”. As the OKI terminal has some good printing functionalities. This scenario could really bring patient value, that is, if PHR would be in place.

 

We could not have chosen a better scenario to demonstrate the value of SOA in healthcare. As we did not only show the benefits of SOA on the value chain, but also showed that SOA really allows to quickly innovate and reuse existing services to re-engineer processes.

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4 Comments

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  1. Pravesh Parbhoo
    Hi Bart,

    Thanks for the informative blog. I just wanted to know, how did you communicate to PI from ISH? i.e. what format/protocol? As far as I know, ISH uses HL7 messaging formats. Whereas PI uses XML, but you can purchase an expensive adapter for this.
    Which is the option that was used in this test case?

    P.

    (0) 
    1. Anonymous
      Dear Pravesh,

      The answer is simple. As we are talking about SOA.

      “HL7 is just another content type and perhaps should just define content for future SOA projects”. Even though we could have used the existing HL7 adapters for PI (SAP Patient Management Enterprise Services do not talk HL7 without the PI HL7 conversion), we did not use HL7 in our project.

      To be honnest, I don’t think we would have managed to develop a Patient Terminal prototype in three days if we used HL7 V3. As we integrated the developed services and existing SAP Patient Management services in diffrent front-end technologies, there was really no need to use HL7.

      (0) 
  2. Claudius Metze
    Hi Bart,
    thank you for sharing your project experiences with the BPX community. I hope that such examples will help others to make use of SOA in Healthcare. I guess it is also a big motivation for all people involved in the development of Healthcare services to hear about real-life adoption.
    Best regards,
    Claudius
    (0) 
    1. Anonymous
      Hi Claudius,

      Since we demonstrated the value from a business and an IT-point of view and can show real life examples, customers seem to understand better what Service Oriented Architectures are really all about, and that the value comes from the content delivered.

      (0) 

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