DRG Workflow: Medical Status 

Use

You can set a case status for the Basic Medical Documentation in the following functions:

·        Maintain Diagnosis Documentation for Case

·        Maintain Case-Related Procedures

·        Create Surgery (Visit)

·        Maintain DRG Data

There is exactly one status valid at any one time per case.

Integration

Through status management, SAP Patient Management provides workflow support for the coding director in relation to Basic Medical Documentation and makes quality control easier for you: you can, for instance, determine at any time for which cases the “all diagnoses, procedures, mechanical ventilation hours are complete” status is set. Appropriate views in the Coding Analyses Work Station enable you to determine which cases are still being processed, have been completed, or still have to be checked.

Setting a status, for example, lets you inform a user that the basic medical documentation is completed and that subsequent processing (DRG determination, inpatient billing, for example) can ensue.

Event Triggering for Workflow Interface

Event triggering for the Workflow interface is integrated; the system triggers the relevant events of object type BUS2097 (PatientCase).

Effects on Patient Billing

You can use the billing block and a user status to prevent a case from being billed.

·        If you have set the Billing Block indicator, the system issues the message N8 367 Case & is blocked for billing (live billing not possible) during the billing run.

·        If the case to be billed has a user status that prevents the business transaction Billing, the system issues the message N6 485 Business transaction “Bill Case” is not supported.  If you are running the billing program in live mode, the system issues this message as an error message and aborts billing. For test billing, you can customize this message along the same lines as the message N8 367 in SAP Patient Management message control. The system outputs a warning message by default in case of a test billing.

You can modify the system behavior by maintaining the relevant entry for this message (Function A000, AppAr N6, MsgNo 485, Default Type W) in the IS-H Implementation Guide by choosing SAP Healthcare - Industry-Specific Components for Hospitals ® System Parameters ® Message Control ® Maintain Messages.

Selecting Cases by Status

You can use the status of Basic Medical Documentation as a case selection criterion:

·        In the view type Coding Analyses

For more information, see Coding Analyses Work Station.

·        In the report for grouping multiple cases (RNUDRG0A).

For more information, see Data Exchange with DRG Grouper for Multiple Cases.

Prerequisites

To be able to use status management for basic medical documentation, you need to have performed the IMG activities under Medical/Nursing Documentation ® Basic Medical Documentation Status Management in the IS-H Implementation Guide.

You'll find more information in the documentation for the named IMG activities in Customizing for SAP Patient Management.

Features

User Status

In status management for Basic Medical Documentation you can define your own status profiles that can contain any number of "user statuses". You can use any name for these. You can define your own sequence for these user statuses.

Business Transactions

Status management for Basic Medical Documentation makes available business transactions that can be allowed or disallowed in relation to a status. SAP currently provides the following four business transactions:

·        Bill Case

·        Group DRG

·        Change Diagnoses

·        Change Procedures

Change Documents

The system records change documents.

Authorization Checks

If you define authorization keys and assign these to the user statuses in Customizing, the system can perform status-dependent authorization checks.

For example, if you only want a selected group of persons to be able to modify particular user statuses, store an authorization key for these user statuses. You can then assign authorizations for these authorization keys using the authorization object B_USERSTAT.

When setting or deleting a user status, the system checks whether the user is authorized to do this. This authorization check includes the authorization keys of the relevant user status in addition to the status profile and the object type.

Activities

You can maintain this status under the header data in the diagnosis, procedure, surgery and DRG maintenance functions. The system represents the status change dialog by a list box that contains all of the statuses allowed for the current user and case. Provided that you have the respective authorization, you can switch from one status to another using the list box.

This means, for example, that you can change the status from "Basic Documentation in Process" to "Basic Documentation to Be Checked" when the coding director has still to check a case and determine the DRG. You must have created these statuses beforehand in Customizing for SAP Patient Management.

Enhancement to the Standard by BAdI

If you wish to use an enhanced version of the standard status profile for particular cases or in relation to particular organizational units, you can achieve this using the Business Add-In ISH_INIT_MD_STATUS.

For more information about this, see the documentation for the BAdI.

Example