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RELEASE NOTES
SAP ERP 6.0, INDUSTRY EXTENSION

HEALTHCARE, ENHANCEMENT PACKAGE 6
SUPPORT PACKAGES 00 AND 01
07_Introduction
ADD-ON SUPPORT PACKAGE 46
RELEASE NOTES
SAP ERP 6.0
INDUSTRY EXTENSION HEALTHCARE
ENHANCEMENT PACKAGE 6
SUPPORT PACKAGES 00 AND 01
VERSION 1.0
NOVEMBER 8, 2011
Support Package Release Notes for SAP ERP Industry Extension Healthcare 6.0, Enhancement Package 6,
Support Package 00 and Support Package 01.
SAP AG 2011
Version
Support Package Release Notes for SAP ERP 6.0, Industry Extension Healthcare, Enhancement Package 6,
Supoprt Package 00 and Support Package 01.
Version 1.0; November 8, 2011.
Index
Icon
Description
Caution
Example
Note
SAP AG 2011
Contents
GENERAL ........................................................................................................................................................................... 8
ISH_AMBULATORY: Business Function SAP Ambulatory Care Mgmt (Changed) .................................................. 8
ISH_CV_CN: Business Function SAP Pat Mgmt Country Version China (New) ....................................................... 8
ISH_CV_FR: Business Function SAP Pat Mgmt Country Vers France (Changed) ................................................... 8
ISH_CV_IT: Business Function SAP Pat Mgmt Country Vers Italy (Changed) ......................................................... 9
ISH_MAIN: Business Function SAP Patient Management (Changed) ...................................................................... 9
ISH_MISC1: Business Function ISH_MISC1: Business Function SAP (Changed) ................................................. 10
ISH_MISC2: SAP Patient Management Legal Process Adoption 2 (Changed) ...................................................... 11
ISH_MISC3: SAP Patient Management Legal Process Adoption 3 (New) .............................................................. 11
SAP AMBULATORY CARE MANAGEMENT ................................................................................................................... 12
General ...................................................................................................................................................................... 12
ISH_AMBULATORY DE: Support of KBV Coding Rule Set (Enhanced) ................................................................ 12
Treatment ................................................................................................................................................................. 12
ISH_AMBULATORY DE: Prescription Assistant (Enhanced) .................................................................................. 12
ISH_AMBULATORY DE: Blank Form Printing (New) .............................................................................................. 12
Billing ......................................................................................................................................................................... 13
ISH_AMBULATORY DE: Support of Outpatient Coding Guidelines (Enhanced) .................................................... 13
ISH_AMBULATORY DE: PPA Billing Field ID 5011 (Changed) .............................................................................. 14
ISH_AMBULATORY DE: PPA Billing Field ID 4126 (New) ..................................................................................... 14
ISH_AMBULATORY DE: New Fields for PPA Billing with Q2/2011 (New) ............................................................. 14
ISH_AMBULATORY DE: PPA Billing Field ID 3119 (New) ..................................................................................... 14
SAP PATIENT MANAGEMENT ........................................................................................................................................ 14
BASIC DATA ..................................................................................................................................................................... 14
Hospital Structure ................................................................................................................................................. 14
ISH_CV_CN: Enhancement of Hospital Specialties (New)...................................................................................... 14
ISH_MISC3: Accommodation Costs - Indicator for Additional Nursing Charge (New) ............................................ 15
ISH_CV_FR: Defining Nursing Home Cases (EHPAD) (Enhanced) ....................................................................... 15
Business Partner .................................................................................................................................................... 15
ISH_CV_FR: Ins. Prov. Master Data: "Consil Gnral" Indicator (New) ............................................................... 15
ISH_MISC1: Enhancement in Employee/Physician Data Maintenance (New) ....................................................... 16
ISH_MISC1: Search for Employee/Physician by Specialty (New) ........................................................................... 16
Service Master Data .............................................................................................................................................. 16
ISH_MAIN: Service Master Data - New Charge Types (New) ................................................................................. 16
Clinical Work Station ............................................................................................................................................ 17
ISH_MAIN: User Param.: End Automatic View Refresh (New) ............................................................................... 17
PATIENT MANAGEMENT ................................................................................................................................................ 17
General ...................................................................................................................................................................... 17
ISH_CV_CN: Enhancement of Case Master Data (New) ........................................................................................ 17
ISH_CV_FR: Readmission of a Patient (New) ......................................................................................................... 18
ISH_CV_FR: PMSI Model 2011 (Changed) ............................................................................................................. 18
ISH_MAIN: Patient Telephone Number Valid Throughout Case (New) .................................................................. 20
ISH_MAIN: Avoiding Unintentional Patient Master Data Changes (New) ............................................................... 21
ISH_MAIN CH: Insurance Verification (Changed) ................................................................................................... 22
ISH_MAIN CH: Swiss Healthcare Smart Card (Changed) ...................................................................................... 22
ISH_MAIN DE: German Electronic Health Card (Enhanced) .................................................................................. 22
ISH_MAIN AT: EKVK - Alphanumeric Card Number (Changed) ............................................................................. 22
ISH_MAIN AT: P321/ELDAL - Different Birthdate from SVNR (Changed) .............................................................. 22
ISH_MISC3: Places of Birth and Death (New) ......................................................................................................... 23
ISH_MISC3: Accommodation Costs - Indicator for Additional Nursing Charge (New) ............................................ 23
Patient Master Data .............................................................................................................................................. 23
ISH_CV_CN: Enhancement of Patient Master Data (New) ..................................................................................... 23
SAP AG 2011
ISH_MAIN DE: Comparison of Geographical Areas (New) ..................................................................................... 24

Inpatient Case ......................................................................................................................................................... 24
ISH_CV_FR: Clin. Proc. Builder: Entering Case Classifications (New) ................................................................... 24
ISH_MISC1: Store Postdischarge Phys. for Future Hospital Stays (New) .............................................................. 25
Outpatient Case ...................................................................................................................................................... 26
ISH_MAIN SG: Mental Health Legal Status (New) .................................................................................................. 26
ISH_MAIN DE: Checks When Entering a Referring Physician (Changed) .............................................................. 27
ISH_MISC1: Store Postdischarge Phys. for Future Hospital Stays (New) .............................................................. 27
General Case Processing .................................................................................................................................... 28
ISH_MAIN: Entry of "Estimated Length of Stay" (Enhanced) .................................................................................. 28
Care Unit Management ........................................................................................................................................ 29
ISH_MAIN: Care Unit Overview Graphic Replaced (Changed) ............................................................................... 29
MEDICAL/NURSING DOCUMENTATION ....................................................................................................................... 29
General ...................................................................................................................................................................... 29
ISH_CV_IT:Restricting Number of DRG Diagnoses and Procedures (New) ........................................................... 29
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder (Changed) .................................................................... 30
ISH_MAIN DE: Nursing Complex Procedures - Documentation Support (New) ..................................................... 31
ISH_MAIN DE: OPS 2010 Psychiatry - Documentation Support (New) .................................................................. 31
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: MHLS (Changed) ........................................................ 31
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: Exits (Changed) .......................................................... 31
Basic Medical / Nursing Documentation ........................................................................................................ 33
ISH_AMBULATORY DE: Support of Outpatient Coding Guidelines (Enhanced) .................................................... 33
ISH_AMBULATORY DE: Report for Checking Outp. Coding Guidelines (New) ..................................................... 34
ISH_CV_FR: Clinical Work Station - Occupancy View Absences (New) ................................................................ 34
ISH_MAIN IT, SG: Discharge Date as Reference for Catalog Determination (New) .............................................. 34
ISH_MAIN SG: Enhancements to Medical Documentation (New) .......................................................................... 35
ISH_MAIN AT: Scoring - Intensive Care Documentation (Enhanced) ..................................................................... 37
ISH_MAIN DE: Check on Diagnostic Certainty (Enhanced) .................................................................................... 37
ISH_MAIN: Entry of "Estimated Length of Stay" (Enhanced) .................................................................................. 38
ISH_MAIN DE: Preassgmt of Discharge Diag., Diag. Certainty (Changed) ............................................................ 39
ISH_MAIN: Enhancement to Interface for Diagnosis BAdIs (Changed) .................................................................. 39
ISH_MISC1 DE: Marking Procedures Relevant for Additional Charges (New) ....................................................... 40
PATIENT ACCOUNTING.................................................................................................................................................. 40
General ...................................................................................................................................................................... 40
ISH_CV_CN: Patient Accounting (New) .................................................................................................................. 40
ISH_CV_FR: Billing for Drugs and Medical Products (New).................................................................................... 40
ISH_CV_FR: Billing for SE Services (Changed) ...................................................................................................... 46
ISH_CV_FR: Billing for Daily Hospital Rates in State Hospitals (Changed) ............................................................ 49
ISH_CV_FR: Per Diem Fee (PJ Services), New Valuation Formula (New) ............................................................ 49
ISH_CV_FR: Care Path, Revenue Account Assignment (New) .............................................................................. 50
ISH_CV_FR: Billing for Private Rehabilitation Clinics (Changed) ............................................................................ 52
ISH_CV_FR: Billing for Retransfers at Private Institutions (Changed) .................................................................... 53
ISH_CV_FR/MISC2: Contract Scheme Items - Time-Dependent (New) ................................................................. 54
ISH_MAIN AT: Setting Stat. Cases to Final Billed (RNWATNFAL0) (Changed) ..................................................... 55
ISH_MAIN AT: Scoring (Changed) .......................................................................................................................... 56
ISH_MAIN CH: Use of Flat-Rate Taxes (New) ........................................................................................................ 56
ISH_MAIN: Automatic Proposal of Contract Scheme (Changed) ............................................................................ 56
ISH_MAIN CH: Swiss DRG (New) ........................................................................................................................... 56
ISH_MAIN CH: Uniform Invoice Form (Changed) ................................................................................................... 56
ISH_MAIN DE: DRG Billing (FPV 2011) (Changed) ................................................................................................ 56
ISH_MAIN DE: Treatment Certificates (Enhanced) ................................................................................................. 56
ISH_MAIN CH: Outp. Cases - CO Order Aut. on Case Creation (New) .................................................................. 56
ISH_MAIN CH: Test Billing Also Possible Without IV (Enhanced) .......................................................................... 57
SAP AG 2011
ISH_MAIN CH: Adjust Revenue Accrual for SwissDRG (Enhanced) ...................................................................... 57

ISH_MAIN CH: Ext. Order: Restrict Search to Open Orders (Enhanced) ............................................................... 57
ISH_MISC1 CH, AT, FR: Fees: Fee Relevance Time-Dependent (Enhanced) ...................................................... 57
ISH_MISC2 FR: Service Rule for Nursing Service (R27) (New) ............................................................................. 57
Insurance Relationship ........................................................................................................................................ 58
ISH_MAIN AT: Querying Insurant Data - VDAS (Changed) .................................................................................... 58
Services ..................................................................................................................................................................... 58
ISH_CV_FR: Adjustments to Service Rules F05 and F00 (Changed)..................................................................... 58
ISH_CV_FR: Service Rule Generate Per Diem Fees (F10) (Changed) .................................................................. 61
ISH_CV_FR: Service Rule Exemption from Patient Contribution (F05) (Changed) ................................................ 61
ISH_CV_FR/MISC2: Service Rule Absence Control (F21) (New) ........................................................................... 62
ISH_CV_FR: Service Rule Gen. Daily Hospital Rate (F07, F11) (Changed) .......................................................... 63
ISH_MAIN AT: LR A4 - Check on Maximum Values (Changed) ............................................................................. 63
ISH_MAIN: Multiplication Factor for Private Insurance with Basic Policy (New) ..................................................... 63
Insurance Verification .......................................................................................................................................... 64
ISH_MISC1 AT: Insurance Verification - Alt. System Behavior (Changed) ............................................................. 64
Copayment................................................................................................................................................................ 64
ISH_MAIN DE: Default Case-Related Copayment Exemption Reasons (New) ...................................................... 64
ISH_MAIN DE: Practice Fee: New Use for University Outpat. Cases (Enh.) .......................................................... 64
ISH_MAIN DE: Practice Fee: Canceling Dunned Copyt Invs in R16 (Changed) .................................................... 64
ISH_MAIN DE: Practice Fee: Ins. Provs with Copayment Waiver (Changed)......................................................... 64
ISH_MAIN DE: Copayment Changes due to 301 Amendment, 09/22/2010 (Enh.) ............................................... 64
ISH_MAIN DE: Gen. Demands for Copayment (Report RNZUZBI1) (Enhanced) .................................................. 64
ISH_MAIN DE: Posting Back Dunned Copayment Receivables (Enhanced) ......................................................... 65
ISH_MAIN DE: Reverse Clearing for Copayment Receivables (Enhanced) ........................................................... 65
Down Payment ........................................................................................................................................................ 67
ISH_MAIN FR: Down Payment Monitor - Interim Billing Date (Enhanced) .............................................................. 67
ISH_MAIN: Down Payment Monitor - Executing Service Rules (Enhanced) .......................................................... 67
Billing ......................................................................................................................................................................... 67
ISH_CV_FR: Sample Form for Invoice Form S 3404 (Changed) ............................................................................ 67
ISH_CV_FR: Interim Billing for Nursing Home Cases (Changed) ........................................................................... 68
ISH_CV_FR: Partial Cancellation for Nursing Home Cases (Changed) .................................................................. 69
ISH_MAIN DE: PPA Billing Field ID 3319 (New) ..................................................................................................... 69
ISH_MAIN DE: PPA Billing Field ID 5011 (Changed) .............................................................................................. 69
ISH_MAIN DE: PPA Billing Field ID 4126 (New) ..................................................................................................... 69
ISH_MAIN DE: New Fields for PPA Billing with Q2/2011 (New) ............................................................................. 69
INFORMATION SYSTEM ................................................................................................................................................. 70
Business Information Warehouse Interface ................................................................................................. 70
ISH_CV_CN: Ministry of Healthcare Reporting (New) ............................................................................................. 70
Other Statistics ...................................................................................................................................................... 71
ISH_CV_FR: Evaluations for Nursing Homes (New) ............................................................................................... 71
COMMUNICATION ........................................................................................................................................................... 71
General ...................................................................................................................................................................... 71
ISH_CV_CN: Card Reader (New) ............................................................................................................................ 71
ISH_CV_FR: Comm. Procedure FRB2 (Electronic Invoice) (Changed) .................................................................. 72
ISH_CV_FR: Comm.: RSF - Standardized Invoice Message (Changed) ................................................................ 74
ISH_CV_FR: Comm.: NOEMIE Payment Information for Electronic Invoice (New) ................................................ 75
ISH_MAIN AT: Scoring: WGF-Specific Data Structure (Changed) .......................................................................... 76
Communication with Systems Outside the Hospital ................................................................................. 76
ISH_CV_CN: BMI Communication (New) ................................................................................................................ 76
ISH_MAIN SG: DRG-Datenaustausch mit 3M-Codefinder (gendert) .................................................................... 76
ISH_MAIN AT: Diagnosis Entry - Check (Changed) ................................................................................................ 77
ISH_MAIN AT: Outpatient Data Reporting - SCOAD (New) .................................................................................... 77
ISH_MAIN AT: NWATPARAM Parameter SCO_KOMP (New) ............................................................................ 78
SAP AG 2011
ISH_MAIN AT: Communication Procedure P321 (Changed) .................................................................................. 78

ISH_MAIN AT: Scoring - Intensive Care Documentation (Enhanced) ..................................................................... 78
ISH_MAIN CH: Electronic Invoice INXML (Changed).............................................................................................. 78
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: MHLS (Changed) ........................................................ 78
ISH_MAIN CH: ALIS Error Handling: Display Import Date (Enhanced) .................................................................. 78
ISH_MAIN AT: GINA - Various Changes (Changed) ............................................................................................... 79
ISH_MAIN AT: EDIVKA - SEPA Payment Transactions, Room Number (Enhanced) ............................................ 79
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: Exits (Changed) .......................................................... 79
ENTERPRISE SOA .......................................................................................................................................................... 80
General ...................................................................................................................................................................... 80
ISH_CV_CN: Enterprise Services (New) ................................................................................................................. 80
TOOLS .............................................................................................................................................................................. 81
General ...................................................................................................................................................................... 81
ISH_CV_FR: Sample Form for Invoice Form S 3404 (Changed) ............................................................................ 81
ISH_MAIN AT, CH: Case Archiving (Changed) ....................................................................................................... 81
ISH_MAIN: Finding the Terminal (New) ................................................................................................................... 81
CLINICAL SYSTEM .......................................................................................................................................................... 82
General ...................................................................................................................................................................... 82
ISHMED_MAIN: Business Function Clinical System (Changed) ............................................................................. 82
ISHMED_MISC01: Business Function Clinical System MISC01 ............................................................................. 83
ISHMED_SCD: Clin. Syst. Situation Based Clinical Documentation (Changed) ..................................................... 83
GENERAL DUTIES ........................................................................................................................................................... 84
General ...................................................................................................................................................................... 84
ISHMED_MAIN: Gen Utilities - Case Archiving Release (Enhanced) ..................................................................... 84
EXTENDED BASIC DATA ................................................................................................................................................ 84
Parametrized Document Categories ............................................................................................................... 84
ISHMED_MAIN: Parameterized Document Categories (Changed) ......................................................................... 84
CLINICAL DOCUMENTATION ......................................................................................................................................... 85
Examination and Lab Results ............................................................................................................................ 85
ISHMED_SCD: Clinical Documentation - Vital Signs (Enhanced) ........................................................................... 85
ISHMED_SCD: Clinical Documentation - Vital Signs (Changed) ............................................................................ 86
Allergy Documentation ......................................................................................................................................... 87
ISHMED_MISC01: Allergy Documentation (New) ................................................................................................... 87
CLINICAL ORDER ............................................................................................................................................................ 88
General ...................................................................................................................................................................... 88
ISHMED_MAIN: Clinical Order - Selection List (New) ............................................................................................. 88
ISHMED_MAIN: Clinical Order - Screen Modification (Changed) ........................................................................... 89
ISHMED_SCD: Clinical Order - User Parameter N1CORD_PAT (New) ................................................................. 89
MEDICAL PATIENT DATA ORGANIZATION................................................................................................................... 89
General ...................................................................................................................................................................... 89
ISHMED_MAIN: PatOrg. - Functions for Selected Entries (Enhanced) ................................................................... 89
ISHMED_MAIN: PatOrg. - Aspects: Nursing Notes Mode (Enhanced) ................................................................... 90
ISHMED_MAIN: PatOrg. - Aspects: Inpatient Progress Notes Mode (Enhanced) .................................................. 90
ISHMED_MAIN: PatOrg. - BAdI ISHMED_CALLOF_CHECK (New) ...................................................................... 90
ISHMED_MISC01: Patient Record - Introduction (New).......................................................................................... 91
ISHMED_MISC01: Patient Record - General Basic Settings (New) ........................................................................ 91
ISHMED_MISC01: Patient Record - Create Configurations (New) ......................................................................... 91
ISHMED_MISC01: Patient Record - Dialog Design (New) ...................................................................................... 94
ISHMED_MISC01: Patient Record - Patient Header (New) .................................................................................... 95
ISHMED_MISC01: Patient Record - Data Display (New) ........................................................................................ 96
ISHMED_MISC01: Patient Record - Data Filtering (New) ....................................................................................... 98
ISHMED_MISC01: Patient Record - Indicators (New) ............................................................................................. 98
ISHMED_MISC01: Patient Record - Object Search (New)...................................................................................... 99
ISHMED_MISC01: Patient Record - Enhancement Possibilities (New) ................................................................ 100
PLANNING ...................................................................................................................................................................... 100
SAP AG 2011
General .................................................................................................................................................................... 100

ISHMED_MAIN: Planning - User Parameter N1PTSWTM (New) ......................................................................... 100
ISHMED_MAIN: Planning - Change Reason Query (Changed) ............................................................................ 101
ISHMED_MAIN: Planning - Display Locked Scheduling Type (New) .................................................................... 101
SURGERY SYSTEM ...................................................................................................................................................... 101
Surgery Planning .................................................................................................................................................. 101
ISHMED_MAIN: Surgery System - Calculate Surgery (Enhanced) ....................................................................... 101
OR Documentation ............................................................................................................................................... 104
ISHMED_MAIN: Surgery System - Call Surgery Work Station (Enhanced) .......................................................... 104
ISHMED_MAIN: Surgery System - Team Entry Times (Changed) ........................................................................ 105
ISHMED_SCD: Surgery System - Surgery Scheduling Status Tolerance (Enhanced) ......................................... 105
NURSING PROCESS DOCUMENTATION .................................................................................................................... 106
General .................................................................................................................................................................... 106
ISHMED_SCD DE: Nursing Complex Procedure Score (PKMS) (New) ............................................................... 106
MEDICATION ................................................................................................................................................................. 107
Medication Master Data ..................................................................................................................................... 107
ISHMED_MAIN: Medication - Drug Administration Base Item (New) .................................................................... 107
ISHMED_MAIN: Medication - Master Data and Settings (Enhanced) ................................................................... 108
ISHMED_MAIN: Medication - eMAR (Enhanced) .................................................................................................. 108
ISHMED_MAIN: Medication - Order (Enhanced) ................................................................................................... 109
ISHMED_MAIN: Medication - Order Templates (Enhanced) ................................................................................. 109
Medication Order .................................................................................................................................................. 110
ISHMED_MAIN: Medication - Bar Code in Administration Process (New) ............................................................ 110
ISHMED_MAIN: Medication - Views in Clin. Work Station (Enhanced) ................................................................ 111
ISHMED_MAIN: Medication - Drug Search (Enhanced) ....................................................................................... 111
PATIENT TRANSPORT SERVICE ................................................................................................................................. 112
General .................................................................................................................................................................... 112
ISHMED_MAIN: Patient Transport Service - Subsystem Connection (New) ........................................................ 112
CHARTING ..................................................................................................................................................................... 113
General .................................................................................................................................................................... 113
ISHMED_SCD: Chart (Enhanced) ......................................................................................................................... 113
SAP AG 2011
GENERAL
ISH_AMBULATORY: Business Function SAP Ambulatory Care Mgmt (Changed)
As of SAP ERP 6.0, Industry Extension Healthcare, the business function SAP Ambulatory Care Management
(ISH_AMBULATORY) provides new and enhanced functions in various components of SAP Ambulatory Care
Management.
For more information about the new features available in SAP enhancement package 6 (IS-H 606) for this
business function, see the following release notes:
ISH_AMBULATORY DE: Blank Form Printing (New)
ISH_AMBULATORY DE: PPA Billing Field ID 4126 (New)
ISH_AMBULATORY DE: PPA Billing Field ID 5011 (Changed)
ISH_AMBULATORY DE: New Fields for PPA Billing with Q2/2011 (New)
ISH_AMBULATORY DE: Report for Checking Outp. Coding Guidelines (New)
ISH_AMBULATORY DE: Prescription Assistant (Enhanced)
ISH_AMBULATORY DE: Support of KBV Coding Rule Set (Enhanced)
ISH_AMBULATORY DE: Support of Outpatient Coding Guidelines (Enhanced)
See also
You can access the release notes for SAP ERP 6.0, Industry Extension Healthcare on SAP Service
Marketplace under the quick link /healthcare-releasenotes Release Notes. To display the release notes for
the corresponding support packages, choose Release Notes for Support Packages.
ISH_CV_CN: Business Function SAP Pat Mgmt Country Version China (New)
As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), business
function SAP Patient Management CV China (ISH_CV_CN) is available.
See also
ISH_CV_CN: Enhancement of Patient Master Data (New)

ISH_CV_CN: Enhancement of Hospital Specialties (New)
ISH_CV_CN: Card Reader (New)
ISH_CV_CN: Enhancement of Case Master Data (New)
ISH_CV_CN: Enterprise Services (New)
ISH_CV_CN: Patient Accounting (New)
ISH_CV_CN: BMI Communication (New)
ISH_CV_CN: Ministry of Healthcare Reporting (New)
ISH_CV_FR: Business Function SAP Pat Mgmt Country Vers France (Changed)
The business function SAP Patient Management Country Version France (ISH_CV_FR) has been available
since SAP enhancement package 4 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 604). For more
information, see the release note ISH_CV_FR: Business Function SAP Pat Mgmt Country Version France (New)
for SAP enhancement package 4. For information about the new features available with SAP enhancement
package 6 (IS-H 606) for this business function, see the following release notes:
ISH_CV_FR: Comm. Procedure FRB2 (Electronic Invoice) (Changed)
ISH_CV_FR: Billing for Drugs and Medical Products (New)
ISH_CV_FR: Billing for SE Services (Changed)
ISH_CV_FR: Sample Form for Invoice Form S 3404 (Changed)
SAP AG 2011
ISH_CV_FR: Comm.: RSF - Standardized Invoice Message (Changed)

ISH_CV_FR: Comm.: NOEMIE Payment Information for Electronic Invoice (New)
ISH_CV_FR: Billing for Daily Hospital Rates in State Hospitals (Changed)
ISH_CV_FR: Readmission of a Patient (New)
ISH_CV_FR: Per Diem Fee (PJ Services), New Valuation Formula (New)
ISH_CV_FR: Adjustments to Service Rules F05 and F00 (Changed)
ISH_CV_FR: Care Path, Revenue Account Assignment (New)
ISH_CV_FR: Billing for Private Rehabilitation Clinics (Changed)
ISH_CV_FR: Billing for Retransfers at Private Institutions (Changed)
ISH_CV_FR: PMSI Model 2011 (Changed)
See also
You can access the release notes for SAP ERP 6.0, Industry Extension Healthcare on SAP Service Marketplace
under the quick link /healthcare-releasenotes Release Notes. To display the release notes for the
corresponding support packages, choose Release Notes for Support Packages.
ISH_CV_IT: Business Function SAP Pat Mgmt Country Vers Italy (Changed)
The business function SAP Patient Management Country Version Italy (ISH_CV_IT) has been available since
SAP enhancement package 3 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 603). For more
information, see the release note ISH_CV_IT: Business Function SAP Pat Mgmt Country Version Italy (New) for
SAP enhancement package 4. For more information about the new features available in SAP enhancement
package 6 (IS-H 606) for this business function, see the following detailed release note:
ISH_CV_IT: Restricting Number of DRG Diagnoses and Procedures (New)
See also
ISH_MAIN: Business Function SAP Patient Management (Changed)

Since SAP ERP 6.0, Industry Extension Healthcare, new and enhanced functions in various components of SAP
Patient Management have been available with the business function SAP Patient Management (ISH_MAIN). For
more information, see the SAP ERP 6.0 release note ISH_MAIN: Business Function SAP Patient Management.
ISH_MAIN: User Param.: End Automatic View Refresh (New)
ISH_MAIN: Discharge Date as Reference for Catalog Determination (New)
ISH_MAIN: Finding the Terminal (New)
ISH_MAIN: Patient Telephone Number Valid Throughout Case (New)
ISH_MAIN: Care Unit Overview Graphic Replaced (Changed)
ISH_MAIN: Multiplication Factor for Private Insurance with Basic Policy (New)
ISH_MAIN: Entry of "Estimated Length of Stay" (Enhanced)
ISH_MAIN AT: Outpatient Data Reporting - SCOAD (New)
ISH_MAIN AT: Diagnosis Entry - Check (Changed)
ISH_MAIN AT: Communication Procedure P321 (Changed)
ISH_MAIN AT: LR A4 - Check on Maximum Values (Changed)
SAP AG 2011
ISH_MAIN AT: NWATPARAM - Parameter SCO_KOMP (New)

ISH_MAIN AT: Scoring (Changed)
ISH_MAIN AT: Scoring - Intensive Care Documentation (Enhanced)
ISH_MAIN AT: Setting Stat. Cases to Final Billed (RNWATNFAL0) (Changed)
ISH_MAIN AT: Querying Insurant Data - VDAS (Changed)
ISH_MAIN AT, CH: Case Archiving (Changed)
ISH_MAIN CH: Uniform Invoice Form (Changed)
ISH_MAIN CH: Electronic Invoice INXML (Changed)
ISH_MAIN CH: Automatic Proposal of Contract Scheme (Enhanced)
ISH_MAIN CH: Insurance Verification (Changed)
ISH_MAIN CH: Swiss Healthcare Smart Card (Enhanced)
ISH_MAIN CH: Swiss DRG (New)
ISH_MAIN CH: Use of Flat-Rate Taxes (New)
ISH_MAIN DE: Comparison of Geographical Areas (New)
ISH_MAIN DE: Copayment Changes due to 301 Amendment, 09/22/2010 (Enh.)
ISH_MAIN DE: Treatment Certificates (Enhanced)
ISH_MAIN DE: DRG Billing (Flat Rate Agreement, FPV 2011) (Changed)
ISH_MAIN DE: German Electronic Health Card (Enhanced)
ISH_MAIN DE: PPA Billing Field ID 4126 (New)
ISH_MAIN DE: PPA Billing Field ID 5011 (Changed)
ISH_MAIN DE: New Fields for PPA Billing with Q2/2011 (New)
ISH_MAIN DE: OPS 2010 Psychiatry - Documentation Support (New)
ISH_MAIN DE: Nursing Complex Procedures - Documentation Support (New)
ISH_MAIN DE: Practice Fee: Insurance Providers with Copayment Waiver (Changed)
ISH_MAIN DE: Practice Fee: New Use for University Outpatient Cases (Enh.)
ISH_MAIN DE: Practice Fee: Canceling Dunned Copayment Invoices in R16 (Changed)
ISH_MAIN DE: Checks When Entering a Referring Physician (Changed)
ISH_MAIN DE: Check on Diagnostic Certainty (Enhanced)
ISH_MAIN DE: Posting Back Dunned Copayment Receivables (Enhanced)
ISH_MAIN DE: Reverse Clearing for Copayment Receivables (Enhanced)
ISH_MAIN DE: Preassgmt of Discharge Diag., Diag. Certainty (Changed)
ISH_MAIN DE: Default Case-Related Copayment Exemption Reasons (New)
ISH_MAIN DE: Gen. Demands for Copayment (Report RNZUZBI1) (Enhanced)
ISH_MAIN IT, SG: Discharge Date as Reference for Catalog Determination (New)
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder (Changed)
ISH_MAIN SG: Enhancements to Medical Documentation (New)
ISH_MAIN SG: Mental Health Legal Status (New)
See also
You can find the release notes for SAP ERP 6.0, Industry Extension Healthcare, business function SAP Patient
Management (ISH_MAIN) on the SAP Service Marketplace under the quick link /healthcare-releasenotes
Release Notes. To display the release notes for the corresponding support packages, choose Release Notes for
Support Packages.
ISH_MISC1: Business Function ISH_MISC1: Business Function SAP (Changed)

As of SAP ERP 6.0, Industry Extension Healthcare, the business function SAP Patient Management: Legal
Process Adoption (ISH_MISC1) provides new and enhanced functions in various components of SAP Patient
Management.
10
SAP AG 2011
ISH_MISC1: Enhancement in Employee/Physician Data Maintenance (New)

ISH_MISC1: Store Postdischarge Phys. for Future Hospital Stays (New)
ISH_MISC1: Search for Employee/Physician by Specialty (New)
ISH_MISC1 AT: Insurance Verification Alternative System Behavior (Changed)
ISH_MISC1 DE: Marking Procedures Relevant for Additional Charges (New)
See also
ISH_MISC2: SAP Patient Management Legal Process Adoption 2 (Changed)

As of SAP ERP 6.0, Industry Extension Healthcare, the business function SAP Patient Management: Legal
Process Adoption 2 (ISH_MISC2) provides you with new and enhanced functions in various components of SAP
Patient Management.
business function, see the following release note: ISH_MISC2: Service Rule for Nursing Service (R27) (New)
See also
ISH_MISC3: SAP Patient Management Legal Process Adoption 3 (New)

As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), the business
function SAP Patient Management: Legal Process Adoption 3 (ISH_MISC3) is available. You can use this
business function to implement enhancements that include process improvements based on legal changes.
These include:
Use of places of birth and death
For further information, see the release note ISH_MISC3: Places of Birth and Death (New).
Accommodation costs
This business function provides you with additional extended services that are generated at room and bed
level, both for organizational units (OUs) and building units (BUs).
For further information, see the release note ISH_MISC3: Accommodation Costs - Indicator for Additional
Nursing Charge (New).
Healthcare Communication Framework for country version China
If this business function is activated, you can map BMI communication for the patient management process in
the Chinese country version of SAP Patient Management (IS-H).
For more information about functions for the country version China, see the main release note for the business
function ISH_CV_CN: Business Function SAP Pat Mgmt Country Version China (New).
For more information about BMI communication, see ISH_CV_CN: BMI Communication (New).
These release notes are only available in English.
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See also
For more information, see Business Function Sets and Business Functions Healthcare SAP Patient
Management SAP Patient Management: Legal Process Adoption 3 in the SAP Library.
For more information about Support Package release notes for SAP Patient Management and SAP Ambulatory
Care Management, see SAP Service Marketplace under the quick link /healthcare-releasenotes.
SAP AMBULATORY CARE MANAGEMENT

General
ISH_AMBULATORY DE: Support of KBV Coding Rule Set (Enhanced)
General diagnosis checks in line with the outpatient coding guidelines (AKR) for PPA cases have now been
introduced with SAP Note 1464042.
function SAP Ambulatory Care Management (ISH_AMBULATORY), diagnoses are now also checked against
the special coding guidelines published by the Federal Association of Panel Physicians (KBV).
To be able to run the checks, you must have implemented version 1.61.00 of amasys. You must also transfer the
messages for the coding rule set (KRW) from amasys to SAP Patient Management (IS-H) using report
RNU_MSGUPDKRW, so that the message long texts are displayed in IS-H.
You must rerun report RNU_MSGUPDKRW to repeat transfer of the KRW messages after each amasys update.
This enhancement is available as of:
SAP Patient Management (IS-H) 4.72, Add-On Support Package 39
SAP ERP 6.0, Industry Extension Healthcare (IS-H 600), Support Package 24, business function SAP
Ambulatory Care Management (ISH_AMBULATORY)
SAP enhancement package 3 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 603), Support Package
12, business function SAP Ambulatory Care Management (ISH_AMBULATORY)
See also
For more information, see SAP Note 1483209 and the documentation for report RNU_MSGUPDKRW.
Treatment
ISH_AMBULATORY DE: Prescription Assistant (Enhanced)
This release note is only relevant for the country version Germany and is not available in English.
ISH_AMBULATORY DE: Blank Form Printing (New)

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Billing
The regulations relating to the outpatient coding guidelines (Ambulante Kodierrichtlinien, AKR) for the Federal
Association of Panel Physicians (KBV) in integrated PPA billing with the amasys system are supported with the
following Support Packages:
SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), business function
SAP Ambulatory Care Management (ISH_AMBULATORY)
If you choose the Check pushbutton during diagnosis maintenance, amasys checks the diagnoses. If there is an
outpatient coding guideline for a diagnosis, the system sends a message, for example ICD code A01.1 with AKR
note >B1101 Gastroenteritis and Colitis< (technical name: NAMASYS 200). If this message appears, the
program displays an additional Outpt Coding Guideline pushbutton in the message dialog box. To display the
corresponding coding guideline, select the message and choose this pushbutton. The system displays the
relevant outpatient coding guideline in the local browser.
Effects on System Administration

The amasys system provides a URL that you can use to display the outpatient coding guidelines in the local
browser.
Effects on Customizing
As of SAP ERP 6.0, the Customizing activity Outpatient Coding Guidelines has been added to the settings under
SAP Healthcare - Industry-Specific Components for Hospitals SAP Ambulatory Care Management
Administration.
In the Customizing activity Outpatient Coding Guidelines, you can maintain the URL that is called by the local
browser at the SAP frontend for a specific institution. The amasys system provides this URL with the quarterly
update.
The system can display the coding guidelines along with (error) messages during diagnosis maintenance,
depending on the context.
In the Customizing activity Display Outpatient Coding Guidelines, you can display them in the local browser
without reference to the context. This allows you to test that the URL is accessible locally. You can also access
this function outside of Customizing using the transaction code N_SHOW_AKR.
In SAP Patient Management 4.72, you can make the required settings in transaction SM30/table TNAKR. You
can display the coding guidelines independently of the context using program RNSHOWAKR.
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See also
For more information, see SAP Note 1464042.
ISH_AMBULATORY DE: PPA Billing Field ID 5011 (Changed)


ISH_AMBULATORY DE: New Fields for PPA Billing with Q2/2011 (New)

SAP PATIENT MANAGEMENT

BASIC DATA
Hospital Structure
ISH_CV_CN: Enhancement of Hospital Specialties (New)
function SAP Patient Management Country Version China (ISH_CV_CN) is available.
The system delivers the department codes issued by the MoH authority and the local BMI authority. The
Organization Management must map these department codes with the hospital structure. In addition, you can
enter the departmental codes in the Specialty (ISH_FACHR) field.
You create the specialty categories E (BMI) and F (MoH) in Customizing for SAP Healthcare Industry-Specific
Components for Hospitals under Hospital Basic Data Hospital Structure Organizational Structure Define
Specialty Categories.
You map the organization structure to the BMI-specific structure and the MoH-specific structure in Customizing
for SAP Healthcare Industry-Specific Components for Hospitals under Hospital Basic Data Hospital
Structure Organizational Structure Code Specialties.
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ISH_MISC3: Accommodation Costs - Indicator for Additional Nursing Charge (New)

function SAP Patient Management: Legal Process Adoption 3 (ISH_MISC3), additional extended services that
are generated at room and bed level are available for both organizational units (OUs) and building units (BUs).
To ensure that the system adds the additional nursing charge, you must select the Additional Nursing Charge
indicator when nursing the OU or BU in question.
This function is available in all country versions except Germany.
The system always takes account of the daily hospital rate at bed level, regardless of whether or not this
indicator is selected. If the indicator is selected, the system also generates all the relevant services.
An example of additional accommodation costs is the surcharge for air conditioning in a room (for example, in
the country version China).
ISH_CV_FR: Defining Nursing Home Cases (EHPAD) (Enhanced)

As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), Support
Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR), you can define
nursing home cases as follows:
Nursing home cases are cases whose admitting specialty is marked as a nursing home in specialty category 7.
This new feature is also available with the following Support Package:
SAP ERP 6.0, Industry Extension Healthcare, SAP enhancement package 5 (IS-H 605), Support Package 09,
business function SAP Patient Management Country Version France (ISH_CV_FR)
To mark a specialty as a nursing home, enter the value P (nursing home) in column UC (ISH_UNQCD) for
specialty 7 in the Customizing settings for coding specialties.
Then assign this specialty to the departmental organizational units for the nursing home in master data.
For more information, see the Healthcare Implementation Guide under SAP Healthcare Industry-Specific
Components for Hospitals Hospital Basic Data Hospital Structure Organizational Structure Code
Specialties.
Business Partner
ISH_CV_FR: Ins. Prov. Master Data: "Consil Gnral" Indicator (New)
Package 01, business function SAP Patient Management Country Version France (ISH_CV_FR), a Consil
Gnral indicator has been added to the insurance provider master data.
If the insurance provider is a consil gnral, you select the Consil Gnral indicator in the insurance provider
master data or insurance provider type.
In France, consils gnrals cover a portion of the patient's costs for nursing home (EHPAD) treatment,
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depending on their level of care.

This indicator is relevant during processes such as payment distribution and in some evaluations.
ISH_MISC1: Enhancement in Employee/Physician Data Maintenance (New)

function SAP Patient Management: Legal Process Adoption (ISH_MISC1), a third name field is available in data
maintenance for employees and physicians.
The new name field is available in the following form structures:
RNF06 Admission data-movement
RNF07 Admission-referral physician/hospital
RNF071 Referring physician
RNF073 Family physician
RNF08 Discharge
RNF082 Postdischarge physician
Note for German country version:
You can still access the maintenance dialog for PPA identification numbers (physician number, place of work
number) directly when creating a physician without having to save beforehand.
These enhancements are available as of:
15
06

function SAP Patient Management: Legal Process Adoption (ISH_MISC1), the person's specialty is available as
an additional search criterion in the input help when entering employees and physicians.
In addition, a Specialty column containing the specialties assigned to the employee or physician has been added
to the result list for the search function.
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Service Master Data

ISH_MAIN: Service Master Data - New Charge Types (New)
This release note only applies to the country version Austria and is not available in English.
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Clinical Work Station

ISH_MAIN: User Param.: End Automatic View Refresh (New)
function SAP Patient Management (ISH_MAIN), the following change applies:
You can set up the views in the Clinical Work Station in SAP Patient Management so that the system refreshes
them automatically in a predefined sequence. Until now, automatic logoff for Clinical Work Station users working
with the automatic refresh function did not take effect if the views were set up in this way. The new user
parameter WP_TERMINATE_RFSH can be used to implement automatic logoff even if the user is working with
the automatic refresh function.
The following conditions apply:
If the new parameter is not included in a users user defaults, the system ends the automatic refresh after 60
minutes if there is no user interaction during this period (default setting).
If a period other than 60 minutes is required for a certain user, you can make a 3-digit numeric entry for the
parameter to specify this period in minutes.
If you do not want the system to end the automatic view refresh for a user, you can make a non-numeric entry
(for example, NO) for the new parameter.
This change is also available with the following Support Packages:
SAP ERP 6.0, Industry Extension Healthcare, Support Package 26, business function SAP Patient
Management (ISH_MAIN) and business function SAP Ambulatory Care Management (ISH_AMBULATORY)
SAP ERP 6.0, Industry Extension Healthcare, SAP enhancement package 3 (IS-H 603), business function
SAP Patient Management (ISH_MAIN) and business function SAP Ambulatory Care Management
(ISH_AMBULATORY), Support Package 15
See also
PATIENT MANAGEMENT
General
ISH_CV_CN: Enhancement of Case Master Data (New)
You can make assignments to insurance relationships in case-related variants of the Clinical Process Builder.
This subscreen is available if you have activated the business function SAP Patient Management Country
Version China (ISH_CV_CN). To describe cases more precisely according to your own business requirements,
you can define classification categories and the respective classification types of your own.
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You specify the discharge types in Customizing for SAP Healthcare Industry-Specific Components for
Hospitals under Patient Management Movements Define Movement Types.
You enter the place type of newborn admission or death in Customizing for SAP Healthcare - Industry-Specific
Components for Hospitals under Medical/Nursing Documentation Define Places of Birth and Death.
You enter the patient conditions at admission and at discharge in Customizing for SAP Healthcare IndustrySpecific Components for Hospitals under Patient Management Patient Management Movements Define
Reasons for Movement.
You enter the case classification categories in Customizing for SAP Healthcare Industry-Specific Components
for Hospitals under Patient Management Patient Management Cases Define Classification Categories.
You enter the classification types as required by the BMI in Customizing for SAP Healthcare Industry-Specific
Components for Hospitals under Patient Management Patient Management Cases Define Classification
Types.
You enter the accident types for cases in Cusotmizing for SAP Healthcare Industry-Specific Components for
Hospitals under Patient Management Movements Define Accident Types.
ISH_CV_FR: Readmission of a Patient (New)

Package 02, business function SAP Patient Management Country Version France (ISH_CV_FR), a function is
available for processing the readmission of a patient after "discharge to an external hospital" when their absence
lasted less than 48 hours.
This new feature is also available with the following Support Packages:
SAP ECC 6.0, Industry Extension Healthcare, SAP enhancement package 4 (IS-H 604), Support Package 15,
ISH_CV_FR: PMSI Model 2011 (Changed)

function SAP Patient Management Country Version France (ISH_CV_FR), the system accommodates the
changed requirements for the following EDI procedures based on the 2011 PMSI Model:
FRRSS: Standardized Discharge Message (PMSI MCO)
FRRSP: Standardized Message for Radiotherapy Preparation (PMSI MCO)
FRVID: VIDHOSP File for Inpatient and Home Treatment
FRACE: Standardized Outpatient Clinic Invoice Message (RSF-ACE)
All the above procedures determine which message type (or message structure) is to be used for reporting
based on the discharge date.
The new VIDHOSP format contains information about healthy newborn infants and organ removals.
Newborns
The system identifies newborns by the admission type. You should therefore make sure that they are marked as
"Newborn".
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To enable the system to distinguish sick from healthy infants, you must also select the appropriate case
classification for both.
For this purpose, you must create your own "classification category" (SAP Healthcare Industry-Specific
Components for Hospitals Patient Management Cases Define Classification Categories). When doing
this, do not select any of the available checkboxes.
Then assign two "classification types" with the internal keys 20 (healthy newborn) and 21 (sick newborn) to the
new classification type.
If a case classification has not been maintained for a newborn, the system interprets it as a healthy newborn
(this means you must at least assign the appropriate case classification to for sick newborns).
For ease of data entry, you can also use the Treatment Category field and have the system generate the case
classification from the treatment category (for more information, see Customizing for SAP Healthcare under
Patient Accounting Treatment Categories Assign Case Classifications to Treatment Categories).
Organ Removals
The system identifies organ removals by the case category. A new indicator for organ removals is available
when you define the case category.
You can define case categories in Customizing for SAP Healthcare under Patient Management Cases
Define Case Categories.
Make sure you assign the correct case category for organ removals.
Enhancements have also been made to the EDI procedure FRRSS. In some cases, such as deliveries,
pregnancies without delivery, and terminations of pregnancies for medical reasons, Model 2011 requires you to
indicate the date of the last menstrual cycle.
You can enter the date of the last menstrual cycle in the delivery data for the case or use the following BAPIs to
determine it:
BAPI_PATCASE_ADDINPATADMISS (Create Admission)
BAPI_PATCASE_CHANGEINPATADMISS (Change Admission)
BAPI_PATCASE_GETINPATADMISS (Display Admission)
BAPI_PATCASE_ADDOUTPATVISITCAS (Create Visit and Case)
BAPI_PATCASE_CHANGEOUTPATVISIT (Change Visit)
BAPI_PATCASE_GETOUTPATVISIT (Display Visit)
The following new EDI procedures for FICHCOMP messages are also available with Model 2011:
FRFPO: Data Transfer of FICHCOMP File for Organ Removal (PMSI MCO)
FRFXI: Data Transfer of FICHCOMP File for Cross-Institution Treatment (PMSI MCO)
These options (FPO and FXI) have been added to the report Manual Dispatch Order Creation for Various MCO
Procedures (/ISHFR/RN_MCO_ORDER_CREATE) to allow you to create dispatch orders for the new
procedures.
The messages and files are created using the usual reports (RNC30100 for message creation and RNC30101
for file creation).
For more information about activating the new procedures, see Customizing for Branchenlsung Krankenhaus
under Communication Electronic Data Interchange Customizing Step-by-Step FR: Procedure for MCO
Customizing.
For more information about the new procedures, see the documentation for the report Manual Dispatch Order
Creation for Various MCO Procedures (/ISHFR/RN_MCO_ORDER_CREATE).
There have been no changes to the existing FICHCOMP procedures:
FRUCD: Data Transfer of FICHCOMP File for Drugs (PMSI MCO)
FRLPP: Data Transfer of FICHCOMP File for Medical Products (PMSI MCO)
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Online Connection to Grouper

As of March 1st, 2011, you must use the new version of the PDG-MCO grouper (V13.11c). This version supports
the interface (RUM) versions 15 (Model 2010) and 16 (Model 2011).
As of this release, SAP also supports Model 2011 and thus, RUM version 16.
The system determines the correct interface version from the discharge date (RUM version 16 from discharge
date March 1st, 2011). The same applies to the interface for grouper confirmations (RDS structure).
Once you have installed the current grouper version, you do not need to make any changes to the SAP system.
Please note that some of the functional enhancements are only available if you apply SAP Notes 1569721 and
1569774.
ISH_MAIN: Patient Telephone Number Valid Throughout Case (New)

function SAP Patient Management (ISH_MAIN), you can specify in Customizing for SAP Patient Management
(IS-H) that the system is to synchronize the patient's telephone number in all movements in an inpatient case at
an institution.
This enables the system to support patient telephone number cards, whereby the patient is assigned a
telephone number that is valid throughout their hospital stay, regardless of whether or not they are transferred
from one department to another.
SAP ERP 6.0, Industry Extension Healthcare (IS-H 600), Support Package 27, business function SAP Patient
Management (ISH_MAIN)
16, business function SAP Patient Management (ISH_MAIN)
Caution: After applying the Support Package, please read the correction instructions in SAP Note 1589223.
System behavior once the new function has been activated in Customizing (see Implementation Guide):
The system replicates a telephone number the user has entered in a movement to all the other movements for
the case.
If the user deletes the telephone number in a movement, the system deletes it from all the other movements
for the case.
If the user creates a new inpatient case from the admission of an existing inpatient case in case revision, the
system does not copy the telephone number, since the patient will normally be given a new telephone number
when a new hospital stay begins.
Effects on Existing Data
System behavior once the new function has been activated in Customizing (see Implementation Guide) and the
user is processing old cases that have different telephone numbers in different movements:
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Creating new movements:

The system proposes the telephone number from the most recent inpatient movement. When the user saves
the transaction, the system copies this telephone number to all other movements. If the new movement is
created using a BAPI and a telephone number is not specified explicitly, the system also copies the telephone
number from the most recent inpatient movement to this and all other movements.
Processing existing movements:
The system displays the telephone number that is currently stored in the movement. When the user saves the
transaction, the system copies this telephone number to all other movements. This also applies when
processing existing movements using a BAPI.
You can make the above settings in Customizing under SAP Healthcare Industry-Specific Components for
Hospitals Basic Settings System Parameters Maintain Institution-Specific, Time-Independent
Parameters Patient Management Default telephone number of movement:
Entry value:
"F" = Telephone number applies throughout case
The values available previously are also still valid:
" " = No proposal for telephone number
"Z" = Telephone number from assignment
"V" = Telephone number from previous movement
ISH_MAIN: Avoiding Unintentional Patient Master Data Changes (New)

As of SAP enhancement package 6 for SAP ERP 6.0, Support Package 01, Industry Extension Healthcare (IS-H
606), business function SAP Patient Management (ISH_MAIN), you can protect patient master data from
unintentional changes more effectively.
In Customizing, you can select patient master data fields that you want to protect to prevent unintentional
changes. The system does not allow changes to these selected fields in the Clinical Process Builder (transaction
NV2000). When the user accesses the transaction in change mode, the fields are display only. Fields in patient
master data that have not been selected in Customizing for protection can be changed directly.
When a user creates a new patient master record, the fields are not protected at first.
To make changes to protected patient master data fields, choose Edit Protected Data Unprotect. The
system displays a message indicating that changes to patient master data should only be made in exceptional
cases and you must then specify a change reason. The previously protected fields are then released and ready
for input.
The system logs the change reasons. To display them, choose Edit Protected Data Display Changes in the
menu. You can display the change documents for the change reasons logged.
Patient master data can always be changed when an electronic card is read, even if master data fields are
protected. Since the field protection simply constitutes a change to the user interface, the behavior of electronic
interfaces (such as BAPIs or Enterprise Services) remains unchanged.
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You can view a list of the fields and dynpros that can be protected in Customizing under SAP Healthcare
Industry-Specific Components for Hospitals Basic Settings Screen Control Display Protectable Fields
(SAP).
To protect patient master data fields to avoid unintentional changes, choose SAP Healthcare Industry-Specific
Components for Hospitals Basic Settings Screen Control Maintain Screen Modification in Customizing.
When you select a screen with protectable patient master data fields, the system displays checkboxes in the
Protected column. The system protects patient master data fields for which you select an indicator in this
column.
Choose Copy Protection to copy your settings to all the other screen modification entries for this screen. The
system lists all the other screen modification entries for this screen (for example, for other user groups). You can
use checkboxes to select the other screen modification entries you want to change. When you do this, the
system only copies the information as to whether a field is to be protected. It does not copy other settings, such
as whether the field is required or optional. The changes only take effect when you choose Save.
If you do not make any entries to protect fields in this Customizing activity, the system behavior does not
change.
You can define possible change reasons in Customizing under SAP Healthcare Industry-Specific Components
for Hospitals Basic Settings Screen Control Maintain Change Reasons for Protected Fields.
ISH_MAIN CH: Insurance Verification (Changed)

This release note is only relevant for the country version Switzerland and is not available in English.
ISH_MAIN CH: Swiss Healthcare Smart Card (Changed)

ISH_MAIN DE: German Electronic Health Card (Enhanced)

This release note applies to the German country version only and is not available in English.
ISH_MAIN AT: EKVK - Alphanumeric Card Number (Changed)

This release note is only relevant for the country version Austria and is not available in English.
ISH_MAIN AT: P321/ELDAL - Different Birthdate from SVNR (Changed)
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ISH_MISC3: Places of Birth and Death (New)

function SAP Patient Management: Legal Process Adoption 3 (ISH_MISC3), you can specify the following:
Place of death as an addition to the patient's death data
Place of birth as an addition to the newborn's birth data
If you want to use places of birth and death in the application, you must first define them in Customizing. You
can do this in the new Customizing activity SAP Healthcare Industry-Specific Components for Hospitals
Medical/Nursing Documentation Define Places of Birth and Death.
ISH_MISC3: Accommodation Costs - Indicator for Additional Nursing Charge (New)

function SAP Patient Management: Legal Process Adoption 3 (ISH_MISC3), additional extended services that
are generated at room and bed level are available for both organizational units (OUs) and building units (BUs).
To ensure that the system adds the additional nursing charge, you must select the Additional Nursing Charge
indicator when nursing the OU or BU in question.
This function is available in all country versions except Germany.
The system always takes account of the daily hospital rate at bed level, regardless of whether or not this
indicator is selected. If the indicator is selected, the system also generates all the relevant services.
An example of additional accommodation costs is the surcharge for air conditioning in a room (for example, in
the country version China).
Patient Master Data

ISH_CV_CN: Enhancement of Patient Master Data (New)
You can enter the citizenship card number in the External patient ID field. You can also enter the ethic of a
patient in the Race field.
You enter a patient's ethnic information in Customizing for SAP Healthcare Industry-Specific Components for
Hospitals under Patient Management Patients Maintain Race.
You specify occupation categories in Customizing for SAP Healthcare Industry-Specific Components for
Hospitals under Patient Management Patients Define Occupation Categories.
You specify the identification document types in Customizing for SAP Healthcare Industry-Specific
Components for Hospitals under Patient Management Basic Settings Maintain Identification Document
Types.
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ISH_MAIN DE: Comparison of Geographical Areas (New)

function SAP Patient Management (ISH_MAIN), the following new feature is available:
Reforms of municipality areas constantly lead to major changes that necessitate an update of the postal code
and geographical area master data. When you update and import postal codes and geographical areas, the
system does not automatically update the geographical areas in the patient and case data.
The following reports are now available for use in comparing geographical areas and postal codes:
Report RNUTEZG_PAT
This report is used to compare the geographical areas in the patient data (NPAT/NADR). The report analyzes
the patients whose geographical area needs to be changed due to the postal code specified.
In test mode, the report displays a list documenting the possible changes and any manual intervention
necessary.
In update mode, the report makes all the changes that can be made automatically.
Report RNUTEZG_FAL
This report is used to compare the geographical areas in the case data (NFAL) with those specified in the
patient data. The report compares the geographical areas in the patient master data that were updated
beforehand with the patient's case data on an institution-specific basis.
In test mode, the report displays a list documenting the possible changes to the geographical areas in the
individual cases.
In update mode, the report makes all the changes that can be made automatically.
In addition, the Business Add-In (BAdI) ISH_GEBIET_CHECK is available for determining geographical areas.
The function described above is also available with the following Support Packages:
SAP ERP 6.0, Industry Extension Healthcare, Support Package 27
SAP ERP 6.0, Industry Extension Healthcare, SAP enhancement package 3 (IS-H 603), Support Package 16
You can access BAdI ISH_GEBIET_CHECK in the following Customizing activity: SAP Healthcare IndustrySpecific Components for Hospitals Patient Management Business Add-Ins for Patient Management
BAdI: Check Geographical Area.
Inpatient Case
ISH_CV_FR: Clin. Proc. Builder: Entering Case Classifications (New)
Package 01, business function SAP Patient Management Country Version France (ISH_CV_FR), the Clinical
Process Builder includes a new subscreen for maintaining case classifications.
In this new subscreen, you can maintain case classifications, such as levels of care, when admitting patients.
Assign the new France-specific subscreen FR: Case Classification to an admission variant. This function only
allows you to edit case classification categories for which you have selected the Display Case Classification
indicator (ISH_CLSSR) in Customizing.
The subscreen only displays the most recent entry for each classification category.
To create a new classification type for the same classification category for a case, you simply change the
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existing entry. This means you overwrite its start date with the new valid-from date and overwrite the previous
classification type (for example, the previous level of care) with the new one (for example, the new level of care).
The system then delimits the previous case classification type as of the new start date and creates the new
entry.
Alternatively, you can enter the new classification type in a blank line in the subscreen. If you do not specify a
validity period, the system enters the current date as the end date of the previous classification type and start
date of the current one.
To change the existing entry, you either overwrite the specified classification type or change the validity period.
To view or edit the history of classification types, choose Other Data.
You define the case classification categories (such as the level of care) in Customizing under SAP Healthcare
Industry-Specific Components for Hospitals Patient Management Cases Define Classification
Categories.
You define the corresponding classification types (for example, care level 1) in Customizing under SAP
Healthcare Industry-Specific Components for Hospitals Patient Management Cases Define
Classification Types. Assign an internal classification type to your classification type (for example, 71 - Level of
Care (GIR) 1). The system requires this for processes such as selection and evaluation.

function SAP Patient Management: Legal Process Adoption (ISH_MISC1), you can record a postdischarge
physician in the system for a patient's future hospital stays.
Until now, you could only enter the postdischarge physician for a patients current stay on discharge.
This enhancement means that you can now enter the postdischarge physician when you admit the patient and
use system parameters to specify that the physician is to be stored as a default value for future stays, or that the
default value is to be used. The postdischarge physician is stored separately for inpatient and outpatient
treatment for each patient. In inpatient processing, this is done on admission or discharge; in outpatient
processing, the physician can be recorded for each visit. If a postdischarge physician has already been stored
for a patient, you can copy this physician during admission or discharge for the current stay.
This enhancement is also available as of:
06
15
You can configure the enhancement for a specific institution using the following new system parameters:
Store Postdischarge Physician as Default Value (GET_NBAR) with the following standard behavior: The
system displays a dialog box, in which the user can decide whether or not the physician is to be copied as the
default value for further hospital stays.
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Copy Postdischarge Physician from Default Value (SET_NBAR) with the following standard behavior: The
physician is copied without requiring confirmation; the user does not need to take action.
If you want to change the standard system behavior, change the settings for the two parameters GET_NBAR
and SET_NBAR in the Customizing activity Maintain Institution-Specific, Time-Independent Parameters.

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Outpatient Case
function SAP Patient Management (ISH_MAIN), you can enter the mental health legal status at case level.
The field is displayed on the Case Data subscreen in the Clinical Process Builder (transaction NV2000) and
when you maintain DRG data (transaction NPDRG2). It has also been incorporated in the interfaces of the
BAPIs for creating, changing, and reading case data.
The mental health legal status is required for the DRG grouper in the country version Singapore. For this reason,
the new field is only active in this country version.
The mental health legal status is available as of:
See also
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ISH_MAIN DE: Checks When Entering a Referring Physician (Changed)

function SAP Patient Management (ISH_MAIN) the following new checks are available:
You can enter a referring physician for outpatient cases, together with their place of work number (BSNR) and
lifelong physician number (LANR) on the External Physicians subscreen in the Clinical Process Builder. When
you enter a BSNR and an LANR for a referring physician, the system now displays warning message N1842,
Master data for physician <X> contains errors; notify administrator, if the Ext. Accreditation indicator is not
selected in the physician's business partner master.
When you maintain a physician's master data in the business partner master, the system displays warning
message N1843, BSNR/LANR requires 'External Accreditation' indicator, if the place of work and physician
number are maintained for the physician but the Ext. Accreditation indicator is not selected.
The Ext. Accreditation indicator is important in PPA billing, since the system uses it to determine whether the
physician is sickness fund-affiliated.
SAP Patient Management 4.63B, Add-On Support Package 56
SAP Patient Management 4.72, Add-On Support Package 40
SAP Patient Management (ISH_MAIN), Support Package 14
See also

function SAP Patient Management: Legal Process Adoption (ISH_MISC1), you can record a postdischarge
physician in the system for a patient's future hospital stays.
Until now, you could only enter the postdischarge physician for a patients current stay on discharge.
This enhancement means that you can now enter the postdischarge physician when you admit the patient and
use system parameters to specify that the physician is to be stored as a default value for future stays, or that the
default value is to be used. The postdischarge physician is stored separately for inpatient and outpatient
treatment for each patient. In inpatient processing, this is done on admission or discharge; in outpatient
processing, the physician can be recorded for each visit. If a postdischarge physician has already been stored
for a patient, you can copy this physician during admission or discharge for the current stay.
This enhancement is also available as of:
06
15
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You can configure the enhancement for a specific institution using the following new system parameters:
Store Postdischarge Physician as Default Value (GET_NBAR) with the following standard behavior: The
system displays a dialog box, in which the user can decide whether or not the physician is to be copied as the
default value for further hospital stays.
Copy Postdischarge Physician from Default Value (SET_NBAR) with the following standard behavior: The
physician is copied without requiring confirmation; the user does not need to take action.
If you want to change the standard system behavior, change the settings for the two parameters GET_NBAR
and SET_NBAR in the Customizing activity Maintain Institution-Specific, Time-Independent Parameters.

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General Case Processing

function SAP Patient Management (ISH_MAIN) the following enhancement is available:
The following enhancements now allow you to make a default entry for the estimated length of stay for an
inpatient case according to the admission diagnosis:
The new method SET_LOS Enter Default Length of Stay for the existing Business Add-In (BAdI)
ISH_DIAGNOSIS_NP61
Sample code for the new method SET_LOS Enter Default Length of Stay of the existing BAdI
ISH_DIAGNOSIS_NP61
Changed sample code for the existing method of BAdI ISH_NV2000_PBO
If you implement method MODIFY_DATA of BAdI ISH_NV2000_PBO, you can make a default entry in the
Clinical Process Builder for the expected duration based on the admission diagnosis. You can base your
implementation on the sample code and modify it according to your requirements. The relevant sample code
refers to structure RNBADI_ADM.
If you implement method SET_LOS of BAdI ISH_DIAGNOSIS_NP61, you can make a default entry for the
expected duration based on the admission diagnosis in diagnosis processing (transaction NP61) and the DRG
Work Station (transaction NPDRG2). You can base your implementation on the sample code and modify it
according to your requirements.
The sample code contains two different variants for determining the expected duration based on the admission
diagnosis.
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If the different proposals for the expected duration are only based on a small number of diagnoses, we
recommend choosing option 1.
If your institution uses a wide range of different proposals, option 2 is preferable. To implement option 2, you
must create a customer-specific table containing the desired content, which the BAdI then reads to determine
the expected duration.
For an example of how this table can be structured and read, as well as an example of how option 1 can be
implemented, see the sample code for the two methods.

Care Unit Management

ISH_MAIN: Care Unit Overview Graphic Replaced (Changed)
function SAP Patient Management (ISH_MAIN), the care unit overview graphic (transaction code NR12) is no
longer maintained and has been replaced by the Clinical Work Station (transaction code NWP1), which has been
available since release 4.63.
This change is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
Healthcare (IS-H 605), Support Package 03.
MEDICAL/NURSING DOCUMENTATION
General
ISH_CV_IT:Restricting Number of DRG Diagnoses and Procedures (New)
function SAP Patient Management Country Version Italy (ISH_CV_IT), you can specify in Customizing for SAP
Patient Management (IS-H) that the system is to restrict the number of DRG-relevant diagnoses and procedures
that can be entered for a case to a maximum number.
Caution: This function is only available for the country version Italy.
16, business function SAP Patient Management Country Version Italy (ISH_CV_IT)
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Hospitals Medical/Nursing Documentation DRG Documentation Specify Maximum Number of DRG
Diagnoses and Procedures.
See also
For more information, see SAP Note 1568049 and the documentation for the Customizing activity.
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder (Changed)

function SAP Patient Management (ISH_MAIN), the following changed functions are available in medical
documentation for the country version Singapore. The adjustments support the legal changes accompanying the
introduction of AR-DRG 6.0 in Singapore with the coding and grouping tool 3M Codefinder.
The following new function modules support communication to and from the 3M Codefinder in "CodAllTags"
format.
ISH_DRGCDF_FORMAT_3MTAG_OUT_SG
ISH_DRGCDF_FORMAT_3MTAG_IN_SG
This means the adjustments described in the following release notes are now also supported in communication
with the 3M Codefinder:
The following new interface attributes are available with these changes for grouper communication:
MLS: This interface attribute is linked to the value in the back-end field field NFAL-MHLS.
PRFX: This interface attribute is linked to the value in the back-end field field NDIA-QUALF.
ARE: This interface attribute is linked to the value in the back-end field NDIA-DRG_IMPACT for diagnoses and
NICP-DRG_IMPACT for procedures.
ARCL: This interface attribute is linked to the value in the back-end field NDIA-CCL for diagnoses and NICPCCL for procedures.
MOD: This interface attribute is used to link diagnoses to morphology diagnoses.
The system now uses version 2.0 of the DRG-CDF communication standard instead of version 1.0 to map
internal codes to external codes for the patient's sex (table NPAT, field GSCHL) and discharge mode (table
TN14B, field BWART).

If you use customer exit EXIT_SAPLNCDRGC_006, you must adjust it so that the coding is only processed once
per patient.
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You can make the settings for communication with the 3M Codefinder in Customizing under SAP Healthcare
Industry-Specific Components for Hospitals Communication DRG Data Exchange.
You can use the following Customizing activity to map internal codes to external codes for the 3M Codefinder:
SAP Healthcare Industry-Specific Components for Hospitals Communication Electronic Data Interchange
Map Internal Codes to External Codes.
ISH_MAIN DE: Nursing Complex Procedures - Documentation Support (New)

ISH_MAIN DE: OPS 2010 Psychiatry - Documentation Support (New)

ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: MHLS (Changed)

You can now transfer the mental health legal status from the 3M Codefinder to the SAP Patient Management
system:
Function module ISH_DRGCDF_FORMAT_3MTAG_IN_SG converts the value of the interface attribute
"MLS:". The system transfers the converted value to the back-end field NFAL-MHLS.
This conversion takes place according to the following rules:
o The interface values 1 (Involuntary) and 2 (Voluntary) are transferred unchanged.
o The interface values " " and 9 are transferred as " " (not specified).
No other values are transferred to the system. In this case, the system returns the error message "Invalid entry
&1 for mental health legal status".
This constitutes an enhancement to the function described in the release note ISH_MAIN SG: DRG Data
Exchange with 3M Codefinder (Changed).
ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: Exits (Changed)

Package 01, business function SAP Patient Management (ISH_MAIN), the following applies:
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The following changed functions are available for medical documentation in the country version Singapore. The
adjustments support the legal changes accompanying the introduction of AR-DRG 6.0 in Singapore with the
coding and grouping tool 3M Codefinder.
You can now also use the following customer exits for data exchange with the 3M Codefinder with AR-DRG 6.0:
NC25G001
NC25G002
NC25G003
NC25G004
These allow you to convert the IDs of diagnoses, morphology diagnoses, and procedures from the internal
format (SAP) to the external format (3M Codefinder) and vice versa. The exits do not affect any other attributes
or information transferred from or to the 3M Codefinder.

These exits were already used for data exchange with APR-DRG.
If you had already implemented one of the exits and are now running AR-DRG 6.0, you must adjust your
implementation accordingly.
The context is supplied by the new optional parameter SS_DRG_VERSION.
If you access it in APR-DRG, the parameter has the value APR-DRG, whereas in AR-DRG 6.0 it has the value
"AR-DRG6.0".
Notes on implementation with AR-DRG 6.0:
NC25G001
The exit is accessed with SS_DRG_VERSION = "AR-DRG6.0" and SS_NO_CLASSIFICATION = "X".
As before, parameter SS_DRG_PROCEDURE contains the details of the procedure and
SS_CONVERTED_VALUE_IN the SAP standard formatting, which takes the form ACHI.<external ID>.
If you want to determine this value yourself, you must also return it in the form ACHI.<external ID>.
The system adds the tag COD: later.
NC25G002
The exit is accessed with SS_DRG_VERSION = "AR-DRG6.0".
SS_EXTERNAL_VALUE contains the ID of the procedure in the form ACHI.<external ID>. This means the
system has already removed the tag COD:.
You must make an entry for SS_DRG_PROCEDURE-ICPML in an implementation of the exit.
NC25G003
As before, parameter SS_DRG_DIAGNOSIS contains the details of the diagnosis or morphology diagnosis
and SS_CONVERTED_VALUE_IN the SAP standard formatting, which takes the form T.<external ID> or
TM.<external ID>.
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If you want to determine this value yourself, you must also return it in this form.
Please note that a morphology diagnosis is characterized by its category: SS_DRG_DIAGNOSIS-DTYP1 = 'M'
(or SS_DRG_DIAGNOSIS-DTYP_REF = 'M').
NC25G004
SS_EXTERNAL_VALUE contains the ID of the diagnosis in the form T.<external ID> or the ID of the
morphology diagnosis in the form TM.<external ID>. This means the system has already removed the tag
COD:.
You must make an entry for SS_DRG_DIAGNOSIS_BAPI-DIA_KEY1 and enter DIA_TYP1 = "M" for
morphology diagnoses in an implementation of the exit.
Basic Medical / Nursing Documentation

The regulations relating to the outpatient coding guidelines (Ambulante Kodierrichtlinien, AKR) for the Federal
Association of Panel Physicians (KBV) in integrated PPA billing with the amasys system are supported with the
following Support Packages:
SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), business function
SAP Ambulatory Care Management (ISH_AMBULATORY)
If you choose the Check pushbutton during diagnosis maintenance, amasys checks the diagnoses. If there is an
outpatient coding guideline for a diagnosis, the system sends a message, for example ICD code A01.1 with AKR
note >B1101 Gastroenteritis and Colitis< (technical name: NAMASYS 200). If this message appears, the
program displays an additional <LS>Outpt Coding Guideline pushbutton in the message dialog box. To display
the corresponding coding guideline, select the message and choose this pushbutton. The system displays the
relevant outpatient coding guideline in the local browser.

The amasys system provides a URL that you can use to display the outpatient coding guidelines in the local
browser.
As of SAP ERP 6.0, the Customizing activity Outpatient Coding Guidelines has been added to the settings under
SAP Healthcare Industry-Specific Components for Hospitals SAP Ambulatory Care Management
Administration.
In the Customizing activity Outpatient Coding Guidelines, you can maintain the URL that is called by the local
browser at the SAP frontend for a specific institution. The amasys system provides this URL with the quarterly
update.
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The system can display the coding guidelines along with (error) messages during diagnosis maintenance,
depending on the context.
In the Customizing activity Display Outpatient Coding Guidelines, you can display them in the local browser
without reference to the context. This allows you to test that the URL is accessible locally. You can also access
this function outside of Customizing using the transaction code N_SHOW_AKR.
In SAP Patient Management 4.72, you can make the required settings in transaction SM30/table TNAKR. You
can display the coding guidelines independently of the context using program RNSHOWAKR.
See also
ISH_AMBULATORY DE: Report for Checking Outp. Coding Guidelines (New)

ISH_CV_FR: Clinical Work Station - Occupancy View Absences (New)

Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR), a new
occupancy view Absences is available in the Clinical Work Station.
You can use this view to display all absent patients and monitor the absence duration.
In particular, you can compare the actual duration of the patient's absence with a reference duration of your
choice, for example 30 days. To do this, enter the desired reference duration in the Compared Absence Duration
field on the absence selection screen. The system compares the value you enter here with the actual duration of
the patient's absence. If the actual absence duration for a case exceeds the specified reference duration, the
system displays a red traffic light in the Symbol for Absence Duration column in the absence view. If the actual
absence is shorter than the reference duration, the system displays a green traffic light in the absence view. If
the end of the absence has the status "Planned", the system uses the current date to determine the actual
duration.
ISH_MAIN IT, SG: Discharge Date as Reference for Catalog Determination (New)
function SAP Patient Management (ISH_MAIN), you can specify in Customizing for SAP Patient Management
(IS-H) that the system is to use the discharge date for catalog determination instead of the admission date.
If a discharge does not yet exist for a case, the system uses the current date as an approximated value. Catalog
determination using the discharge date is required, for example, in the DRG systems for the country versions
Singapore and Italy.
Caution: This function is only available for the country versions Italy and Singapore.
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SAP ERP 6.0, Industry Extension Healthcare (IS-H 600), Support Package 24 (for Singapore only), business
function SAP Patient Management (ISH_MAIN)
Hospitals Medical/Nursing Documentation DRG Documentation Specify Discharge Date as Reference
for Catalog Determination.
See also
SAP Note 1262252 (country version Italy) is rendered obsolete by this Customizing activity.

function SAP Patient Management (ISH_MAIN), the following new functions are available in medical
documentation for the country version Singapore. The enhancements support the legal changes accompanying
the introduction of AR-DRG 6.0 in Singapore with the coding and grouping tool 3M Codefinder.
The following new features are available in diagnosis entry:
The new attribute Diagnosis Qualifier (NDIA-QUALF), which can be displayed and maintained in transactions
NP61 and NPDRG2 (table and detail screen) and on all the diagnosis subscreens in NV2000.
You can specify which values and descriptive texts are allowed for the Diagnosis Qualifier attribute in
Customizing for SAP Patient Management (IS-H). The Diagnosis Qualifier attribute corresponds to the
parameter "PRFX" in communication with the 3M Codefinder.
The new attribute Impact of Diagnosis on DRG Determination (NDIA-DRG_IMPACT), which can be displayed
in transaction NPDRG2 and on the DRG Diagnoses subscreen in transaction NV2000.
The system automatically determines concrete values for the attribute Impact of Diagnosis on DRG
Determination during DRG grouping. This means the field is display only. The attribute Impact of Diagnosis on
DRG Determination corresponds to the parameter "ARE" in communication with the 3M Codefinder.
The attribute Complication Level of Diagnoses (for DRGs) (NDIA-CCL), which is now also available for the
country version Singapore. You can display it in transaction NPDRG2 and on the DRG Diagnoses subscreen
in transaction NV2000.
The system automatically determines concrete values for the attribute Complication Level of Diagnoses during
DRG grouping. This means the field is display only. The attribute Complication Level of Diagnoses
corresponds to the parameter "ARCL" in communication with the 3M Codefinder.
The addition of the two new attributes Diagnosis Qualifier (DIAG_QUALF) and Impact of Diagnosis on DRG
Determination (DRG_IMPACT) to the following BAPIs:
BAPI_CASEDIAGNOSIS_GETLIST
BAPI_CASEDIAGNOSIS_GETDETAIL
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BAPI_CASEDIAGNOSIS_CREATEMULT
BAPI_CASEDIAGNOSIS_CHANGEMULT
BAPI_CASEDIAGNOSIS_MODIFYMULT
The addition of the two new attributes Diagnosis Qualifier (QUALF) and Impact of Diagnosis on DRG
Determination (DRG_IMPACT) to the following structures for Business Intelligence (BI) extractors:
NBWD_0HC_DIAGNOSE
NBWD_0HC_DIAGNOSES_DELTA
The new connection type "M" for diagnoses (NDIA-DTYP1, NDIA-TYP2, NDIA-TYP_REF)
You can use connection type "M" to connect morphology diagnoses and ICD-10 diagnoses. To do this, the
morphology diagnoses and ICD-10 diagnoses must be created together in a technical diagnosis catalog.
Morphology diagnoses are marked with an "M" in the Type for ICD-10 Diagnoses field (NKDI-DTYP) in
diagnosis master data.
The procedure for creating and undoing a connection is the same as that for supplementary diagnosis
connections (connection type "!").
The following new features are available in procedure entry:
The new attribute Impact of Procedure on DRG Determination (NICP-DRG_IMPACT), which can be displayed
in transaction NPDRG2 and on the Procedures subscreen in transaction NV2000. The system automatically
determines concrete values for the attribute Impact of Procedure on DRG Determination during DRG grouping.
This means the field is display only. The attribute Impact of Procedure on DRG Determination corresponds to
the parameter "ARE" in communication with the 3M Codefinder.
The new attribute Complication Level of Procedure (for DRGs) (NICP-CCL)
You can display this in transaction NPDRG2 and on the Procedures subscreen in transaction NV2000.
The system automatically determines concrete values for the attribute Complication Level of Procedure during
DRG grouping. This means the field is display only. The attribute Complication Level of Procedure
corresponds to the parameter "ARCL" in communication with the 3M Codefinder.
The addition of the two new attributes Impact of Procedure on DRG Determination (DRG_IMPACT) and
Complication Level of Procedure (for DRGs) (DRG_CCL) to the following BAPIs:
o BAPI_CASEPROCEDURE_GETLIST
o BAPI_CASEPROCEDURE_GETDETAIL
o BAPI_CASEPROCEDURE_CREATEMULT
o BAPI_CASEPROCEDURE_CHANGEMULT
The addition of the two new attributes Impact of Procedure on DRG Determination (DRG_IMPACT) and
Complication Level of Procedure (for DRGs) (CCL) to the following structures for forms or BI extractors:
o RNF62
o RNF63
o RNF64
o NBWD_0HC_PROCEDURE
o NBWD_0HC_PROCEDURES_DELTA

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Hospitals Medical/Nursing Documentation SG: Maintain Diagnosis Qualifier .
See also
For more information, see the release note ISH_MAIN SG: Enhancements to Medical Documentation
(Changed).

ISH_MAIN DE: Check on Diagnostic Certainty (Enhanced)

According to the addendum to 301, which came into effect on July 1st, 2010, certain diagnoses must be
transmitted with a valid diagnostic certainty in AMBO messages. The following values are allowed (code 17):
A: Excluded diagnosis
V: Tentative diagnosis
Z: (Symptomless) condition after diagnosis in question
G: Confirmed diagnosis
During diagnosis maintenance, you can check whether a valid diagnostic certainty has been entered (in the
Diagnostic Certainty field) using the Business Add-In (BAdI) ISH_INTEND_BILLTYPE and a new check.
Since some of the required information is not yet available when diagnosis maintenance takes place, billing type
determination cannot take place at this point. You can use this BAdI to determine the billing type that is likely to
be used to bill the case from the information provided in the interface.
According to the expected billing type determined by the BAdI, the system checks for a valid diagnostic certainty
during diagnosis entry in transaction NP61 or in the Clinical Process Builder (transaction NV2000).
The following internal billing types are currently relevant:
15: Outpatient surgeries
16: Services acc. to P116b para. 2 SGB V (by AMBO)
17: University outpatient clinics as per P117 SGB V
18: Psychiatric outpatient clinics as per P118 SGB V
19: Social pediatric centers as per P119 SGB V
The check is run if the following prerequisites are met:
You have created an implementation for BAdI ISH_INTEND_BILLTYPE. The implementation returns one of
the above internal billing types for the case in question.
The diagnosis you are creating or editing has one of the following diagnosis categories:
Referral diagnosis, in which case the following additional conditions must be met:
A sickness fund-affiliated physician must be entered as the referring physician (the Place of Work Number
and/or Physician Number fields must contain entries for the referring physician).
You have specified the expected internal billing type 15 or 16 for this case using the BAdI.
Treatment diagnosis, in which case you should note the following:
If the treatment involves outpatient surgery (the Outpatient Surgery indicator is selected in Customizing for the
movement type), the Surgery Diagnosis indicator (NDIAOPDIA) must be selected.
If the treatment does not involve outpatient surgery (the Outpatient Surgery indicator is not selected in
Customizing for the movement type), the Discharge Diagnosis indicator (NDIA-ENDIA) must be selected.
You have specified the expected internal billing type 16, 17, 18, or 19 for this case using the BAdI.
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If the check determines that a valid diagnostic certainty has not been maintained but is required, the system
displays the warning message N6 476, Diagnosis &1 does not have valid diagnostic certainty. You can configure
this message in message control for function NDIA.
Please note that as of July 1st, 2010 (that is, as of version 0.9 of the DKG-301 communication standard), data
transfer in the AMBO message only takes place for diagnoses for which either the Surgery Diagnosis indicator is
selected (and the diagnoses were entered for a movement with the movement type Outpatient Surgery) or the
Discharge Diagnosis indicator is selected (if there is no surgery diagnosis or outpatient surgery).
If you have not selected these indicators for your diagnoses up to now, make sure one of these indicators
(Discharge Diagnosis or Surgery Diagnosis, see above) is selected for the treatment diagnoses that are relevant
for billing - those that are to be transferred in the AMBO message - by July 1st, 2010 at the latest.
When sending backdated AMBO messages in accordance with the 120 agreement for university outpatient
clinics using the alternative procedure (Ersatzverfahren), these diagnosis indicators must also be selected for
cases from the first and second quarters of 2010. If you transfer backdated AMBO messages for cases as part of
the transition solution, mark all the billing-relevant diagnoses as discharge or surgery diagnoses according to the
criteria relevant for you.
Since the criteria for selecting these indicators can be very different, it is not possible to provide a report for
automatic selection. Make sure the relevant diagnoses are marked accordingly before you execute report
RNC120AMBO to generate the events for the AMBO messages in the alternative procedure.
SAP Patient Management (IS-H) 4.63B, Add-On Support Package 52

The following enhancements now allow you to make a default entry for the estimated length of stay for an
inpatient case according to the admission diagnosis:
The new method SET_LOS Enter Default Length of Stay for the existing Business Add-In (BAdI)
ISH_DIAGNOSIS_NP61
Sample code for the new method SET_LOS Enter Default Length of Stay of the existing BAdI
ISH_DIAGNOSIS_NP61
Changed sample code for the existing method MODIFY_DATA of BAdI ISH_NV2000_PBO
If you implement method MODIFY_DATA of BAdI ISH_NV2000_PBO, you can make a default entry in the
Clinical Process Builder for the expected duration based on the admission diagnosis. You can base your
implementation on the sample code and modify it according to your requirements. The relevant sample code
refers to structure RNBADI_ADM.
If you implement method SET_LOS of BAdI ISH_DIAGNOSIS_NP61, you can make a default entry for the
expected duration based on the admission diagnosis in diagnosis processing (transaction NP61) and the DRG
Work Station (transaction NPDRG2). You can base your implementation on the sample code and modify it
according to your requirements.
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The sample code contains two different variants for determining the expected duration based on the admission
diagnosis.
If the different proposals for the expected duration are only based on a small number of diagnoses, we
recommend choosing option 1.
If your institution uses a wide range of different proposals, option 2 is preferable. To implement option 2, you
must create a customer-specific table containing the desired content, which the BAdI then reads to determine
the expected duration.
For an example of how this table can be structured and read, as well as an example of how option 1 can be
implemented, see the sample code for the two methods.
ISH_MAIN DE: Preassgmt of Discharge Diag., Diag. Certainty (Changed)

ISH_MAIN: Enhancement to Interface for Diagnosis BAdIs (Changed)

The methods listed now include the additional import parameter I_DOCVIEW:
BAdI ISH_DIAGNOSIS_NP61
o Method RNDIA_CREATE
o Method RNDIA_BLANK
BAdI ISH_DIAGNOSIS_CVERS
o Method CREATE
o Method CHANGE
o Method CHECK
BAdI ISH_DIAGNOSIS_CUST
o Method CREATE
o Method CHANGE
o Method CHECK
This parameter allows you to determine the department stay, as well as the movement to which the diagnosis is
assigned. This is the leading movement for the department stay or the visit. Please note that this depends on the
form of documentation specified for the diagnoses in the Implementation Guide.
This movement also provides you with the case number and institution. You can use this information to read
additional case data, for example to set up an implementation that is dependent on the case type.
Sample code is available for the methods.
Please note that you cannot use parameter I_DOCVIEW in transaction NPDRG2, since the user only specifies
the department to which the diagnosis belongs when they create the diagnosis in this transaction.
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ISH_MISC1 DE: Marking Procedures Relevant for Additional Charges (New)

PATIENT ACCOUNTING
General
ISH_CV_CN: Patient Accounting (New)
To enable the automatic generation of insurance provider relationship, you assign an insurance provider to the
corresponding card type in Customizing for SAP Healthcare Industry-Specific Components for Hospitals under
Patient Accounting Business Partners / Insurance Relationships Define Card Category for Smart Cards.
You enter the admission fee in Customizing for SAP Healthcare Industry-Specific Components for Hospitals
under Patient Accounting Service Rules Define Outpatient Admission Fee.
You define the allowed discounts in Customizing for SAP Healthcare Industry-Specific Components for
Hospitals under Patient Accounting Billing Pricing (Using Conditions) Define Discount for Admission
Day/Discharge Day.

function SAP Patient Management: Country Version France (ISH_CV_FR) contains the following new billing
options for drugs and medical products in addition to flat rate services. These billing options are currently
relevant for private hospitals in France that follow the rules for service-based billing (T2A billing) when handling
acute treatment (MCO).
These changes are available as of: SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
Healthcare (IS-H 605), Support Package 02, business function SAP Patient Management Country Version
France (ISH_CV_FR).
Introduction and Legal Background

Private hospitals in France are subject to the regulations for service-based billing (T2A) and bill the social
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insurance fund directly for their services. The hospitals can bill for certain drugs (UCD services) and medical
products (LPP services) in addition to the GHS, GHT, SE, and dialysis flat rates. The list of drugs and medical
products for which billing is possible is specified by law.
For more information about the billing rules, see the guide to billing for drugs and medical products at private
hospitals (in French): "Guide Pratique pour la Facturation des Mdicaments Produits et Prestations Facturables
en sus de Prestations dHospitalisation par les Etablissements de Sant Privs", which is available at
http://www.ameli.fr/professionnels-de-sante/directeurs-d-etablissements-de-sante/vous-informer/guide-defacturation-du-codage-en-sus.php.
Explanation of Terms Used:

GHS services (GHS: groupe homogne de sjour) are billable DRG services used to bill inpatient acute
treatment cases (MCO). They are recorded in the SAP system as services with charge type F5.
GHT services are flat rates for billing for home treatment (HAD). Please note that the specific billing rules for
home treatment are not supported in the IS-H country version France.
SE services are flat rates for outpatient cases that are billed in connection with certain medical services
(CCAM services). They are recorded in the SAP system as services with the new charge type FE.
Dialysis flat rates can be billed in inpatient or day patient cases involving dialysis. They are recorded in the
SAP system as services with the new charge type FD.
Billing for Drugs and Medical Products with a Reduced Purchase Price
If the hospital negotiates a price lower than the reference price for drugs and medical products, the hospital can
bill part of the difference between the reference price and purchase price using the margin share rate.
The margin share rate is a percentage value used to map the difference between the reference price of a service
and its purchase price. The statutory margin share rate in France is currently set at 50%.
Example: A drug has a reference price of 100 and the hospital buys it at a purchase price of 90. The hospital
can bill 90 plus a margin share rate of 5 for this drug. The margin share rate is calculated as follows:
(reference price - purchase price) * 50%
You can define margin share rates and bill them in the SAP system.
The prerequisites for performing billing for drugs and medical products according to the above conditions are
described below:
Creation of Drugs and Medical Products as Billable Services
Drugs (UCD services) and medical products (LPP services) that you want to bill are created as services in
SAP Patient Management.
Drugs, which are identified by a UCD code, are services with charge type F8 (UCD).
Medical products, which are identified by an LPP code, are services with charge type F4 (LPP).
You create these services in your institution's service catalog or import the UCD and LPP catalogs using the
import programs provided for this purpose.
You enter the reference price of the services in a price column in the catalog or the import programs copy the
gross prices of the services to the service master automatically as reference prices.
Costs for drugs and medical products are already included in the price of the flat rate to be billed (GHS, SE
service, or dialysis flat rate) in T2A billing for acute treatment, so that these costs cannot be billed with the
addition of the flat rate. This applies with the exception of an official list of UCD and LPP services for which
billing with the addition of a flat rate is explicitly allowed. This list is published by the French state health
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insurance fund.
You must select the T2A indicator on the France tab page in the service master for UCD and LPP services that
are included in this list. The T2A indicator in the SAP system controls the billability of the service according to a
billable flat rate entered for the case.
We recommend that you mark UCD and LPP services as non-billable inpatient and outpatient services in the
service master. This means the system initially creates these services as non-billable in case-related service
entry. You can then have the system mark them as billable using service rules F12 UCD - Billability with Flat
Rate and F13 LPP - Billability with Flat Rate if the case meets the conditions for billing the service.
Please note that the T2A indicator is selected automatically in the service master when you import the UCD
services using the import program IS-H FR: Import UCD Service Master Data. However, the catalog for
importing LPP services does not contain the information as to whether an LPP service is billable with the
addition of a flat rate service. You must therefore select the T2A indicator manually for LPP services.
It is also important for the billability of the services that their grouping codes are maintained on the Gen. France
tab page in the service master. The import programs enter the grouping codes in the service master
automatically when importing the catalogs.
Some UCD services can be billed with the addition of flat rate services both in pharmacy sales and in patient
treatment. In this case, the system uses the grouping code specified in the Outp. Grouping Code field in the
service master when billing UCD services in pharmacy sales. The system uses the grouping code specified in
the Grouping Code field in the service master when billing UCD services with the addition of flat rate services.
Entry of Drugs and Medical Products with Reference to a Case

Before you can bill UCD and LPP services for a case involving acute treatment, the following prerequisites must
be fulfilled:
The case has a billable flat rate service that allows billing for drugs and medical products.
The case has a UCD or LPP service for which the T2A indicator is selected in the service master.
When entering UCD and LPP services for a case, the following fields are particularly important for billing:
Service
You enter the UCD or LPP service in this field. These are services with charge type F8 (UCD) and F4 (LPP).
Quantity
In this field, you enter the quantity administered.
Purchase Price
If you are able to obtain a purchase price that is below the reference price of the service, enter the purchase
price for a quantity of 1 of the service entered. The system calculates the margin share rate automatically and
creates a corresponding margin service with the price calculated. For more information, see Effects on
Customizing.
Multiplication Factor
If you have administered a portion of the service, can enter it in the Multiplication Factor field. Please note that
in this case, the service quantity has a value of 1.
Physicians in the role of Prescriber and Performer
You must specify the physician who prescribed the service and the physician who performed it when
processing controlled services, since this data is required for the electronic invoice B2. You can activate a
check to determine whether the prescriber and performer of the services have been entered for billable UCD
and LPP services in a case. For more information, see Effects on Customizing.

If you bill UCD and LPP services with a purchase price that is below the reference price of the service, the
system creates a margin service using service rules F14 and F15. You must create these margin services in the
in-house catalog with the following attributes beforehand:
Service ID: EMI
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Short text: Ecart mdicament indemnisable

Grouping code: EMI
Extended Service indicator not selected
No charge type
Service ID: ETI
Short text: Ecart tarif indemnisable
Grouping code: ETI
Extended Service indicator not selected
No charge type
You create the master records of these services without a price, since the services and their prices are entered
automatically by service rules according to the services performed for a case.
The following new charge types have been introduced for flat rate services and the system uses them for internal
service checks:
Flat rate for emergency treatment, ATU: charge type FB
Technical flat rates FTN, FTR: charge type FC
Dialysis flat rates: charge type FD
SE services: charge type FE
Material flat rate, FFM: charge type FF
Create these services with the corresponding charge types or add the charge type to existing service master
records.

Please note that service rule F04, LPP Price Calculation, which was used until now to calculate the price of an
LPP service according to the specified purchase price, is no longer relevant and is no longer supported. It has
been replaced by the new service rule F15, LPP Service: Margin Service. If necessary, adjust the check
procedure for service rules.
Billing for Drugs and Medical Products with a Financing Rate
If the hospital concludes a best practices contract (Contrat de Bon Usage) with the regional hospital agency
(Agence Rgionale de l'Hospitalisation ARH) and adheres to the terms, the French social insurance fund fully
reimburses the costs for billable drugs and medical products in accordance with regulations. If the hospital does
not adhere to the terms of the contract, the percentage refund for drugs and medical products is reduced, either
globally for the entire institution or with regard to individual drugs and medical products, by assigning the hospital
a financing rate of between 100% and 70%.
For example, a financing rate of 70% reduces the statutory reimbursement of costs for drugs and medical
products by 30%. The hospital is charged the amount not reimbursed. The hospital must not bill the patient or
other insurers for this amount.
You can now perform billing for drugs and medical products using a global, institution-wide financing rate, or an
alternative service-related financing rate, and generate corresponding electronic B2 messages.
If your institution has a global financing rate of 100%, you do not need to make any new system settings.
However, if you have a global, institution-wide financing rate that is below 100%, as well as additional special
financing rates for individual UCD or LPP services, you must configure pricing in such a way that the amount for
which the social insurance fund is billed for drugs and medical products is reduced in accordance with the
financing rate. However, the hospital must not bill other insurers or self-payers for the amount not covered by the
social insurance fund, so that this leads to a genuine loss of revenue for the hospital.
You define the financing rate in your institutions pricing procedure using a separate condition type. For more
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information, see Effects on Customizing.

service checks:
ATU (flat rate for emergency treatment): charge type FB
Material flat rate (FFM): charge type FF
records.
New Service Rules F12 - F18 for Service Entry
New service rules can be used to define the billability of the UCD and LPP services and to create the EMI or ETI
margin service:
UCD Service: Billability with Flat Rate (service rule F12)
If you enter a UCD service for which the T2A indicator is selected in the service master, this service rule
selects the billing indicator in the UCD service if a billable flat rate has also been entered for the same case. If
you cancel the flat rate or set it to non-billable, this service rule removes the billing indicator from the UCD
service. Please note that UCD services for which the T2A indicator is not selected are not processed by the
service rule.
LPP Service: Billability with Flat Rate (service rule F13)
If you enter an LPP service for which the T2A indicator is selected in the service master, this service rule
selects the billing indicator in the LPP service if a billable flat rate has also been entered for the same case. If
you cancel the flat rate or set it to non-billable, this service rule removes the billing indicator from the LPP
service.
Please note that LPP services for which the T2A indicator is not selected are not processed by the service
rule.
UCD Service: Margin Service (service rule F14)
If the purchase price of a billable UCD service is lower than its reference price, this service rule generates a
margin service whose price is calculated as follows:
price = (reference price - purchase price) * margin share rate
The service rule assigns the UCD service to the margin service and ensures that relevant changes to the UCD
service are also copied to the margin service. If you cancel the UCD service or delete the purchase price, this
service rule cancels the margin service.
LPP Service: Margin Service (service rule F15)
If the purchase price of a billable LPP service is lower than its reference price, this service rule generates a
margin service whose price is calculated as follows:
price = (reference price - purchase price) * margin share rate
The service rule assigns the LPP service to the margin service and ensures that relevant changes to the LPP
service are also copied to the margin service. If you cancel the LPP service or delete the purchase price, this
service rule cancels the margin service.
Check for Prescribing and Performing Physicians for UCD Services
The new service rule F17 checks the billable UCD services in a case (services with charge type F8) to
determine whether they are assigned a performing physician (business partner with the role Specialist
(Performing)) and a prescribing physician (business partner with the role Requester). Please note that when
processing outpatient cases, the system checks whether both the performing and prescribing physician have
been entered with the service, whereas it only checks for the prescribing physician for the UCD service when
processing inpatient cases.
If a UCD service is not assigned a prescribing physician, the system displays the warning message Service &
has no prescribing physician (message /ISHFR/NFR263).
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If the UCD service is not assigned a performing physician, the system displays the warning message Service
& has no performing physician (message /ISHFR/NFR264).
Check for Prescribing and Performing Physicians for LPP Services
The new service rule F18 checks whether a prescribing and performing physician is entered for material
services from the LPP catalog. Material services in the LPP catalog are assigned charge type F4 in the service
master.
If an LPP service is not assigned a prescribing physician, the system displays the warning message Service &
has no prescribing physician (message /ISHFR/NFR263).
If the LPP service is not assigned a performing physician, the system displays the warning message Service
& has no performing physician (message /ISHFR/NFR264).
You can specify the message type for these messages or suppress them altogether. You can do this in
Customizing for SAP Healthcare under Basic Settings System Parameters Message Control Maintain
Messages. Create the following entry in the Customizing table for this activity:
o Function: N017
o Application area: /ISHFR/NFR
o Message number: 263 or 264
o Default type: W
o Message type: Message type of your choice
o Suppress: If you do not want the system to display the message, select this indicator.
To use the new service rules, you must carry out the following Customizing activities:
Define an assignment type for the assignment of the UCD or LPP services to the margin service under SAP
Healthcare Industry-Specific Components for Hospitals Hospital Basic Data Service Master Data
Define Assignment Types. Create the assignment type with the maintenance indicator S (Assignment of
Performed Services).
Define the margin services to be created, the assignment type to be used, and the catalog column for
determining the reference price of the service and the margin share rate in Customizing under SAP Healthcare
Industry-Specific Components for Hospitals Patient Accounting Service Rules Country-Specific
Service Rules EMI/ETI Margin Service. The statutory margin share rate is currently set at 50% for UCD and
LPP services.
Activate service rules F12, F13, F14, F15, F17, and F18 at the desired callup points. You do this in
Customizing under SAP Healthcare Industry-Specific Components for Hospitals Patient Accounting
Service Rules Define Rule Types and Maintain Check Procedure. Define the sequence of the service rules
so that the system first checks whether the UCD and LPP services are billable. The system can then check
whether a prescriber and performer have been entered, and finally, whether a margin service is to be billed.
Customizing for Billing for Drugs and Medical Products with a Financing Rate
To process financing rates below 100% when billing drugs and medical products, you must make the following
additional Customizing settings for pricing in SAP Patient Management:
1. Create two condition tables for defining your global institution-wide financing rate and service-dependent
financing rates.
For example, you could use the Institution, Charge Type, T2A Indicator, and Insurance Provider Type fields
for the condition table for determining your institution-wide financing rate.
You could use the Institution, Insurance Provider Type, T2A Indicator, Service Catalog, and Service fields for
the condition table for determining the service-dependent financing rates.
To do this, choose SAP Healthcare Industry-Specific Components for Hospitals Patient Accounting
Billing Pricing (Using Conditions) Conditions Create Condition Tables in Customizing.
2. Define an access sequence containing the two new condition tables. The condition table for servicedependent financing rates should be first in the access sequence. You should also select the Exclusive
indicator for this first access.
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Billing Pricing (Using Conditions) Conditions Define Access Sequences in Customizing.

3. Create a condition type with the following attributes:
o Condition category: Value L (condition category L ensures that the condition is processed correctly)
o Condition class: Value A (discount or surcharge)
o Calculation type: Value A (percentage)
Billing Pricing (Using Conditions) Conditions Define Condition Types in Customizing.
4. Define the financing rates that apply in your institution as condition records for the condition tables you
created in step 1.
Billing Pricing (Using Conditions) Conditions Maintain Condition Records in Customizing. To define
a financing rate of 70%, you must specify an amount of -30 in the condition record.
5. Define the internal usage 78 for the condition type you created in step 3. This usage enables the system to
identify the condition type that is used for the financing rate, for example so as to display the financing rate
used in the B2 message.
Billing Pricing (Using Conditions) Define Usage of Condition Types in Customizing.
6. Maintain the pricing procedure for your institution and insert the condition type you created in step 3 in the
pricing procedure with requirement 537. Please note that this condition type must come last in the pricing
procedure. It can only be followed by tax conditions (category D conditions).
Billing Pricing (Using Conditions) Pricing Procedures Maintain Pricing Procedure in Customizing.
See also
For more information about billing SE services, creating the electronic B2 message, and the RSF invoice
overview in billing for drugs and medical products with additional flat rates, see the following release notes:
For more information about configuring special forms of billing, see SAP Healthcare Industry-Specific
Components for Hospitals Patient Accounting Billing Configure Special Forms of Billing Notes on
Configuring Forms of Billing in Customizing.

function SAP Patient Management Country Version France (ISH_CV_FR), you can perform billing for SE
services in connection with CCAM services. SE services are flat rates that cover the cost of outpatient treatment
requiring the use of inpatient equipment, such as the operating room or recovery room. You can only bill SE flat
rates if legally defined CCAM services are performed and billed. CCAM is the abbreviation for the French catalog
of medical services and procedures (Classification commune des actes mdicaux).
These changes are available as of SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
France (ISH_CV_FR).
According to French law, there are four different SE services:
SE1: Endoscopy services without anesthesia
SE2: General services without anesthesia
SE3: Outpatient treatment involving short-term inpatient observation, included in list 3
SE4: Outpatient treatment involving short-term inpatient observation, included in list 4
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A separate list of CCAM services that allows billing is defined by law (applies as of February 19, 2009) for each
SE service. For more information, see http://www.legifrance.gouv.fr Accueil Les autres textes lgislatif et
rglementaires NOR: SASH0904095A.
Rules for Billing SE Services
You can only bill for a maximum of two SE services per treatment. You can bill the more expensive of the two
in full. You must bill the second SE service with a discount of 50%.
You cannot bill SE services together with other flat rates, such as GHS.
If you bill a CCAM service whose price exceeds EUR 91 in addition to the SE service, the patient contribution
is reduced to EUR 18. The patient contribution of EUR 18 must be deducted from the most expensive SE
service during billing.
If UCD and LPP services are billed with the addition of flat rates, they can also be billed with the addition of SE
services.
For more information (in French) about the statutory billing rules for SE services, see the homepage of the
French social insurance fund at http://www.sante-sports.gouv.fr sant Les dossiers de la sant de A Z
F Facturation (rgles) Forfait scurit environnement.
The following functional enhancements support billing of SE services in accordance with the above rules:
Automatic generation of the SE service according to the CCAM services performed and those that are billable,
using service rule F16
The new service rule Inclusion for Service Pair CCAM SE Flat Rate (F16) generates and cancels billable SE
services according to CCAM services entered for specific cases. The SE services are generated on the basis
of the included service pairs (table NLPA) defined in Customizing for service rule F16.
The service rule also checks that there are no more than two SE services (services with the new charge type
FE) per case.
Please note that you must create inclusions with rule type R4 for pair inclusions relating to services other than
CCAM and SE services.
Calculation of a discount of 50 % for the second SE service
You must mark the service for which a discount is to be calculated manually during service entry. You can do
this using the Billing Category field or another customer-specific field of your choice. You can only do this if
you have defined billing categories for different discounts. For example, you can define a billing category for a
discount of 50 % on an SE service and a second billing category for a discount of 10 % on a technical flat rate
(FTN, FTR). You enter the discount to be calculated for a service in case-related service entry by assigning the
desired billing category to the service.
The discount is then calculated during pricing. To do this, you must insert a corresponding condition in the
pricing procedure.

service checks:
ATU (flat rate for emergency treatment): charge type FB
Material flat rate (FFM): charge type FF
records.
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The service rule Inclusion for Service Pair CCAM SE Flat Rate (F16) uses the service inclusions you define to
generate or cancel SE flat rates based on the case-related billable CCAM services. Create the inclusions for
service pairs in Customizing with the following attributes:
Rule type: F16
Service 1: CCAM service
Service 2: SE service
Service Inclusions indicator: Active
Unilateral indicator: Active
Indicator Check Quantity for Service Rule Pairs: Not active
Date indicator: This indicator has no effect on service rule F16, since it creates a maximum of 2 billable SE
services per case or visit.
Type of message: Enter the message type the service rule is to use to display messages.
Note: If the table of inclusions for service pairs (table NLPA) contains a large number of entries, system
performance in manual maintenance can be poor. If this is the case, you can maintain the table for a restricted
data area. To do this, call up the table maintenance function, SM30, enter the table name NLPA, and choose
Enter Conditions. Choose Execute and select the conditions Institution and Rule Type. In this way, you can
maintain the data area for your institution and rule type F16.
If you want to calculate a discount on a service, add a corresponding condition to the pricing procedure. The
system settings for implementing discount calculation using a condition depending on the Billing Category field
are described below.
1. Create a billing category for calculating discounts for SE services. To do this, choose SAP Healthcare
Industry-Specific Components for Hospitals Patient Accounting Billing Maintain Billing Categories in
Customizing.
Please note that you can also maintain a billing category here for other services that require a different
discount (for example, a discount of 10% when billing two FTN or FTR services).
2. Create a condition table for use in defining the discount rates. For example, you can use the Institution,
Charge Type, and Billing Category fields for the condition table.
Billing Pricing (Using Conditions) Conditions Create Condition Tables in Customizing.
3. Define an access sequence containing the new condition table.
Billing Pricing (Using Conditions) Conditions Define Access Sequences in Customizing.
4. Create a condition type with the following attributes:
o Condition class: Value A (discount or surcharge)
o Calculation type: Value A (percentage)
Billing Pricing (Using Conditions) Conditions Define Condition Types in Customizing.
5. Define the valid discount rates for each billing category as condition records for the condition tables you
created in step 2.
Billing Pricing (Using Conditions) Conditions Maintain Condition Records in Customizing.
6. Maintain the pricing procedure for your institution and insert the condition type you created in step 4 in the
pricing procedure.
Billing Pricing (Using Conditions) Pricing Procedures Maintain Pricing Procedure in Customizing.
See also
For more information about billing for SE services with the addition of UCD and LPP services, see the release
note ISH_CV_FR: Billing for Drugs and Medical Products (New).
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ISH_CV_FR: Billing for Daily Hospital Rates in State Hospitals (Changed)

function SAP Patient Management Country Version France (ISH_CV_FR), the following change is available:
State hospitals bill for nursing charges (PJ) and daily hospital rates (FJ). The patient pays a contribution relative
to the nursing charge (PJ).
No exemption from patient contribution
Patients who are not exempt from the patient contribution pay 20% of the nursing charge (PJ). This amount
includes the daily hospital rate (FJ), which currently amounts to EUR 18 per day.
Exemption from patient contribution
Patients who are exempt from the patient contribution only pay the daily hospital rate (FJ) of EUR 18 per day.
The social insurance fund receives 100% of the nursing charge.
In both cases, the daily hospital rate (FJ) and nursing charge (PJ) for which the patient is billed must be posted
to separate FI revenue accounts. This was previously not possible for cases where the patient was not exempt
from the patient contribution.
Previously, the patient contribution of 20% of the nursing charge (PJ) was posted to the self-payers invoice as a
single item. This meant it was not possible to post the price components separately in FI.
This new function allows you to split the patient contribution into two items on the invoice: one for the daily
hospital rate (FJ) and a second for the remaining amount. The system behavior has been adjusted so that the
amount corresponding to the daily hospital rate, which is included in the patient contribution of 20% of the
nursing charge, is deducted from this amount and indicated as a separate item on the invoice.
The remaining amount is posted to the self-payers invoice as the patient contribution along with the daily
hospital rate (FJ).
At the same time, the amount for the PJ service is increased by the amount for the daily hospital rate (FJ) on the
invoice for the social insurance fund.
For an example of how an inpatient case is billed for a patient who is not exempt from the patient contribution,
see the Support Package release notes listed below.
A number of changes have been made to the code so that the services are split correctly. For example, the
internal service-related exemption reason N (included in patient contribution) is now no longer used. Exemption
reason N has been removed from the list of allowed values and is no longer set by service rule F05.
You do not need to change the Customizing settings.
Due to these code changes, the system automatically splits the services according to the new procedure. The
procedure for filling the messages in the FRB2 (invoice transfer according to B2 norm CP) and FRVID
(VIDHOSP file for inpatient and home treatment) communication procedures has been adjusted in accordance
with the changes.
These changes are available as of:
14, business function SAP Patient Management Country Version France (ISH_CV_FR)
04, business function SAP Patient Management Country Version France (ISH_CV_FR)
ISH_CV_FR: Per Diem Fee (PJ Services), New Valuation Formula (New)
Package 02, business function SAP Patient Management Country Version France (ISH_CV_FR), a new
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valuation formula 40 is available for calculating the per diem fee.

This formula calculates the number of patients in hospital at midnight, including one day if the discharge type is
"Deceased" or the patient was discharged on the admission day.
This new feature is also available with the following Support Packages:
ISH_CV_FR: Care Path, Revenue Account Assignment (New)

function SAP Patient Management Country Version France (ISH_CV_FR), you can post the statutory patient
contribution and the additional PSC patient contribution for deviations from the coordinated care path in two
separate processes. For example, this means you can split these two components of the patient contribution
between different insurance relationships and post them to separate revenue accounts (according to countryspecific legal requirements).
Before you can process the price components of a service separately, you must generate an additional service
that represents the PSC patient contribution. You can do this using the new service rule F20, which generates a
service for the PSC patient contribution if the outpatient visit is outside the care path and the billable service
performed is relevant to the PSC. The two services are assigned to each other using a separate assignment
type (service-service assignment). During billing, the system reduces the amount covered by the social
insurance fund for the original service by the PSC patient contribution amount and bills the self-payer for this
amount using the service for the PSC patient contribution.
Prerequisites:
Create a service for the PSC patient contribution in service master data. This service should not be assigned a
charge type or price and should allow an alternative service text.
Create a new assignment type (for example, PSC) with maintenance indicator "S". For more information, see
Customizing for SAP Healthcare Industry-Specific Components for Hospitals under Hospital Basic Data
Service Master Data Define Assignment Types.
Activate the new service rule F20 - Generate PSC Patient Contribution for Care Path (PSC) in the check
procedure.
Create a new condition type (for example, ZPSC) with the following attributes: Condition class: A (discount or
surcharge) Calculation type: B (fixed amount) Manual entries: D (not possible to process manually) Item
condition: selected.
For more information, see Customizing for SAP Healthcare Industry-Specific Components for Hospitals
under Patient Accounting Billing Pricing (Using Conditions) Conditions Define Condition Types.
Assign the usage FR: Price Adjustment for Coord. Care Path (internal value 74) to the condition type for the
price adjustment (for example, ZPSC).
For more information, see Customizing for SAP Healthcare Industry-Specific Components for Hospitals
under Patient Accounting Billing Pricing (Using Conditions) Conditions Define Usage of Condition
Types (Direct Pat. Billing, etc.).
Enter the condition type in the pricing procedure with the requirement 118. For an example of how to define the
pricing procedure, see Customizing for SAP Healthcare Industry-Specific Components under Patient
Accounting Billing Configure Special Forms of Billing Notes on Configuring Forms of Billing.
Functions:
Service Rule F20 - Generate PSC Patient Contribution for Care Path (PSC)
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If the service rule is to generate a service for the PSC patient contribution, the following conditions must be
satisfied:
The case type must be outpatient.
The case must include a service that has been entered in the Customizing table for the coordinated care path
and is covered by the social insurance fund.
For more information, see Customizing for SAP Healthcare Industry-Specific Components for Hospitals under
Patient Accounting Business Partners/Insurance Relationships Payment Distribution Adjust Coverage
According to Care Path.
If the case has an insurance relationship with a social insurance fund and the Copayt Waiver field contains the
value C (birth) or D (accident at work), the system does not generate a PSC patient contribution, even if there
has been a deviation from the coordinated care path.
You specify which service is to be generated with which assignment type in Customizing for SAP Healthcare
Industry-Specific Components for Hospitals under Patient Accounting Service Rules Country-Specific
Service Rules Generate PSC Patient Contribution for Care Path (F20).
The system enters the following text in the Alternative Text field for the generated service: "PSC patient
contribution for & from &". This means it is possible to identify the service to which the PSC patient contribution
service relates in service entry. To be able to change the service text, the service must allow the entry of an
alternative text in the master data. You should not specify a price in the master data for the service to be
generated; the system calculates this automatically during payment distribution.
If the PSC patient contribution already exists, the system updates it when changes are made to the original
service (this applies to organizational units, the billing indicator, and the service date). If the original service is
canceled, the system also cancels the assigned PSC patient contribution service.
Payment Distribution and Pricing

If the coordinated care path is not adhered to for a service, the system calculates the PSC patient contribution
and deducts this amount from the coverage amount for the highest ranking social insurance fund.
The deduction is documented as a price reduction (condition with usage FR: Price Adjustment for Coord. Care
Path (for example, ZPSC)); this means the results are stored in the condition tables so that it is possible to trace
why a price adjustment was made and to what amount. The system performs calculation using gross amounts.
You can also determine why a discount/surcharge was made from the detailed log of payment distribution.
Since the PSC patient contribution is not usually covered by complementary insurance, make sure it is only
covered by the self-payer when defining the contract schemes.You can display PSC patient contribution services
in individual payment distribution but you cannot change them here. PSC patient contribution services are
defined in Customizing for SAP Healthcare Industry-Specific Components for Hospitals under Patient
Accounting Service Rules Country-Specific Service Rules Generate PSC Patient Contribution for Care
Path (F20).
Revenue Account Assignment

You can use the standard revenue account assignment function to post the PSC patient contribution to a
separate account, since this portion is mapped by a separate service.
Invoice Printing
Once an assignment has been created between the original service and the PSC patient contribution, you can
print the results on the invoice form as desired.
The invoice form /ISHFR/BILL uses function module /ISHFR/INVOICE_DATA_GET to obtain all the data for
printing.
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The function module calls the BAdI /ISHFR/ISH_FR_B2.

If you need to merge services, you can do this using BAdI method CHANGE_B2_DATA.
The services are passed on to the BAdI in table CS_INV_DATA-T_POS and you can change them.
For information about the service assignments, see table IS_DATA-T_NLLZ.
These new features are also available with the following Support Packages:
ISH_CV_FR: Billing for Private Rehabilitation Clinics (Changed)

function SAP Patient Management Country Version France (ISH_CV_FR), you can perform billing for per diem
fees (PJ) at private rehabilitation clinics.
In billing for private clinics, by contrast to state hospitals, the daily hospital rate (Forfait Journalier) is included in
the price of the per diem fee and does not have to be added to it.
This change affects the following functions:
Service rule F07 for generating the daily hospital rate (Forfait Journalier) for private clinics
When performing billing using per diem fees, the daily hospital rate (Forfait Journalier) is now generated in the
same way as in billing with GHS services.
The following rule applies to cases with per diem fees:
o If the hospital stay lasts longer than 30 days, the daily hospital rate must always be generated as of
day 31 (irrespective of the price of the two services).
o If the current case is a "medical subsequent case" and the total length of stay exceeds 30 days, the
daily hospital rate must be generated for the entire case.
Patient Accounting Service Rules Country-Specific Service Rules Service Rules Overview.
Condition for deducting daily hospital rates (FJ)
In certain circumstances, the system generates a daily hospital rate (FJ) for the patient's stay. In this case, the
system deducts the price of the daily hospital rate from the corresponding per diem fee (PJ) for the day.
Define a condition type (for example, ZRHA) with the following data:
o Condition class A (surcharges or discounts)
o Calculation rule G (formula)
o Structure condition B (cumulated condition)
o Group condition X
o Item condition X
Then define this condition type in Customizing for SAP Healthcare - Industry-Specific Components for Hospitals
under Patient Accounting Billing Pricing (Using Conditions) Define Usage of Condition Types (Direct
Pat. Billing, etc.), specifying the usage type 79 FR: Rehabilitation - FJ Reduction.
Then create a new customer-specific calculation formula and specify it in the pricing procedure for the condition
type.
To create the calculation formula, call up transaction VOFM. Then proceed as follows:
1. Choose Formulas Condition Value.
2. Now enter a new customer-specific formula (in the customer name range) in a blank line and choose F5
to access the source text.
3. Enter the code for accessing function module /ISHFR/COND_REHAB_REDU here.
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call function '/ISHFR/COND_REHAB_REDU'

exporting
i_komk = komk
i_komp = komp
tables
t_xkomv = xkomv
changing
c_xkomv = xkomv
c_xkwert = xkwert
exceptions
others = 1.
4. Save and activate the changes and choose F3 to return to the condition value overview screen,
Maintain: Formulas Condition Value.
5. Now select the new calculation formula and choose Edit Activate.
6. Then save the changes again.
For an example of how to define the pricing procedure, see Customizing for SAP Healthcare - Industry-Specific
Components under Patient Accounting Billing Configure Special Forms of Billing Notes on Configuring
Forms of Billing.
ISH_CV_FR: Billing for Retransfers at Private Institutions (Changed)

function SAP Patient Management Country Version France (ISH_CV_FR), the following changes are available:
Admission
When creating a retransfer, the system searches for suitable previous cases (cases with discharge to an
external hospital with an existing GHS service) and creates an assignment between the cases.
To use this function, you must first create the relevant assignment types in Customizing. When doing this, use
the internal functions 7 (Readmission Weekend) and 8 (Previous Case Readmission Weekend).
When changes are made to the case, the system checks whether the assignment is still required and deletes it if
necessary.
You can override assignments that were created manually by making an assignment to a different case. Once
an assignment has been made, the system does not change it (but may delete it if necessary).
Billing
During billing, the system runs a number of consistency checks. For example, cases that involve a retransfer
must have an assignment to the previous case, the previous case must already be billed, and so on.
Service Rules
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The system does not calculate an EXH surcharge (service rule F09) for retransfers (with the same GHS).
Pricing
The system calculates a reduction for the GHS service according to the GHS coefficient in the following
circumstances:
If the case involves a retransfer after 48 hours (the Retransfer and Admission from External Hospital indicators
are selected in the admission type)
If the length of stay is between 2 and 10 days
If the GHS to be billed is also specified in the assigned case (assignment type Readmission)
You can find this in the master data of the GHS service on the France-Specific Data tab page. If the field does
not contain an entry after your system upgrade, you must import the GHS service catalog again using the Import
GHS Service Master Data report (/ISHFR/RNWFRGHS_LOAD).
The system does not calculate a reduction outside of this length of stay.
The reduction also applies when the patient is deceased.
If an EXB reduction applies to the GHS, the system calculates the GHS price according to the following
formula:
GHS price = ("GHS price" - "EXB reduction") * GHS reduction factor
If there is no "EXB reduction", the following formula is used:
GHS price = "GHS price" * GHS reduction factor
Price calculation takes place in the existing condition formula 116. This means you do not need to make
changes to the pricing procedure.
You can determine whether or not the system has applied a GHS reduction and if so, the reduction amount, in
the DRG Work Station. New fields containing this information have been added here.
Caution: The Total Reductions field contains the total of all reductions, both EXB and GHS. The entry in the
Total Price field is the price including all surcharges and reductions.
B2
The procedure for filling the messages in the communication procedure FRB2 (invoice transfer according to B2
norm CP) has been adjusted in accordance with the changed requirements.
ISH_CV_FR/MISC2: Contract Scheme Items - Time-Dependent (New)

Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR) and business
function SAP Patient Management: Legal Process Adoption2 (ISH_MISC2), you can create time-dependent
contract scheme items.
When handling nursing home cases when the patient's stay covers a period of years, the coverage amounts
have to be adjusted over time (for example, at the end of a calendar year).
Defining Time-Dependent Contract Scheme Items
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You can now make these time-dependent changes on the detail screen for the contract scheme items.
Choose the value FR: Time-Dependent Item Data in the Calculation field and enter a description. Enter a
description that indicates the purpose of the contract scheme item. This text is displayed in the case-related
function Maintain Coverage Rate and you can make adjustments to the time-dependent item data here.
Then choose Multiple Selection to access the time-dependent contract scheme items.
Specify the validity and percentage or amount. You can specify a calculation type to define how the amount or
percentage entered is to be interpreted in payment distribution:
Cover Amount
If you select this value, the system copies the amount or percentage entered in the insurance relationship to
which this contract scheme is assigned.
Exclude Amount
If you select this value, the system passes on the amount or percentage entered to the next insurance
relationship.
Adjusting Individual Time-Dependent Contract Scheme Items

You can make adjustments to individual time-dependent contract scheme items using the function for
maintaining case-related insurance relationships.
To do this, choose Maintain Coverage Rate. The system displays all the contract scheme items for which the
value FR: Time-Dependent Item Data is specified in the Calculation field on the left hand side. Double click on
the contract scheme item you want to change. The system displays all the existing periods for this item on the
right hand side. If you make an entry in the Ind. Amount or Ind. Pct field, this overrides the Customizing settings.
You can also change the intervals.
To do this, choose New Entry. Create the desired interval with the corresponding amount or percentage. When
you save, the system adjusts the existing intervals automatically so that the periods do not overlap. The system
does not adjust intervals entered by the user so as to avoid overwriting data entered manually. The date fields
for these intervals are ready for input.
The system uses the values from Customizing in payment distribution for periods to which you have not made
adjustments.
business function SAP Patient Management Country Version France (ISH_CV_FR) and business function SAP
Patient Management: Legal Process Adoption 2 (ISH_MISC2)
For more information about defining contract schemes, see the Healthcare Implementation Guide under SAP
Healthcare Industry-Specific Components for Hospitals Patient Accounting Business Partners / Insurance
Relationships SG,CA,CH,FR,IT: Maintain Contract Schemes.
ISH_MAIN AT: Setting Stat. Cases to Final Billed (RNWATNFAL0) (Changed)

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ISH_MAIN AT: Scoring (Changed)

ISH_MAIN CH: Use of Flat-Rate Taxes (New)

ISH_MAIN: Automatic Proposal of Contract Scheme (Changed)

function SAP Patient Management (ISH_MAIN), the system only proposes the contract scheme if the case type
specified in Customizing for the contract scheme at header level matches that of the current case.
If the case type in the contract scheme does not match that of the case, the system displays the information
message NZ 053, Contract scheme cannot be copied from proposal list.
SAP ERP Industry Extension Healthcare 6.0, Support Package 22
business function SAP Patient Management (ISH_MAIN)
ISH_MAIN CH: Swiss DRG (New)

ISH_MAIN CH: Uniform Invoice Form (Changed)

ISH_MAIN DE: DRG Billing (FPV 2011) (Changed)

ISH_MAIN DE: Treatment Certificates (Enhanced)

ISH_MAIN CH: Outp. Cases - CO Order Aut. on Case Creation (New)

This release note only applies to the country version Switzerland and is not available in English.
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ISH_MAIN CH: Test Billing Also Possible Without IV (Enhanced)

ISH_MAIN CH: Adjust Revenue Accrual for SwissDRG (Enhanced)

ISH_MAIN CH: Ext. Order: Restrict Search to Open Orders (Enhanced)

ISH_MISC1 CH, AT, FR: Fees: Fee Relevance Time-Dependent (Enhanced)

As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), business function
SAP Patient Management: Legal Process Adoption (ISH_MISC1): Valid from and Valid to fields have been added to
the Customizing table Items for Fee Relevance (TNWCH91). The system uses the service date to determine the
validity of fee relevance.
Caution: You must execute report RNWCHUTL47_604 once to initialize the new date fields (even if you have
not activated the business function SAP Patient Management: Legal Process Adoption (ISH_MISC1)). This
report enters 01/01/1990 as the valid-from date and 12/31/9999 as the valid-to date for all existing entries.
This enhancement is available as of the following Support Packages:
SAP ERP 6.0, Industry Extension Healthcare, SAP enhancement package 4 (IS-H 604), business function SAP
Patient Management (ISH_MAIN) and business function SAP Patient Management: Legal Process Adoption
(ISH_MISC1), Support Package 17
ISH_MISC2 FR: Service Rule for Nursing Service (R27) (New)

Package 1, business function SAP Patient Management: Legal Process Adoption 2 (ISH_MISC2), service rule
R27 is available for generating nursing services (ISH_CHECK_SERVICES_CARE_LEVEL).
This service rule is currently only available for use in the country version France.
This service rule determines the services to be generated (charge type FG) according to a case classification
(for example, level of care).
The system only generates the services if the case type is Inpatient (day patient cases are not supported at
present) and the case has not yet been final billed.
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It is only possible to generate a service if a case classification (level of care) is specified and there is a valid
Customizing entry for the case classification in the Service to Be Generated for Each Level of Care table
(TNLOC_SERV). If a case is not assigned a case classification for a specific period, the system does not
generate a service.
Each time the service rule is executed, the system determines which services should be generated and
compares these with the existing services. The system creates, changes, or cancels services as required (for
example, if the case classification has changed). This also applies to services that were created manually.
You can specify whether the service is also to be created during an absence in the service master data:
If you select the Absence-Relevant checkbox (NTPK-ABWRL), the system does not generate the service
during an absence.
If you do not select the Absence-Relevant checkbox (NTPK-ABWRL) the system generates the service during
an absence.
business function SAP Patient Management: Legal Process Adoption 2 (ISH_MISC2)
You must activate service rule R27 in the check procedure.
You do this in Customizing under SAP Healthcare Industry-Specific Components for Hospitals Patient
Accounting Service Rules Define Rule Types and Maintain Check Procedure.
You specify the conditions for generating the services in Customizing under SAP Healthcare IndustrySpecific Components for Hospitals Patient Accounting Service Rules Service to Be Generated for
Each Level of Care.
Insurance Relationship
ISH_MAIN AT: Querying Insurant Data - VDAS (Changed)
Services
ISH_CV_FR: Adjustments to Service Rules F05 and F00 (Changed)
function SAP Patient Management Country Version France (ISH_CV_FR), changes have been made to the
service rules Exemption from Patient Contribution (F05) and Generate Patient Contribution (F00).
Service rule Exemption from Patient Contribution (F05)
Inpatient case:
If the value 1 Cumulated Amountis entered in the master data for the CCAM services in the case and the
cumulated value for all relevant services exceeds the threshold, all the services in the case (including nonCCAM services) are exempt (the value A is entered in field NLEI- /ISHFR/EXO_CP).
If the value 2 Individual Amount is entered in the master data for one or more CCAM services for the case, the
amounts cannot be cumulated (these services can only be processed individually). In this case, if one of the
services (with the value 2 in its master data) exceeds the threshold on its own, only this service is exempt (the
system enters the value B in field NLEI- /ISHFR/EXO_CP).
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If required, cumulation takes place for all CCAM services for the case that have been marked accordingly and
is not restricted by performance date or performer.
Outpatient case:
Service rule F05 processes the cumulated CCAM services for a visit that have the value 1 Cumulated Amount
in their service master and that have the same service performer. If the cumulated amount for these services
exceeds the threshold, the system enters the exemption reason A for these services for the visit. In addition,
one of the following conditions must apply to these services:
o The Cost Reimbursement SI field in the service master (/ISHFR/NTPKFR-KOERS_SV) contains the
value 1.
o The Cost Reimbursement SI field in the service (NLEI-/ISHFR/KOE_SV) contains the value X.
o The T2A indicator is selected in the service master.
o The Pharmacy Sales indicator is selected in the service master.
If cumulation is necessary, it takes place for all the CCAM services for a visit with the same performing
physician that are marked accordingly. Exception: Anesthesia services (activity = 4) are not restricted by
performing physician but only by the visit.
If the value 2 Individual Amount is entered in the master data for one or more services for the case, the
amounts cannot be cumulated (these services can only be processed individually). In this case, if one of the
services with the value 2 Individual Amount in its master data exceeds the threshold on its own, only this
service is exempt (the system enters the value B in field NLEI- /ISHFR/EXO_CP).
Patient Accounting Service Rules Country-Specific Service Rules Threshold for Exemption per Contract
Scheme (F05).
New exemption reason G

Exemption from the patient contribution for inpatient stays exceeding 30 days has changed. Service rule F05
enters the exemption reason G (stay > 30 days) for per diem fees (charge type FA) and the GHS service (charge
type F5) for hospital stays with the admission type Medical Subsequent Case according to the following rules:
If the system cannot determine previous days, all per diem fees are exempt from copayment as of the
admission date + 30 days. The GHS service is exempt from copayment if the length of stay exceeds 30 days.
If the system determines previous days and the total hospital stay for both cases exceeds 30 days, the entire
per diem fee (not just from the 31st day onwards) or the GHS service for the medical subsequent case is
exempt.
If the hospital stay involves an admission from an external hospital and the stay is not a medical subsequent
case relating to the previous case, service rule F05 enters the exemption reason G (stay > 30 days) for per diem
fees (charge type FA) and GHS services (charge type F5) according to the following rules:
If the system cannot determine previous days, all per diem fees are exempt from copayment as of the
admission date + 30 days. The GHS service is exempt from copayment if the length of stay exceeds 30 days.
If the system determines previous days and the total hospital stay for both cases exceeds 30 days, the entire
per diem fee from the 31st day onwards (including previous days) is exempt.
New exemption reason N

The value N Manual Exemption Exclusion is now available.
By entering the value N , you can remove patient contribution exemptions that were entered automatically at
service level by the system due to case-related exemption reasons. If you enter one of the exemption reasons F
(ALD), H (maternity and accident at work), J (insurance without patient contribution), K (FSV or FSI), E
(prevention), or L (exemption according to copayment waiver) for a case, service rule F05 automatically enters
the case-related exemption reason for all relevant services entered with reference to the case. However, if
certain services are not exempt from the patient contribution, you can enter the new value N manually in the
Exemption from Patient Contribution field (/ISHFR/EXO_CP) and thus cancel the exemption for this service.
In payment distribution, the system treats the value N as if the field were blank.
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Please note that the system will only not overwrite the manual entry N if the exemption reason F (ALD), H
(maternity and accident at work), J (insurance without patient contribution), K (FSV or FSI), E (prevention), or L
(exemption according to copayment waiver) would otherwise apply.
If the system determines other exemption reasons, it replaces the manual entry N with the reason it has
determined. This applies to the exemption reasons A (cumulated CCAM amount), B (individual CCAM amount),
C (individual service), D (entire case), G (length of stay > 30 days), M (Alsace), and O (subsequent stay).
Service rule Generate Patient Contribution (F00)
The service rule Generate Patient Contribution (F00) is used to generate a service for the flat-rate patient
contribution (charge type = F0). To do this, service rule F00 evaluates the service-related internal exemption
reasons A and B, which are entered by service rule F05, if a case contains "expensive" CCAM services.
Expensive CCAM services are services belonging to charge type F1 that reach a certain threshold, either when
cumulated or individually. This threshold is stipulated by law.
The following changes have been made to this system behavior:
Inpatient case:
If all the CCAM services for a case have the grouping code ADI (radiology services), the system does not
generate the patient contribution service.
Depending on the hospital type (field V_TN01-HCAT), service rule F00 creates the service for the flat-rate
patient contribution for inpatient cases according to the following rules:
If the institution belongs to the hospital type 'state', service rule F00 creates the service for the flat-rate patient
contribution once the threshold for the CCAM services with exemption code 1 has been reached (the services
have the internal exemption reason A).
If this is not the case and the case has CCAM services with exemption code 2 whose value reaches the
threshold (internal exemption reason B), service rule F00 does not create the service for the flat-rate patient
contribution.
If the institution belongs to the hospital type 'private', service rule F00 creates the service for the flat-rate
patient contribution once for each case, either if cumuated CCAM services with exemption code 1 reach the
threshold (internal exemption reason A) or if individual CCAM services with exemption code 2 reach the
threshold (internal exemption reason B).
Outpatient case:
If all the CCAM services for a visit have the grouping code ADI (radiology services), the system does not
generate the patient contribution service.
Irrespective of the hospital type (field V_TN01-HCAT), service rule F00 creates the service for the flat-rate
patient contribution for outpatient cases according to the following rules:
If the threshold for CCAM services with exemption code 1 has been reached for each visit and service
performer (internal exemption reason A), service rule F00 creates a service for the flat-rate patient contribution.
If the visit has CCAM services with the exemption code 2 whose individual value reaches the threshold
(internal exemption reason B), service rule F00 creates a service for the flat-rate patient contribution for each
visit and performer.
Patient Accounting Service Rules Country-Specific Service Rules Generate Patient Contribution (F00).
These changes are also available with the following Support Packages:
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ISH_CV_FR: Service Rule Generate Per Diem Fees (F10) (Changed)

Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR), you can also
generate per diem fees for accommodation (charge type FH) using service rule F10 (Generate Per Diem Fees).
In French nursing homes (EHPAD), billing for accommodation is performed on the basis of per diem fees.
You can specify the conditions for generating per diem fees for accommodation in the Customizing table
Generate Per Diem Fees (/ISHFR/TNWFR_F10). Per diem fees for accommodation (charge type FH) are not
generated for absences. The Abs. indicator (field /ISHFR/ISH_ABSENCE) in the Customizing table is not
relevant for per diem fees for accommodation.
You must activate service rule F10 in the check procedure.
Enter the prerequisites for generating the services in the corresponding Customizing table Generate Per Diem
Fees (/ISHFR/TNWFR_F10).
For more information, see Customizing under SAP Healthcare Industry-Specific Components for Hospitals
Patient Accounting Service Rules Country-Specific Service Rules Generate Per Diem Fees (F10).
See also
There are special rules for billing per diem fees for accommodation in French nursing homes. The new service
rule Absence Control (F21) is available for entering per diem fees for accommodation during an absence. For
more information, see the release note ISH_CV_FR/MISC2: Service Rule Absence Control (F21) (New).
ISH_CV_FR: Service Rule Exemption from Patient Contribution (F05) (Changed)

Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR), service rule F05
(Exemption from Patient Contribution) has been changed.
If the case type is "Termination of Pregnancy" and the case contains a service with charge type FI, you cannot
specify exemption reason A or B for any of the services.
As of this release, SAP Patient Management Country Version France supports billing in nursing homes
(EHPAD) in addition to billing for acute treatment (MCO).
Service rule F05 (Exemption from Patient Contribution) sets the service-related exemption from the patient
contribution (NLEI-/ISHFR/EXO_CP) in accordance with the rules that apply for acute treatment. These rules
do not apply to nursing home cases (EHPAD cases). For this reason, service rule F05 has been adjusted so
that service-related exemption reasons are not set for nursing home cases.
These new features are also available with the following Support Package:
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See also
For more information, see the Healthcare Implementation Guide under SAP Healthcare - Industry-Specific
Components for Hospitals Patient Accounting Service Rules Country-Specific Service Rules Service
Rules Overview.
For more information about defining nursing home cases, see the release note ISH_CV_FR: Specialty Coding:
Defining Nursing Home Cases.
ISH_CV_FR/MISC2: Service Rule Absence Control (F21) (New)

Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR) and business
function SAP Patient Management: Legal Process Adoption 2 (ISH_MISC2), service rule F21 is available for
controlling absences (/ISHFR/CHECK_SERVICES_F21).
This service rule is only used in the country version for France.
You can use this service rule to generate per diem fees for accommodation (charge type FH) during absences.
The following conditions must be met before a per diem fee for accommodation can be generated during an
absence:
The case must have the case type "Inpatient".
The case must have at least one absence.
There must be a corresponding entry in the Customizing table Absence Control (/ISHFR/TNWFR_F21). The
service rule selects the most specific entry.
The service rule creates the service that is entered under Service in the Customizing table.
The following rules apply:
If the Abs. Start (absence start) checkbox is selected, this absence day is not counted. This means the system
does not create the absence service for the first day of the absence but from the following day.
If the Abs. End (absence end) checkbox is selected, this absence day is not counted. The system does not
create the absence service for the last day of the absence but up to the day before.
The system only generates the service quantity specified in the "Number" field.
If the duration of the service is longer, the system generates the service specified in the Alt. Serv. (alternative
service) field.
If the per diem fee for accommodation already exists, the system adjusts the service automatically when there
are changes to the absence (for example, date, time, absence type). The system also adjusts or cancels
services that were created manually.
business function SAP Patient Management Country Version France (ISH_CV_FR) and business function SAP
Patient Management: Legal Process Adoption 2 (ISH_MISC2)
You must activate service rule F21 in the check procedure.
You specify the conditions for generating the services in Customizing under SAP Healthcare IndustrySpecific Components for Hospitals Patient Accounting Service Rules Country-Specific Service Rules
Absence Control (F21).
See also
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Components for Hospitals Patient Accounting Service Rules Country-Specific Service Rules Service
Rules Overview.
ISH_CV_FR: Service Rule Gen. Daily Hospital Rate (F07, F11) (Changed)
Package 1, business function SAP Patient Management Country Version France (ISH_CV_FR), service rules
F07 (Daily Hospital Rate - Private Hospitals) and F11 (Daily Hospital Rate - State Hospitals) have changed.
As of this release, SAP Patient Management Country Version France supports billing in nursing homes (EHPAD)
in addition to billing for acute treatment (MCO).
Service rules F07 and F11 generate daily hospital rates according to the rules applying to acute treatment.
These rules do not apply to nursing home cases (EHPAD cases). For this reason, service rules F07 and F11
have been adjusted so that daily hospital rates (charge type F6) are not generated for nursing home cases.
See also
For more information, see Customizing under SAP Healthcare Industry-Specific Components for Hospitals
Patient Accounting Service Rules Country-Specific Service Rules Service Rules Overview.
For more information about defining nursing home cases, see the release note ISH_CV_FR: Specialty Coding:
Defining Nursing Home Cases.
ISH_MAIN AT: LR A4 - Check on Maximum Values (Changed)

ISH_MAIN: Multiplication Factor for Private Insurance with Basic Policy (New)
function SAP Patient Management (ISH_MAIN), the following new feature is available:
Private health insurers are now required by law to offer a basic policy that corresponds to statutory health
insurance. As a result, privately insured patients are subject to certain requirements that previously only applied
to patients with statutory insurance. These include the definition of multiplication factors.
Since the multiplication factor for privately insured patients cannot be used with the basic policy, a different
multiplication factor has to be determined in this situation. For this purpose, an additional characteristic Contract
Scheme has been added to the function for determining the multiplication factor. Service rule R26 is still
available. This service rule determines the correct multiplication factor subsequently, since the fact that the
patient has a basic policy with a private insurer often only comes to light during the course of their treatment.
The function described above is also available with the following Support Packages:
SAP ERP 6.0, Industry Extension Healthcare, Support Package 27
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You can access the function for determining the multiplication factor in the following Customizing activity: SAP
Healthcare Industry-Specific Components for Hospitals Patient Accounting Service Entry Define Rules
for Multiplication Factors.
Insurance Verification
ISH_MISC1 AT: Insurance Verification - Alt. System Behavior (Changed)
Copayment
ISH_MAIN DE: Default Case-Related Copayment Exemption Reasons (New)
This release note only applies to the country version Germany and is not available in English.
ISH_MAIN DE: Practice Fee: New Use for University Outpat. Cases (Enh.)
ISH_MAIN DE: Practice Fee: Canceling Dunned Copyt Invs in R16 (Changed)
ISH_MAIN DE: Practice Fee: Ins. Provs with Copayment Waiver (Changed)
ISH_MAIN DE: Copayment Changes due to 301 Amendment, 09/22/2010 (Enh.)

ISH_MAIN DE: Gen. Demands for Copayment (Report RNZUZBI1) (Enhanced)
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ISH_MAIN DE: Posting Back Dunned Copayment Receivables (Enhanced)

ISH_MAIN DE: Reverse Clearing for Copayment Receivables (Enhanced)

function SAP Patient Management (ISH_MAIN), the switch from the collection to the receivable procedure in
copayment processing has led to new system requirements.
It is now possible to reverse copayment receivables for inpatient stays without having to reverse clearing for
receivable items. As a result, a new function for reverse clearing is available for copayment and is available as
of:
The following new fields for reverse clearing are available in the Receivable Procedure group box in Customizing
under SAP Healthcare Industry-Specific Components for Hospitals Patient Accounting Copayment/Down
Payment Inpatient Copayment Maintain Parameters for Copayment Requests:
Debit and Credit Posting Key
You enter the posting keys that are used for a reverse clearing document in this field.
If you want to use the reverse clearing function, these posting keys are mandatory. They must be set up
beforehand in FI and should only be used for reverse clearing.
Document Type
You can use a custom document type for the reverse clearing document. If you leave this field blank, the
system uses the document type specified for the copayment receivable in the receivable procedure for reverse
clearing.
Payment Block
If you want to prevent payment of the reverse cleared amount to the patient during the FI payment run, you
can set a corresponding indicator here, which is also valid in FI.
Functions in Transaction NE11 (Maintain Copayment):
Choose Copayment Reverse Clearing in transaction NE11 to access reverse clearing.
The documents for which you want to perform reverse clearing must be selected.
The system runs the following checks:
Reverse clearing only possible for copayment receivables that have already been posted
Check if already posted back, transfer posted, reversed/reverse cleared - if so, reverse clearing is not possible
Reverse clearing not supported for outpatient cases
Only supported for insurance providers with receivable procedure
If copayment has already been deducted on an invoice, the invoice must first be reversed
Check for partial payments made (indicated by configurable message N7 548, standard type W (warning))
The R (reversal or reverse clearing indicator) is selected for the document that is to be reverse cleared.
You can specify a posting date and period. The system determines posting periods 1 to 12 automatically. If the
posting date is in December and you specify a special period, the system posts to the special period if this is
possible according to the fiscal year variant.
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If you leave these fields blank, the system enters the current date. This date is used as the posting and
document date.
The document number of the original copayment receivable and the two-digit fiscal year of the original
copayment receivable are entered in field XREF2. The system copies the reminder data, assignment (case
number), document item text, and business area from the original copayment receivable. The Customizing
entries are copied (document type if applicable, posting key, payment block if applicable).
In addition, the following enhancements have been made to the existing reversal function in transaction NE11:
If you access the existing Reverse function for a document and the standard reversal function is no longer
possible because clearing has taken place, the system displays a dialog box indicating that you have the
option of performing reverse clearing.
If you confirm the dialog box, the system performs reverse clearing. The system follows the original procedure
for documents that can be reversed.
Displaying Reverse Cleared Documents:

You can control whether reverse cleared documents are displayed using the same parameters as for reversed
documents. Reverse cleared copayment receivables (inpatient case with specified insurance provider) have a
reversal indicator but no reversal reason and can thus be identified easily.
Reversing Reverse Cleared Copayment Receivables:

You can only reverse a reverse cleared copayment request in Financial Accounting.
If you want the system to prevent this, you must make the appropriate settings in the Financial Accounting
component (for example, document type and/or validation).
If a reverse cleared copayment receivable is reversed in Financial Accounting, the original copayment receivable
is displayed again in transactions NE11 and NE10. The reference (document number and two-digit fiscal year of
the original copayment receivable) in field XREF2 is retained. If you repeat reverse clearing for this original
copayment receivable, the system overwrites the entry in this field.
When you reverse a reverse clearing document directly using transaction FB08 or F.80 in Financial Accounting,
the billing status and other billing parameters (for example, copayment exemption) for the case are not taken into
account. In certain circumstances and if you use the function incorrectly, a posting of this kind can subsequently
cause inconsistencies in copayment processing for the case.
Inpatient Copayment
You can make the settings for the Posting Key, Document Type, and Payment Block fields in the Reverse
Clearing group box in Customizing under SAP Healthcare Industry-Specific Components for Hospitals
Patient Accounting Copayment/Down Payment Inpatient Copayment Maintain Parameters for
Copayment Requests.
Customizable Message
The following message is available in Customizing under SAP Healthcare Industry-Specific Components for
Hospitals Basic Settings System Parameters Message Control Display Customizable Messages
(SAP) to control reverse clearing with existing partial payments:
Function: N019
Application area: N7
Message number: 548 Patient has already made partial payment(s) for case & document &
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Default type: W (warning)
If you want to change the message type or suppress it entirely, you must make an entry for this message in
Customizing under SAP Healthcare Industry-Specific Components for Hospitals Basic Settings System
Parameters Message Control Maintain Messages.
See also
Down Payment
ISH_MAIN FR: Down Payment Monitor - Interim Billing Date (Enhanced)
Package 01, business function SAP Patient Management (ISH_MAIN), the interim billing date is available as a
start parameter for the down payment monitor (RNAANZ01).
This means you can generate down payment requests relative to an interim billing date. For example, you can
generate down payment requests at the start of a period with an interim billing date at the end of the period.
The interim billing date is only displayed in the country version for France.
business function SAP Patient Management (ISH_MAIN).
ISH_MAIN: Down Payment Monitor - Executing Service Rules (Enhanced)

Package 01, business function SAP Patient Management (ISH_MAIN), you can execute service rules in the
down payment monitor (RNAANZ01).
This means you can use the service rules to refresh the services before generating the down payment requests.
To do this, you must specify the event Service Check in Down Payment Monitor (NLRG19) in the check
procedure in Customizing for the service rules to be executed.
Components for Hospitals Patient Accounting Service Rules Define Rule Types and Maintain Check
Procedure.
Billing
In addition to the B2 message, private hospitals are required to submit the printed invoice Bordereau S 3404. As
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of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), Support Package
02, business function SAP Patient Management Country Version France (ISH_CV_FR), the sample Smart Form
/ISHFR/BILL is available.
This sample form has been adjusted to meet the requirements for billing drugs (UCD services) and medical
products (LPP) with the addition of flat rates:
UCD and LPP services are displayed in the middle of the form under the header Produits de la LPP
facturables ET spcialits pharmaceutiques.
The EMI or ETI margin services follow on directly from the corresponding UCD or LPP service.
If you only send the S3404 form to the complementary insurer, the system does not display the UCD or LPP
code on the invoice.
France (ISH_CV_FR).
Note: This is a sample form. You can copy it and modify it according to your requirements.
If you want to use the form, you must enter it in Work Organizer Management in Customizing. You must also
make sure that the relevant grouping codes for UCD services, LPP services, and EMI and ETI services are
assigned to the form group B LPP Services and Blood Derivatives.
To do this, choose SAP Healthcare Industry-Specific Components for Hospitals Hospital Basic Data
Service Master Data CCAM Maintain Grouping Codes in Customizing.
See also
The fields in the invoice form will only be filled correctly if you enter the services, bill them, and create the
corresponding B2 message correctly. For more information, see the following release notes:
ISH_CV_FR: Interim Billing for Nursing Home Cases (Changed)

Package 01, business function SAP Patient Management Country Version France (ISH_CV_FR), you can
perform interim billing for nursing home cases.
If you have assigned a contract scheme that allows interim billing to an inpatient nursing home case, you can
also perform live billing for this case on a specified date, even if the case has not yet been discharged.
Please note that contract schemes with interim billing must meet with certain criteria if billing is to take place
correctly. For example, there should be no maximum amounts or portions < 100% defined for contract schemes
with interim billing. The system does not check whether the contract scheme you create can obtain correct
results in interim billing, nor does it check whether subsequent changes to patient, case, or movement data
invalidate existing interim billing runs.
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ISH_CV_FR: Partial Cancellation for Nursing Home Cases (Changed)

Package 01, business function SAP Patient Management Country Version France (ISH_CV_FR), you can
perform partial cancellations for nursing home cases.
You can now separate self-payer invoices from the logical invoice and cancel them individually without having to
cancel the invoices for other insurance providers that are also part of the same logical invoice. This is only
possible if the self-payer invoice only includes services for which the self-payer has been billed 100% (in other
words, the self-payer invoice does not contain services where the self-payer and other insurance providers have
been billed for separate portions.
If this prerequisite is met, the partial cancellation function is available in the invoice overview in case-related
invoice processing.

This release note only applies to the country version Germany and is not available in English.
ISH_MAIN DE: PPA Billing Field ID 5011 (Changed)


ISH_MAIN DE: New Fields for PPA Billing with Q2/2011 (New)
function SAP Patient Management (ISH_MAIN), the following changes apply:
The following new fields are available when maintaining treatment certificates for referral certificates in SAP
Patient Management. The fields are relevant for the new Model 6 referral certificates, which are valid as of April
1st, 2011.
Diagnosis/Tentative Diagnosis
The system transfers this field to the PPA billing system under the field ID 4207 using report RNABDT00 (IS-H:
BDT Interface).
Findings/Medication
The system transfers this field to the PPA billing system under the field ID 4208 using report RNABDT00 (IS-H:
BDT Interface).
Model 85 (proof of entitlement when entitlement suspended according to section 16 of the Code of Social Law
(SGB V)) was introduced on April 1st, 2011. It is issued by health insurers to inform sickness fund-affiliated
physicians about the patient's entitlement to treatment. Model 85 replaces the healthcare smart card.
The Restricted Entitlement to Services field has been added to the insurance relationship in SAP Patient
Management. If the patient submits a Model 85 referral certificate, the user must select the Restricted
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Entitlement to Services field and admit the insured person using the "alternative procedure". The system
transfers this field to the PPA billing system under the field ID 4204 using report RNABDT00 (IS-H: BDT
Interface).
These changes are also available with the following Support Packages:
SAP Patient Management 4.72, Add-On Support Package 42
Management (ISH_MAIN) and business function SAP Ambulatory Care Management (ISH_AMBULATORY)
Make the following entries for the new fields in Customizing under SAP Healthcare Industry-Specific
Components for Hospitals Patient Accounting Billing Configure Special Forms of Billing DE:
Configure Panel Physician Association Billing Define Field Table for BDT Format:
Field: 4204, Field Label: Restr. Entitlement to Services:
MinL and MaxL: 1, Typ: N, Rule: 142
Field: 4205, Field Label: Order
Field: 4207, Field Label: Diagnosis/Tentative Diagnosis
Field: 4208, Field Label: Findings/Medication
The following settings apply to fields 4205, 4207, and 4208:
Select the Var.L. field.
MinL: 0
MaxL: 60
Typ: A
See also
For information about the change to the Model 6 form for sickness fund-affiliated physicians, see SAP Note
1562312: ACM: N3KVMST06 Referral Certificate Changes with 4.2011.
INFORMATION SYSTEM
Business Information Warehouse Interface
ISH_CV_CN: Ministry of Healthcare Reporting (New)
You can use queries to retrieve the required data for the following Ministry of Healthcare (MoH) reports:
HS1-1 Hospital Annual Report about Beds
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HS4 Hospital Quarterly Report about Discharged Patients

HS1-9 Hospital Monthly Report about Cases and Diagnoses
The MoH reporting function is based on Queries, Operational Data Providers (ODP), and DataSources. You run
queries using Business Explorer to view all the data stored in DataSources and ODPs. You can also export the
data to spreadsheets and edit the spreadsheets afterwards.
To obtain a complete MoH report, you must retrieve the required data from your ERP or clinical system. The
system can be an SAP or non-SAP system.
You define occupation categories in Customizing for SAP Healthcare - Industry-Specific Components for
Hospitals under Patient Management Patients Define Occupation Categories.
You define case end types for outpatient cases in Customizing for SAP Healthcare - Industry-Specific
Components for Hospitals under Patient Management Cases Define Case End Types.
You define insurance provider types in Customizing for SAP Healthcare Industry-Specific Components for
Hospitals under Patient Accounting Business Partners / Insurance Relationships Define Insurance Provider
Types.
Other Statistics
ISH_CV_FR: Evaluations for Nursing Homes (New)
Package 01, business function SAP Patient Management Country Version France (ISH_CV_FR), the following
two evaluations are available for nursing home cases (EHPAD):
Number of Days per Absence Type in Selection Period (EHPAD) (/ISHFR/RNWFR_DAY_ABSENCE)
This statistics report determines the number of days for each absence type and patient in the selection period
for nursing home cases (EHPAD).
Number of Days per Level of Care in Selection Period (EHPAD) (/ISHFR/RNWFR_DAY_NURSLEV)
This statistics report determines the number of days for each level of care and patient and the nursing
allowance for nursing home cases (EHPAD).
For more information, see the report documentation.
COMMUNICATION
General
ISH_CV_CN: Card Reader (New)
You can use the card reader function for the following purposes:
Inpatient and outpatient admission
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Outpatient visit scheduling

Biilling
The card reader function supports magnetic cards and smart cards.
You maintain card categories and types in Customzing for SAP Healthcare Industry-Specific Components for
Hospitals under Communication Chinese Medical Cards Define Card Categories for Cards and Assign
Card Types to Card Categories.
To enable the automatic generation of insurance relationships, you assign insurance providers to card
categories in Customizing for SAP Healthcare Industry-Specific Components for Hospitals under Patient
Accounting Business Partners / Insurance Relationships Assign Insurance Provider to Card Category.
You implement the card reader BAdI (ISH_CARD_READER) in Customizing for SAP Healthcare IndustrySpecific Components for Hospitals under Communication Chinese Medical Cards BAdI: Card Reader. You
can create your own BAdI implementation with reference to the sample BAdI implementation
(EI_ISH_EHC_CN).

function SAP Patient Management Country Version France (ISH_CV_FR), the system creates the electronic
invoice B2 in accordance with the billing rules for drugs and medical products.
France (ISH_CV_FR).
The fields in the B2 message will only be filled correctly if the services are entered and billed correctly for a case.
For more information, see the release note ISH_CV_FR: Billing for Drugs and Medical Products (New).
For more information about the billing rules and the rules for creating the electronic invoice B2, see the French
guide to billing for drugs and medical products in private hospitals ("Guide Pratique pour la Facturation des
Mdicaments Produits et Prestations Facturables en sus de Prestations dHospitalisation par les Etablissements
de Sant Privs", which is available at http://www.ameli.fr -> professionnels-de-sante -> directeurs-detablissements-de-sante -> vous-informer -> guide-de-facturation-du-codage-en-sus.php.
The system makes entries in the following fields in the communication procedure B2:
Aggregation in record type 3:
o The system creates an aggregated row of type 3 for drugs (UCD services) or medical products (LPP
services) that can be billed in T2A billing with the addition of flat rates. Aggregation is performed
according to the following criteria:
Grouping code
Service-related financing rate
Prescribing physician
o The aggregated record type 3 is followed by up to 10 3H (for UCD services) or 3F (for LPP services)
record types containing the detailed service data for the drugs or medical products. If there are more
than ten individual records, the system automatically generates a new message type 3, which is
followed by the additional 3H or 3F record types.
o If you perform billing for drugs or medical products with a purchase price that is lower than the
reference price, the system bills an EMI or ETI margin service, whose price is currently 50% of the
difference between the reference and purchase prices. This margin service is created in an aggregated
row of type 3. Aggregation is performed according to the grouping code and financing rate.
Entries in fields in record type 3 for drugs that can be billed in addition to flat rates (T2A billing):
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Field Prix unitaire (UNITPRICE):

Total invoice amounts for drugs or medical products that were aggregated according to the above rules
o Field Taux de financement (FUNDPERC):
Global or, if applicable, service-specific financing rate
o Field Base de remboursement (REIMBBASE6):
The reimbursement basis is copied from field UNITPRICE.
o Field Montant remboursable par la caisse (COVAMOUNT):
Product of the reimbursement basis, the reimbursement rate determined during billing, and the
financing rate.
o Field Montant total de la dpense (TOTAMOUNT):
The value is copied from the reimbursement basis.
Entries in fields in record type 3H for drugs:
o Field Prix d'achat unitaire TTC (GRPURPRICE):
The system either enters the reference price or (if available) the purchase price of the UCD service in
this field.
o Field Montant unitaire de l'cart indemnisable (UNITMARGIN):
The system calculates the entry for this field according to the following formula: (reference price of
UCD service - purchase price) * margin share rate
o Field Montant total de l'cart indemnisable (TOTMARGIN):
The value in this field is the product of the entry in field UNITMARGIN multiplied by the quantity and the
partial quantity administered.
o Field Montant total factur TTC (GRTOTAMNT):
The value in this field is the calculated by multiplying the price of the service by the quantity and partial
quantity administered.
Entries in fields in record type 3F:
o Field Tarif rfrence LPP ou Prix unitaire sur devis (REFPRICLPP):
The system enters the reference price in this field.
o Field Prix d'achat unitaire (PURCHPRICE):
The system enters the purchase price in this field, if available.
o Field Montant unitaire de l'cart indemnisable (UNITMARGIN):
The system calculates the entry for this field according to the following formula: (reference price of LPP
service - purchase price) * margin share rate
o Field Montant total de l'cart indemnisable (TOTMARGIN):
The value in this field is the product of the entry in field UNITMARGIN multiplied by the quantity and the
margin share rate administered.
o Field Montant total factur (INVPRICE):
The value in this field is calculated by multiplying the price of the service by the quantity.
Special Notes on Creating B2 Messages with Insurance Through AME and CMUC
Adjustment of B2 message if patient insured with special AME coverage

Special rules apply when creating the B2 messages for invoices for treatment costs covered by state health
care for illegal immigrants (AME). The B2 fields that must contain different entries than when processing
invoices to social insurance healthcare funds are described below:
Remains blank.
o Field Montant remboursable par l'organisme complmentaire (CPLIPAMNT):
Total invoice amount for the drugs or medical products aggregated.
Adjustment to B2 message for insurance with special CMUC coverage
Additional insurance policies for general health insurance coverage (CMUC) reimburse the costs not covered
by state health insurance. The system generates B2 messages for these invoices; these messages must
contain different entries from those created for invoices to social insurance health insurers. The B2 fields that
must be filled differently are listed below.
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The reimbursement basis is copied from field UNITPRICE.
o Field Montant remboursable par l'organisme complmentaire (CPLIPAMNT):
Total invoice amount for all the drugs grouped according to the above rules and not reimbursed by the
normal health insurer.
o B2 messages that only contain the invoice to the CMUC insurance provider must not contain record
types 3H and 3F with the detailed service data.
The system creates record types and record type supplements in the B2 message according to the Customizing
settings maintained for the corresponding grouping code. The record type supplements ETI and EMI have been
added for the new grouping codes EMI and ETI. Process entries for the grouping codes EMI and ETI and assign
the record type supplements EMI and ETI to these grouping codes.
You use the grouping code PH8 when performing billing for drugs (UCD services) with the addition of flat rates.
To ensure that the record type supplement type 3H is created for this grouping code in the B2 message, you
must specify the record type supplement Pharmacy UCD (drugs) for the grouping code.
You use the grouping code PII when performing billing for medical products (LPP services) with the addition of
flat rates. To ensure that the record type supplement type 3F is created for this grouping code in the B2
message, you must specify the record type supplement LPP for the grouping code.
ISH_CV_FR: Comm.: RSF - Standardized Invoice Message (Changed)

function SAP Patient Management Country Version France (ISH_CV_FR), the system fills the fields listed below
according to the current RSF message format in the communication procedure FRRSF for creating and
communicating standardized invoice messages (RSF messages). Private clinics in France use RSF messages
to transmit invoice data in the context of the PMSI program.
The fields listed below are now filled or are filled in a different way for the RSF message.
France (ISH_CV_FR).
Entries in fields in all message types:
Field INVOICENR: Number of invoice to the social insurance fund
Entries in fields for message type A:
Field CONTRTYPE: Contract scheme for complementary insurance
Field ASSUMCODE: The insurance verification code is entered according to the following rules:
o Cases without reimbursement by social insurance fund, for example plastic surgery: IV code 2
These are cases with an insurance relationship for the social insurance fund for which an entry with the
internal value No Coverage by SI is specified in the Billable SI field (/ISHFR/BAMO).
o Cases without reimbursement and without social insurance coverage; for example, foreign nationals
without insurance verification: IV code 4
These are cases with an insurance relationship for the social insurance fund, for which an entry with
the internal value No Coverage by SI is specified in the Billable SI field (/ISHFR/BAMO), and where
either the Special Coverage field contains the values AME State Health Insurance or EMGY
Emergency, or the patient is a foreign national (Non-National field is activated).
o Newborn infants for which billing takes place using the mothers invoice: IV code 5
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These are cases admitted with movement type Newborn.

Field BILL_STATE: Billing status of the invoice (paid, partially paid, not paid, unknown)
This field is filled according to the clearing data in the financial accounting document.
Entries in fields for message types B and C:

Field REIMB_AMT: The NOEMIE reimbursement amount is filled according to the following rule:
The system determines the service in the NOEMIE message that corresponds to that in the relevant B
segment and fills it with field REIMB_AMT from entity NOP-PHS (segment 220 of the EDI message).
Field FINCAT: Type of repayment transaction
The system enters the value from field FINCAT in entity NOP-MFI (segment 250 of the EDI message) in field
FINCAT.
Entries in fields for message type H:
Field SPLITCOEEF: Partial quantity
The system enters the partial quantity from the B2 message in this field.
Field GRPURPRICE: Purchase price of the drug
Field UNITMARGIN: Margin share rate per unit
Field TOTMARGIN: Total margin share rate
Entries in fields for message type P:
Field PURCHPRICE: Purchase price of the medical product
Field UNITMARGIN: Margin share rate per unit
Field TOTMARGIN: Total margin share rate
See also
For more information about the communication procedure FRRSF, see the release note ISH_CV_FR: EDI
Comm.: RSF Stand. Inpatient Invoice Message (New) for SAP enhancement package 5 for SAP ERP 6.0.
For more information about importing NOEMIE messages for private hospitals, see the release note
ISH_CV_FR: Comm.: NOEMIE Payment Information for Electronic Invoice (New).
For more information about entering and billing for drugs and medical products, see the release note
ISH_CV_FR: Billing for Drugs and Medical Products (New).
ISH_CV_FR: Comm.: NOEMIE Payment Information for Electronic Invoice (New)

function SAP Patient Management Country Version France (ISH_CV_FR), you can use the standard program
EDI File Import Program (Based On File at OS Level) (RNC301I0) to import the following NOEMIE files (version
NOEMIE PS 2004) into the SAP system:
Reference 576: Payment information for private clinics
Reference 900: Rejection of payment: private clinics
This constitutes the response to the electronic invoice B2. This means the system only processes the
information without errors if an electronic invoice has been sent. Otherwise, the system displays an error
message.
This enhancement allows you to import both NOEMIE messages for public hospitals and those for private
hospitals into the SAP system and display them.
You can display the imported NOEMIE message in the EDI worklist. You can display the corresponding B2
message here.
These functions are available as of SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
France (ISH_CV_FR).
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Reference 576 contains the following entities:

020 Representative
040 Payee
070 Posting Date
080 Message Group
105 Revenue Title
110 Person Insured
120 Patient
It also contains the relevant end segments.
Reference 900 contains the following entities:
070 Posting Date
080 Message Group
150 Insurance Type
100 Invoice Number
110 Person Insured
120 Patient
160 Archiving Criterion
290 Rejection or Information
ISH_MAIN AT: Scoring: WGF-Specific Data Structure (Changed)

Communication with Systems Outside the Hospital

ISH_CV_CN: BMI Communication (New)
As of SAP Enhancement Package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), Business
Function SAP Patient Management Country Version China (ISH_CV_CN), you can communicate with the BMI
system via several transactions.
With the enhancements, you can extract the following key figures:
Admission diagnoses
The MoH report calculates the number of admission diagnoses that are confirmed within three days every
month or every year. The report requires the date of confirmation when the patient is discharged.
Beds and rooms
Number of deceased patients
ISH_MAIN SG: DRG-Datenaustausch mit 3M-Codefinder (gendert)

Ab SAP-Erweiterungspaket 6 fr SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), Business Function
SAP Patient Management (ISH_MAIN) steht Ihnen fr die Landesversion Singapur in der medizinischen
Dokumentation folgende genderte Funktion zur Verfgung. Die Anpassungen untersttzen die gesetzlichen
nderungen zur Einfhrung des AR-DRG 6.0 in Singapur mit dem Kodierungs- und Gruppierungswerkzeug 3MCodefinder.
ber die folgenden neuen Funktionsbausteine wird die Kommunikation zum 3M-Codefinder hin und vom 3MCodefinder zurck im Format "CodAllTags" untersttzt:
ISH_DRGCDF_FORMAT_3MTAG_OUT_SG
ISH_DRGCDF_FORMAT_3MTAG_IN_SG
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Somit werden die in den folgenden Release-Informationen beschriebenen Anpassungen auch bei der
Kommunikation mit dem 3M-Codefinder untersttzt:
ISH_MAIN SG: Status der psychiatrischen Zwangseinweisung (neu)
ISH_MAIN SG: Erweiterung der medizinischen Dokumentation (neu)
Damit stehen folgende neue Schnittstellenattribute fr die Grouperkommunikation zur Verfgung:
MLS: Das Schnittstellenattribut wird mit dem Wert des Backendfeldes NFAL-MHLS verknpft.
PRFX: Das Schnittstellenattribut wird mit dem Wert des Backendfeldes NDIA-QUALF verknpft.
ARE: Das Schnittstellenattribut wird mit dem Wert des Backendfeldes NDIA-DRG_IMPACT bei Diagnosen und
mit NICP-DRG_IMPACT bei Prozeduren verknpft.
ARCL: Das Schnittstellenattribut wird mit dem Wert des Backendfeldes NDIA-CCL bei Diagnonsen und mit
NICP-CCL bei Prozeduren verknpft.
MOD: Das Schnittstellenattribut wird verwendet, um Diagnosen mit Morphologiediagnosen zu verknpfen.
Das System verwendet zur Konvertierung von internen zu externen Codes fr das Geschlecht (Tabelle NPAT
und Feld GSCHL) und den Entlassungsmodus (Tabelle TN14B und Feld BWART) nun die Version 2.0 des
Kommunikationsstandards DRG-CDF and nicht mehr Version 1.0.
Diese Erweiterungen stehen Ihnen bereits zur Verfgung ab:
SAP ERP 6.0, Industry Extension Healthcare (IS-H 600), Support Package 26, Business Function SAP Patient
SAP-Erweiterungspaket 3 fr SAP ERP 6.0, Industry Extension Healthcare (IS-H 603), Support Package 14,
Business Function SAP Patient Management (ISH_MAIN)
Auswirkungen auf die Systemverwaltung

Der Kundenexit EXIT_SAPLNCDRGC_006 muss, wenn er genutzt wird, dahingehend angepasst werden, dass
das Coding fr jeden Patienten nur einmal durchlaufen wird.
Auswirkungen auf das Customizing

Sie knnen die Einstellungen zur Kommunikation mit dem 3M-Codefinder im Customizing vornehmen unter
Branchenlsung Krankenhaus Kommunikation DRG-Datenaustausch.
Zur Konvertierung von internen Codes in externe Codes fr den 3M-Codefinder knnen Sie die CustomizingAktivitt Branchenlsung Krankenhaus Kommunikation EDI-Datenbertragung Interne in externe Codes
konvertieren verwenden.
ISH_MAIN AT: Diagnosis Entry - Check (Changed)

This release note is only relevant to the country version Austria and is not available in English.
ISH_MAIN AT: Outpatient Data Reporting - SCOAD (New)

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ISH_MAIN AT: NWATPARAM Parameter SCO_KOMP (New)

ISH_MAIN AT: Communication Procedure P321 (Changed)


ISH_MAIN CH: Electronic Invoice INXML (Changed)

ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: MHLS (Changed)

You can now transfer the mental health legal status from the 3M Codefinder to the SAP Patient Management
system:
Function module ISH_DRGCDF_FORMAT_3MTAG_IN_SG converts the value of the interface attribute
"MLS:". The system transfers the converted value to the back-end field NFAL-MHLS.
This conversion takes place according to the following rules:
o The interface values 1 (Involuntary) and 2 (Voluntary) are transferred unchanged.
o The interface values " " and 9 are transferred as " " (not specified).
No other values are transferred to the system. In this case, the system returns the error message "Invalid entry
&1 for mental health legal status".
ISH_MAIN CH: ALIS Error Handling: Display Import Date (Enhanced)

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ISH_MAIN AT: GINA - Various Changes (Changed)

ISH_MAIN AT: EDIVKA - SEPA Payment Transactions, Room Number (Enhanced)

ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: Exits (Changed)

Package 01, business function SAP Patient Management (ISH_MAIN), the following applies:
The following changed functions are available for medical documentation in the country version Singapore. The
adjustments support the legal changes accompanying the introduction of AR-DRG 6.0 in Singapore with the
coding and grouping tool 3M Codefinder.
You can now also use the following customer exits for data exchange with the 3M Codefinder with AR-DRG 6.0:
NC25G001
NC25G002
NC25G003
NC25G004
These allow you to convert the IDs of diagnoses, morphology diagnoses, and procedures from the internal
format (SAP) to the external format (3M Codefinder) and vice versa. The exits do not affect any other attributes
or information transferred from or to the 3M Codefinder.

These exits were already used for data exchange with APR-DRG.
If you had already implemented one of the exits and are now running AR-DRG 6.0, you must adjust your
implementation accordingly.
The context is supplied by the new optional parameter SS_DRG_VERSION.
If you access it in APR-DRG, the parameter has the value APR-DRG, whereas in AR-DRG 6.0 it has the value
"AR-DRG6.0".
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Notes on implementation with AR-DRG 6.0:

NC25G001
As before, parameter SS_DRG_PROCEDURE contains the details of the procedure and
SS_CONVERTED_VALUE_IN the SAP standard formatting, which takes the form ACHI.<external ID>.
If you want to determine this value yourself, you must also return it in the form ACHI.<external ID>.
NC25G002
SS_EXTERNAL_VALUE contains the ID of the procedure in the form ACHI.<external ID>. This means the
system has already removed the tag COD:.
You must make an entry for SS_DRG_PROCEDURE-ICPML in an implementation of the exit.
NC25G003
As before, parameter SS_DRG_DIAGNOSIS contains the details of the diagnosis or morphology diagnosis
and SS_CONVERTED_VALUE_IN the SAP standard formatting, which takes the form T.<external ID> or
TM.<external ID>.
If you want to determine this value yourself, you must also return it in this form.
Please note that a morphology diagnosis is characterized by its category: SS_DRG_DIAGNOSIS-DTYP1 = 'M'
(or SS_DRG_DIAGNOSIS-DTYP_REF = 'M').
NC25G004
SS_EXTERNAL_VALUE contains the ID of the diagnosis in the form T.<external ID> or the ID of the
morphology diagnosis in the form TM.<external ID>. This means the system has already removed the tag
COD:
You must make an entry for SS_DRG_DIAGNOSIS_BAPI-DIA_KEY1 and enter DIA_TYP1 = "M" for
morphology diagnoses in an implementation of the exit.
ENTERPRISE SOA
General
ISH_CV_CN: Enterprise Services (New)
You can activate the ISH_CN_LTDX_E Business Configuration Sets (BC Sets) to enable the report RNLDIA02
to generate the ALV output list.
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TOOLS
General
In addition to the B2 message, private hospitals are required to submit the printed invoice Bordereau S 3404. As
of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), Support Package
02, business function SAP Patient Management Country Version France (ISH_CV_FR), the sample Smart Form
/ISHFR/BILL is available.
This sample form has been adjusted to meet the requirements for billing drugs (UCD services) and medical
products (LPP) with the addition of flat rates:
UCD and LPP services are displayed in the middle of the form under the header Produits de la LPP
facturables ET spcialits pharmaceutiques.
The EMI or ETI margin services follow on directly from the corresponding UCD or LPP service.
If you only send the S3404 form to the complementary insurer, the system does not display the UCD or LPP
code on the invoice.
France (ISH_CV_FR).
Note: This is a sample form. You can copy it and modify it according to your requirements.
If you want to use the form, you must enter it in Work Organizer Management in Customizing. You must also
make sure that the relevant grouping codes for UCD services, LPP services, and EMI and ETI services are
assigned to the form group B LPP Services and Blood Derivatives.
See also
The fields in the invoice form will only be filled correctly if you enter the services, bill them, and create the
corresponding B2 message correctly. For more information, see the following release notes:
ISH_MAIN AT, CH: Case Archiving (Changed)

This release note is only relevant for the country versions Austria and Switzerland and is not available in English.
ISH_MAIN: Finding the Terminal (New)

function SAP Patient Management (ISH_MAIN) the following enhancement is available for form printing and the
card reader terminal:
You can use the DETERMINE method of Business Add-In (BAdI) ISH_TERMINAL_DETERMINE to determine
the name of the terminal in your environment.
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The sample code contains suggestions for view and Citrix terminal server environments from VMware. For more
information, see SAP Note 1556276.
CLINICAL SYSTEM
General
ISHMED_MAIN: Business Function Clinical System (Changed)
Since SAP ERP 6.0, Industry Extension Healthcare (IS-H 604), the business function Clinical System
(ISHMED_MAIN) has provided new and enhanced functions in various components of i.s.h.med. You can find
further information on this in the release notes:
SAP Enhancement Package 4: ISHMED_MAIN: Business Function Clinical System.
SAP Enhancement Package 5: ISHMED_MAIN: Business Function Clinical System (Changed)
For information about the new features available for this business function with SAP enhancement package 6
(IS-H 606), see the following release notes:
For enhanced basic data:
ISHMED_MAIN: Parameterized Document Categories (Changed)
For the clinical order:
ISHMED_MAIN: Clinical Order - Selection List (New)
ISHMED_MAIN: Clinical Order - Screen Modification (Changed)
For the patient organizer:
ISHMED_MAIN: PatOrg. - Functions for Selected Entries (Enhanced)
ISHMED_MAIN: PatOrg. - Aspects: Nursing Notes Mode (Enhanced)
ISHMED_MAIN: PatOrg. - Aspects: Inpatient Progress Notes Mode (Enhanced)
ISHMED_MAIN: PatOrg. - BAdI ISHMED_CALLOF_CHECK (New)
For planning:
ISHMED_MAIN: Planning - User Parameter N1PTSWTM (New)
ISHMED_MAIN: Planning - Change Reason Query (Changed)
ISHMED_MAIN: Planning - Display Locked Scheduling Type (New)
For the surgery system:
ISHMED_MAIN: Surgery System - Call Surgery Work Station (Enhanced)
ISHMED_MAIN: Surgery System - Team Entry Times (Changed)
ISHMED_MAIN: Surgery System - Calculate Surgery (Enhanced)
For medication:
ISHMED_MAIN: Medication - Drug Administration Base Item (New)
ISHMED_MAIN: Medication - Bar Code in Administration Process (New)
ISHMED_MAIN: Medication - Views in Clin. Work Station (Enhanced)
ISHMED_MAIN: Medication - Drug Search (Enhanced)
ISHMED_MAIN: Medication - Master Data and Settings (Enhanced)
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ISHMED_MAIN: Medication - eMAR (Enhanced)

ISHMED_MAIN: Medication - Order (Enhanced)
ISHMED_MAIN: Medication - Order Templates (Enhanced)
For the patient transport service:

ISHMED_MAIN: Patient Transport Service - Subsystem Connection (New)
For general utilities:
ISHMED_MAIN: Gen Utilities - Case Archiving Release (Enhanced)
See also
You can find the support package release notes for i.s.h.med Clinical System on the service.ishmed.com
website under Release Notes.
ISHMED_MISC01: Business Function Clinical System MISC01

As of SAP ERP 6.0, Industry Extension Healthcare, Enhancement Package 6 (IS-H 606) the business function
Clinical System: Functional Extensions 6 (ISHMED_MISC01) is available. This business function enables you to
use new functions.
For more information, see the following release notes
Allergy documentation:
Allergy Documentation (New)
Patient record:
ISHMED_MISC01: Patient Record - Introduction (New)
ISHMED_MISC01: Patient Record - General Basic Settings (New)
ISHMED_MISC01: Patient Record - Create Configurations (New)
ISHMED_MISC01: Patient Record - Dialog Design (New)
ISHMED_MISC01: Patient Record - Patient Header (New)
ISHMED_MISC01: Patient Record - Data Display (New)
ISHMED_MISC01: Patient Record - Data Filtering (New)
ISHMED_MISC01: Patient Record - Indicators (New)
ISHMED_MISC01: Patient Record - Object Search (New)
ISHMED_MISC01: Patient Record - Enhancement Possibilities (New)
ISHMED_SCD: Clin. Syst. Situation Based Clinical Documentation (Changed)

Since SAP ERP 6.0, Industry Extension Healthcare (IS-H 605), the business function Clinical System Situation
Based Clinical Documentation (ISHMED_SCD) has provided new and enhanced functions in various
components of i.s.h.med. You can find more information on this in the ISHMED_SCD: BF Clinical System
Situation Based Clinical Documentation release notes for SAP enhancement package 5.
For information about the new features available for this business function with SAP enhancement package 6
(IS-H 606), see the following release notes:
For clinical documentation:
ISHMED_SCD: Clinical Documentation Vital Signs (Enhanced)
ISHMED_SCD: Clinical Documentation Vital Signs (Changed)
For the clinical order:
ISHMED_SCD: Clinical Order - User Parameter N1CORD_PAT (New)
For the Surgery System
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ISHMED_SCD: Surgery System - Surgery Scheduling Status Tolerance (Enhanced)
For nursing process documentation:

ISHMED_SCD DE: Nursing Complex Procedure Score (PKMS) (New)
For the chart:
ISHMED_SCD: Chart (Enhanced)
See also
You can find the support package release notes for i.s.h.med Clinical System on the service.ishmed.com
website under Release Notes.
GENERAL DUTIES
General
ISHMED_MAIN: Gen Utilities - Case Archiving Release (Enhanced)
As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), Business
Function Clinical System (ISHMED_MAIN) unrestricted use of IS-H Case Archiving (archiving object ISH_FALL)
is available, under consideration of case-related i.s.h.med objects.
Until now it was only possible to use IS-H case archiving if case-related i.s.h.med objects existed, once the
installation number had been checked. With this enhancement package the installation number check is no
longer necessary and you can use case archiving without technical restrictions.
See also
Use of case archiving without checking the installation number is also available with SAP enhancement package
5 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 605), support package 02.
EXTENDED BASIC DATA

Parametrized Document Categories
ISHMED_MAIN: Parameterized Document Categories (Changed)
In SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 606), business function
Clinical System (ISHMED_MAIN) changes have been made to the tools for maintaining parameterized
documents (PMD). These are relevant for system administrators who are responsible for the maintenance of
parameterized document categories.
Processing a Definite Design

When you exit the dialog for processing a definite design (transaction N2T7) you will receive a security prompt,
even if you have not made any changes. If you answer this with "Yes" internal adjustments are automatically
made and you must regenerate. If you answer with "No" you do not need to generate.
Data Structure for Documentation Elements
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A component with the name Alias>_X and the format N2_STEXT_TAB is generated in the data structure for
documentation elements of the Long Text or Enhanced Text type. The interface of the Adobe printout is filled
accordingly. You can therefore store a formatting template for printing as dynamic text.
Access to Processing Document Categories

The initial screen for the processing of document categories is identical for the transactions N2T6 (Create
Document Category), N2T7 (Change Document Category) and N2T8 (Display Document Category).
The following functions are available on the initial screen:
Create Document Category; You use this function when you create a new document category.
Change Document Category Version
Display Document Category Version
New Version; You use this function to create a new version of a new document category.
You should note that you can only determine the application whenyou create a new document category. When
you save your definitions for the first time, you will receive a corresponding message.
Alias Names Cannot Be Changed

Until now it was possible to manually change the alias names of the elements generated by the system in the
element list. As of now this is no longer possible, because the generated names form the basis for the
subsequent synchronization with field names in the generated structures.
Enforce New Function Group

In system administration for a parameterized document you can delete the names of the function group and
modules in the menu under Extras Delete Program Name.
You use this function to resolve the following problem concerning legacy data when converting from PMD
Generator version 1 to Generator version 2: The Generator cannot change existing function group names. As a
result there may be several versions of a document category in a function group, although a new function group
is now created when a new document category version is created. You can enforce the renaming of the function
group and modules by deleting the name of the function group and module. This means you are no longer forced
to migrate all versions of a document category when converting to Generator version 2. You now only migrate
the newest version.
In order to remove the superfluous coding from the existing function group, you must also regenerate the
versions in the old function group.
Method for Deleting Duplicate Entries from Multiple Structures

You can use the method API_DELETE_DUPLICATES to delete duplicate entries from a multiple structure. The
functionality is documented in the method documentation of the class CL_ISHMED_PMD_SERVICES.
CLINICAL DOCUMENTATION
Examination and Lab Results
ISHMED_SCD: Clinical Documentation - Vital Signs (Enhanced)
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function Clinical System Situation Based Clinical Documentation (ISHMED_SCD) enhancements for the
following functions are available in the Vital Signs component:
Enter Vital Sign
o When entering vital signs for an examination you can enter a commenting long text.
o If a planned measurement was not measured, you can specify a reason for the "Not Measured"
measurement quality during entry. You determine the possible reasons in customizing.
o The Multiple Selection pushbutton has been replaced with the Vital Signs Catalog pushbutton with
enhanced functionality.
If you use the pushbutton after you have positioned the cursor on a filled line of the entry table, you will
receive a simplified input help.
If the cursor is positioned on an empty line, you will receive the existing input help with multiple
selection.
o When you select a group item, which has the Replace Group characteristic set in the vital signs
catalog, the system will position the sub-items of this group one after the other in the entry table.
Plan Vital Sign Entry
o You can configure groups for planning or presetting vital sign measurements, which the system
subsequently replaces with the contained sub-items, according to the cycle or when presetting in the
entry dialog when generating planned measurements.
o You can create "Systolic" and "Diastolic Blood Pressure" in the catalog under one "Blood Pressure"
group item and set the Replace Group indicator for this group. In the planning dialog you select "Blood
Pressure". Once you have activated the measurement plan, the system plans measurements for the
"Systolic" and Diastolic Blood Pressure" sub-items according to the cycle.
o You can schedule vital sign measurements for your patients, which can or must be specified at time of
input.
o The authorization checks when planning vital sign measurements have been revised.
Interfaces
o The class CL_ISHMED_CLIM_API_VS is available for specifying your own interfaces. You can use the
contained methods to retrieve existing or planned vital signs, read catalog information and create vital
signs. See also the documentation for the class.
o You can use the web service ISHMED_CLIM_GET_VITALSIGNS to retrieve existing vital signs of your
patients.
Effects on Data Transfer

You can also transfer comments from interfaces into the long text of the examination. You should note that the
transferred long text may not contain any formatting (bold, italics, etc.). Use the methods of the API vital signs.
If you wish to use the Specify function, you must execute the Customizing under Industry-Specific Component
Clinical System Clinical Documentation Clinical Measurements Vital Signs: Settings for Specification
and determine which vital signs can or must be specified.
If a separate reason should be entered for the "Not Measured" measurement quality during the vital sign entry,
execute the following activities in Customizing under Industry-Specific Component Clinical System Clinical
Documentation Clinical Measurements:
Vital Signs: Maintain "Not Measured" Reasons: You define the reasons for "Not Measured".
Vital Signs: Create OU Specifics: You determine whether a reason can or must be entered.
ISHMED_SCD: Clinical Documentation - Vital Signs (Changed)

function Clinical System Situation Based Clinical Documentation (ISHMED_SCD) changes are available for the
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Edit Catalogs function in the Vital Signs component.

The configuration of the measured value catalog for vital signs (basic catalog of the "CLIM" - Clinical
Measurements" catalog category) has changed as follows:
If you assign value ranges from a value range catalog to a catalog item, you must ensure that the assigned
value range items are not group items.
You create the individual value ranges in the value range catalog (basic catalog of the "CLIR - Value Ranges"
catalog category). You should use group items to structure this catalog, to which you subordinately assign the
value ranges which belong together. The group items should not be selectable.
In the measurement catalog for vital signs, you assign the sub-items of the value range group to your catalog
item as described in the "Effects on System Administration" section.

In your measurement catalog for vital signs (basic catalog of the "CLIM - Clinical Measurements" catalog
category) you must change the assignment of value ranges, if you have assigned groups of value ranges.
To do this you execute the following steps for each catalog item concerned:
1. Call the item for changing and create a delimitation.
2. In this delimitation, navigate to the delimitation row on the Delimitations tab page by double-clicking. You
will see the delimitation details.
3. Navigate to the tab page for value range assignments.
4. Undo the existing assignment of the group item from the value range catalog.
5. Assign the sub-items of the value range group to your vital sign item as follows:
a) In the assignment dialog navigate to the corresponding value range group.
b) Expand the group and all sub-items.
c) Position the cursor on the relevant value range group and execute the Select Subordinate Items
function. The items are selected.
d) Ensure that no group items are selected.
e) Execute the Continue functions and the individual value ranges are assigned.
6. Save your changes.
See also
You can find more information on this in Customizing under:
Industry-Specific Component Clinical System Cross-Application Settings Basic Catalogs Manage
Basic Catalogs
Industry-Specific Component Clinical System Clinical Documentation Clinical Measurements Catalogs
Manage Basic Catalogs and Basic Catalog Set
Allergy Documentation
ISHMED_MISC01: Allergy Documentation (New)
function Clinical System Functional Extensions 6 (ISHMED_MISC01), the following enhancements are available
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in the Maintain Allergies for Patient dialog.
Allergen Search
You use the Allergen Search to check a manually entered character string in the Allergen field for suitable
entries in the allergen catalog. In case of an exact match, the catalog value is automatically transferred with the
corresponding catalog key. If several entries can be considered, the user decides which entry should be
transferred.
Allergy Catalog pushbutton for selecting several catalog entries

The new Allergy Catalog pushbutton is available for this purpose. If you select the Allergen from an empty field,
a dialog opens for the selection of any number of entries in the entire allergen catalog. With the exception of the
hierarchy level of the allergen groups, you can select entries at all levels.
Change Documents pushbutton for displaying change documents

For administrative checks and document requirements, a new Change Documents pushbutton is available in the
application, which you can use to display a change document for an allergen dataset.
If you wish to use the allergen search, you will need an allergen catalog. You define the allergen catalog in
customizing for i.s.h.med under Industry-Specific Component Clinical System Cross-Application Settings
Basic Catalogs.
You can find information on the specific requirements of an allergen catalog in customizing for i.s.h.med under
Industry-Specific Component Clinical System Clinical Documentation Allergy Documentation.
CLINICAL ORDER
General
ISHMED_MAIN: Clinical Order - Selection List (New)
As of SAP enhancement package 6 for SAP ERP 6.0, industry extension Healthcare (IS-H 606), business
function Clinical System (ISHMED_MAIN), the Select Assigned Services pushbutton is available for selecting all
assigned services of a group service.
This pushbutton is available for all group services which contain requestable services.
You should note that when you use this pushbutton all assigned services are selected, regardless of whether
these are requestable group services or individual services. The group service for which the pushbutton is
clicked, however, is not selected.
See also
The selection list is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
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ISHMED_MAIN: Clinical Order - Screen Modification (Changed)

Function Clinical System (ISHMED_MAIN) the prioritization of the properties of fields in header components is
available.
If you order two order items with the same header components but with different definitions concerning statusdependent screen modification in one clinical order, the following sequence applies:
Must
Can
Display
Inactive
See also
ISHMED_SCD: Clinical Order - User Parameter N1CORD_PAT (New)

function Clinical System Situation Based Clinical Documentation (ISHMED_SCD) the user parameter
N1CORD_PAT is available for the clinical order.
You can use this parameter to control whether the patient header including the order header should be displayed
open.
See also
This user parameter is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
MEDICAL PATIENT DATA ORGANIZATION

General
ISHMED_MAIN: PatOrg. - Functions for Selected Entries (Enhanced)
function Clinical System (ISHMED_MAIN) modified behavior is available in the i.s.h.med patient organizer for
calling a function via a context menu with several selected entries.
If you have previously selected several objects of the same object type and then called the context menu by
right-clicking on one of the entries, the system previously only called the selected function for the entry for which
the context menu was opened.
The system will now also take into account the other selected entries for the Release and Cancel/Delete
functions called via the context menu.
Note that you can only use the Release function for services, documents and progress entries. You should also
note that the function call is restricted to the selected entries of one object type. This means you cannot, for
example, simultaneously select documents and services and call the Release function.
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See also
The modified system behavior for calling a function via tha context menu with several selected entries is also
available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 605),
support package 02.
ISHMED_MAIN: PatOrg. - Aspects: Nursing Notes Mode (Enhanced)

Function Clinical System (ISHMED_MAIN) the nursing notes mode is available for use of the mode as nursing
progress notes.
See also
The nursing notes mode for using the aspect as nursing progress notes is also available with SAP enhancement
package 5 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 605), support package 03.
ISHMED_MAIN: PatOrg. - Aspects: Inpatient Progress Notes Mode (Enhanced)

Function Clinical System (ISHMED_MAIN) the inpatient progress notes mode is available for use of the mode as
inpatient progress notes.
See also
The inpatient progress notes mode for using the aspect as inpatient progress notes is also available with SAP
enhancement package 5 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 605), support package 03.
ISHMED_MAIN: PatOrg. - BAdI ISHMED_CALLOF_CHECK (New)

Function Clinical System (ISHMED_MAIN) the business add-in (BAdI) ISHMED_CALLOF_CHECK is available.
You can use this BAdI to execute the customer-specific checks before the patient organizer is called thereby
controlling the call of the patient organizer.
The BAdI is also available for the patient viewer within the documentation work station and for the medical
patient appointment calendar. You receive the caller using the import parameter I_CALLER of the method
CHECK_AT_BEGIN.
With this BAdI you also receive a sample implementation which contains the check of the treatment contract for
the patient. You can copy this sample implementation into a customer-specific implementation and supplement
or change it as necessary.
See also
The BAdI ISHMED_CALLOF_CHECK is also available with SAP enhancement package 5 for SAP ERP 6.0,
Industry Extension Healthcare (IS-H 605), Support Package 05.
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ISHMED_MISC01: Patient Record - Introduction (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), you can use the patient record for the
display of patient-related and case-related information.
The patient record is an application that uses new technologies and functions for displaying this data.
You can use the patient record across all institutions for patients with patient master data (but not for patients
with provisional patient master data).
ISHMED_MISC01: Patient Record - General Basic Settings (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), you can make general basic settings for
the patient record.

You can make settings for the design and usability of the patient record in the Implementation Guide under SAP
Healthcare Industry-Specific Component Clinical System Patient Record.
Before you start to configure the application and assign the configurations to users, you need to create the
preconditions for the optimal use of the patient record:
Object Types for Patient Record:
This IMG activity lists the object types delivered with the standard system. You can define further, customerspecific object types (for example, results values of a pain scale that you enter in a parameterized document),
as required.
In this transaction, you can also define your own transformations for the object types for the single object
display (see also Data Display).
Period Selections for Patient Record:
Predefined periods for data selection are also delivered with the standard system. You can enhance these with
your own period definitions (for example, "in the past 3 days"), as required. The system also automatically
provides case periods for selection in the patient record (see also Data Display).
You can set one of the periods as the start period for the patient record (for example, the last two days). If you
have not defined a default period, the system uses the case period of the case that was transferred from the
context when the patient record was called.
Manage Indicators for Tracking:
Optionally, users can assign an indicator to the objects in the patient record (see also Indicators) to make the
tracking of these objects easier (for example, for resubmission, transfer). In this IMG activity, you can define
relevant indicators (icons and their labeling).
Set Up Search for Patient Record:
This IMG activity provides a description to help you use the SAP search engine TREX in the context of patientrelated data (see also Object Search).
ISHMED_MISC01: Patient Record - Create Configurations (New)

Function Clinical System Functional Extensions 6 (ISHMED_MISC01) you can create your own configurations
for the patient record or for the Web Dynpro components used in the configuration.
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The configuration N1PREC_CONFIG_DEFAULT for the component FPM_OVP_COMPONENT is provided in

the standard software delivery. You can use this configuration as a copy template to create customer-specific
configurations. The table below provides an overview of the available objects, their components, the default
configuration, the fullscreen configuration and the structure assigned to the components (if applicable):
Object
Type
Vital Signs
Lab Values
Documents
Diagnoses
Progress
Entries
Clinical
Orders
Services
Medication
Orders
Component
Configuration
Fullscreen Configuration
Structure
N1PREC_
VITALSIGNS
N1PREC_LAB
_FINDINGS
N1PREC_
DOCUMENTS
N1PREC_
DIAGNOSES
N1PREC_
PROGDOC
N1PREC_
CORDERS
N1PREC_
SERVICES
N1PREC_
MEORDERS
N1PREC_VITALSIGNS
_DEFAULT
N1PREC_LAB_
FINDINGS_DEFAULT
N1PREC_DOCUMENTS
_DEFAULT
N1PREC_DIAGNOSES
_DEFAULT
N1PREC_PROGDOC
_DEFAULT
N1PREC_CORDERS
_DEFAULT
N1PREC_SERVICES
_DEFAULT
N1PREC_MEORDERS
_DEFAULT
N1PREC_VITALSIGNS
_DEFAULT_FULL
N1PREC_LAB_FINDINGS
_DEFAULT_FULL
N1PREC_DOCUMENTS
_DEFAULT_FULL
N1PREC_DIAGNOSES
_DEFAULT_FULL
N1PREC_PROGDOC
_DEFAULT_FULL
N1PREC_CORDERS
_DEFAULT_FULL
N1PREC_SERVICES
_DEFAULT_FULL
N1PREC_MEORDERS
_DEFAULT_FULL
RN2CLIO_DOCUMENT
RN2CLIO_DIAMOV
RN2CLIO_IPPD
RN2CLIO_CORDPOS
bzw. RN2CLIO_ANF
RN2CLIO_SERVICE and
RN2CLIO_NRSSERVICE
RN2CLIO_MEORDER
Moreover, the following additional configurations are provided in the standard system:
N1PREC_SERVICES_MED for the exclusive selection of medical services
N1PREC_SERVICES_NRS for the selection of nursing services
N1PREC_SERVICES_ADMIN for the selection of administrative services
N1PREC_PROGDOC_NRS for the exclusive selection of nursing notes
Note that to use fullscreen configurations (see also the Display Data release note), you either have to enter an
explicit fullscreen configuration in the configuration for the User Interface Building Block (UIBB) or adhere to the
naming convention given above (same name as the configuration with the ending "_FULL"), which is
automatically used for the fullscreen display.
Example:
Your configuration for diagnoses is called ZN1PREC_DIAG1; the fullscreen configuration must therefore be
called ZN1PREC_DIAG1_FULL, if no other configuration is specified explicitly.
If no fullscreen configuration exists, the system uses the same configuration for the normal display and the
fullscreen display.
The following components are provided to flag objects and to search for objects:
Flagging:
Component N1PREC_TAGGING with the configurations
o N1PREC_TAGGING_DEFAULT
o N1PREC_TAGGING_DEFAULT_FULL
Search:
Component N1PREC_SEARCH
You can change the configuration of the patient record in the Implementation Guide under Industry-Specific
Component Clinical System Patient Record Edit Configurations.
These configurations are the standard configuration of the Floorplan Manager in the Overview Page (OVP)
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specification. You can find general information on the Floorplan Manager in the SAP Library (by searching for
the Floorplan Manager for Web Dynpro ABAP on the help.sap.com website).
When configuring the patient record you should only use main pages.
In order to be able to use a configuration for the patient record you must have entered the Web Dynpro
component N1PRECCTRL in the application control settings. The configuration N1PRECCTRL_DEFAULT is
provided for this purpose.
In the configuration of the User Interface Building Blocks (UIBBs) selection options are also available in addition
to the SAP standard functions (Hide/Show Columns etc.). Using these selection options you can significantly
influence the structuring of the patient record.
Example:
You wish to structure the documents for the patient from a variety of view points (e.g. departments, document
categories, etc.). To do this you use
various UIBBs in a section which you have defined as stacked
a tab page component (component FPM_TABBED_UIBB) with a configuration, in which you incorporate all
UIBBs of different configurations (e.g. radiological findings, discharge summaries, surgery documents, etc.)
In the configuration of the UIBBs you can also use filtering (see also the Filtering Data release note) and
optionally define the fullscreen configuration. In the fullscreen configuration you can integrate further columns in
the layout selection, display further filter options, etc.
The Number of Visible Rows in the UIBB configuration lets you define the maximum space required by a UIBB.
Note that when a results list lies below this maximum number, the system only displays the actual number of
rows.
Example:
You have defined a maximum number of 10 (rows) for your UIBB documents. If 20 documents are selected in a
corresponding time period selection, the system will display 10 rows and offer the option of scrolling to the other
documents. In a selection which only contains 2 documents as the result, the system will only display these 5
rows (without a scrollbar).
You can deactive the personalization feature in the patient record configuration to prevent users from hiding or
moving UIBBs and then losing their way around the patient record. This also prevents problems which may arise
when you implement a standardized patient record throughout the hospital and adapt and enhance this on a
permanent basis, since the system does not automatically apply such modifications for users with personalized
settings.
Moreover, in the configuration you can set the processing mode for collapsed UIBBs to the value "Defer
Participation (in FPM Event Loop) (Lazy Loading)". This means that additional information in the UIBBs is loaded
only when required and not when the patient record is called, thus improving performance.
For the UIBBs always use the rendering type "tray", so that information is displayed correctly and the fullscreen
option can be used.
You can assign configurations to users or roles. To do this, in the Implementation Guide, choose IndustrySpecific Component Clinical System Patient RecordAssign Configurations to Users/Roles. You can use *
entries to assign one customer-specific configuration to all users in your hospital.
If you assign one configuration to a user and simultaneously assign another configuration to a role of this user,
the system uses the configuration that is directly assigned to the user.
If you assign several roles to a user and different configurations are assigend to these roles, the system uses
the first configuration found.
If you directly assigned different configurations to a user, the system also uses the first configuration found.
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ISHMED_MISC01: Patient Record - Dialog Design (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), you can use the patient record.
The application's GUI status provides the Update function. You can use this function to update the patient record
without modifying the selected selection period or the selected page (in contrast to F5).
The patient record displays the patient header in the upper screen area (see also Release Note
ISHMED_MISC01: Patient Record Patient Header (New).
Below this, the system displays the header of the floorplan manager, i.e. of the patient record. In the first row of
this header, the system presents information about the seleted selection period.
Below this, the system displays the toolbar which provides the following elements:
Period selection:
The system provides all the selection periods you defined (see also Release Note General Basic Settings) and
also the case periods (see below) for selection.
Page navigation:
If you have defined several pages in your configuration of the patient record (see also Release Note Create
Configurations) and selected the Allow Page Selector checkbox, the system displays the selectable pages.
Note that in the configuration you also put the pages on separate pushbuttons (event
FPM_CHANGE_CONTENT_AREA) and can define a function key setting for this, for example, to also enable
navigation via keyboard shortcuts.
Personalization icon:
This icon is available if you have selected the Allow Personalization checkbox.
Print icon:
This icon is available if you have selected the Allow Printing checkbox.
Help icon:
This icon is available if you have selected the Allow Help checkbox.
All user-interface building blocks (UIBBs) defined in the configuration and the related patient data are then
available to you in the patient record's display area. The following forms of display are possible:
Tables:
The system displays the following objects in table form:
o Documents
o Diagnoses
o Orders (clinical orders and requests)
o Medication orders
o Services
In all tables, the system displays the objects grouped by date, except for medication orders, which are
displayed with the validity interval.
Regardless of this system behavior, you can change the sort order of your tables with a simple click on the
table column header. You can sort according to several columns by pressing and holding the Ctrl key
while clicking in the table header.
You can display details on specific objects directly in the table. Additionally, you can have the system
display the status history for objects with status (e.g. documents).
Flowsheets:
The system displays the following objects in flowsheet form:
o Vital signs
o Lab values
Lists:
The system displays the following objects in list form:
o Progress entries
o The Flagging UIBB
Search
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For details about the search, see also Object Search.
Case periods
For selection purposes, the system automatically provides the cases assigned to the patient as case periods
within the period selection. The system sets the case start using the start date defined in the case. If the start
date is missing, the system displays
the admission date for an inpatient case
the date of the first visit for an outpatient case
The case end is defined using the case end date. If the end date is missing, the system displays
the discharge date for an inpatient case
the date of the last visit for an outpatient case
The system displays the case periods in descending order according to the start date of this case period.
The system only shows the last 5 cases. If the patient has more than 5 (cross-institution) cases, the system
displays the entry "More". By selecting this entry you call a dialog box containing all cases for the patient.
ISHMED_MISC01: Patient Record - Patient Header (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), the patient record is available in whose
upper area the system displays the patient header.
The patient record displays patient-related and case/related data in order to
Identify patients uniquely (risk management)
Assign patients from an organizational perspective
Identify important medical information that may call for an active response by the medical/nursing staff
Identify important information relevant to billing
Provide demographic information about the patient
The patient header essentially shows patient-related information first (upper area). Below this, the system
displays case-related data (in different colors).
You can view the following information in the patient header (from left to right) in the upper area:
Patient name
Patient ID
Birthdate
Sex
Age
Principal/main diagnosis (DRG, hospital or department main diagnosis)
If further treatment diagnoses exist for movements in the same department, these can be viewed by clicking
the main diagnosis.
Indicator for private patient
VIP indicator
Deceased indicator
Risk factors
If risk factors are documented, you can view a list of the risk factors by clicking the icon.
Allergies
If risk factors are documented, you can view a list of the allergies by clicking the icon.
You can view the following information in the patient header (from left to right) in the lower area:
Case number
Admission date
Case type
Status of the movement, for example:
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o Planned admission
o New admission; admission within last 30 hours
o Active stay
o Planned discharge; the discharge is displayed as the quick info text
o No active stay
o Patient is absent
Department/care unit/room/bed
Length of stay in days
Indicator showing if the average length of stay or high trim point has been exceeded
Number of pre- or postoperative days
If the patient has several surgeries during his/her stay, the system primarily displays the number of days until
the next surgery. If no more surgeries are planned, the system shows the postoperative days.
Attending physician
ISHMED_MISC01: Patient Record - Data Display (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), the main patient data is available in the
patient record.
You can call the single object display for the following objects:
Documents
Diagnoses
Medication orders
Clinical orders
Services
You call the single object display by clicking the hotspot on the object name. A dialog appears in which the
system presents the selected object in the display defined using the transformation. All other objects that are
displayed in the UIBB are available for direct navigation in the single object display dialog.
A detailed display (display of further information directly in the patient record) is available for the following
objects:
Documents:
The detailed display can only be used for parameterized documents (i.e. the detailed display is not possible for
WordContainers or PDFs and images in an archive). Additionally, you need to set the display format XML for
the quick view in the document managment data.
We recommend that you store a transformation for the XML display in the document management data, which
restricts the detailed display to the key information (for example, result, recommendation).
Clinical orders:
The system displays the assigned services for the clinical order or request in the detailed display. For an order
with a cycle, the system only displays the ordered services. The system displays the individual settings for the
order or patient in the UIBB Services.
Lab values:
You can display individual lab parameters in graphical format directly below this lab parameter. Note that to do
this, you need to click the hotspot for the lab parameter.
Medication orders:
For medication orders, the overview display (table) already contains information about specifics and planned
activities. In the detailed display, the system shows information about planned interruptions, drug substitutions,
the next scheduled administration and the last administration.
Progress entries:
For the progress entries, the system displays the administrative data for the note (for example, documenting
OU, category).
You call the detailed display by using the corresponding pushbutton in the overview display of the objects.
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Note the following special features of the object display in the overview:
Case period:
Note that the system displays all case-related objects - including the objects that are assigned to preadmission
and postdischarge visits - and also all purely patient-related objects in the specified case period.
Status:
The system displays the various statuses in color as follows:
o Initial status of an object highlighted in yellow
o Final status of an object highlighted in green
o Intermediate status of an object highlighted in blue
Diagnoses
Note the following special features:
o Selection:
Since diagnoses are still valid if the start date of the selection is after the date when a diagnosis is
created, the system displays these diagnoses immediately the assigned case for the diagnoses occurs
in the selection period.
Example: Case period
The system always displays multi-case diagnoses unless you have selected the Hide Multi-Case
Diagnoses option in the UIBB selection options and the case is not the one that is currently selected.
o Display:
The system displays specifics for diagnoses in a separate column. This can be information on
indicators for multi-case diagnoses, blocking indicator and medical secondary diagnosis.
In addition, the system highlights multi-case diagnoses in gray.
Lab values/vital signs:
You should note the following special features:
o As part of the configuration process, you can define the sort order of the values (by default, the most
recent values are shown on the right).
o You can have the system display the respective most recently measured value within the selection
interval in a separate column. This is useful if you have numerous measurements for which specific
values are only recorded irregularly and which are consequently not immediately visible in the display.
o The system highlights values that deviate from the normal range in color; for example, lab values red,
problematic vital sign values orange and critical values red.
o When a comment has been entered for a lab value, a hotspot is provided. If the normal range at the
time of the measurement deviates from the currently displayed normal range, the system also provides
a hotspot.
For vital signs, the system shows a comment area below the flowsheet instead of the hotspot for
deviating normal ranges.
Clinical orders:
Several services can exist for clinical orders. The system concatenates these in the overview. The same
applies for documents entered for these services. In this case, the system displays a pushbutton that has the
following effect:
o If there is only one document for the order, the system calls this document directly in the single object
display.
o If several documents exist, the system lists them with the services in the detail area for the order when
you use the hotspot.
Progress entries:
You can define the number of entries to be displayed in the configuration. If several entries exist for the
selection period, functions are provided for scrolling in the entries.
Medication orders:
The system displays all medication orders whose validity period occurs in the selection period. This also
applies for currently suspended medication orders.
Services:
If a service belongs to a clinical order, the system displays a corresponding icon in the overview display
column. If you click the hotspot on this icon, the system calls the single object display for this clinical order.
If a document exosts for the service, the system calls this document directly in the single object display.
If several documents exist for a service, the system displays these documents below the service.
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ISHMED_MISC01: Patient Record - Data Filtering (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), you can filter the patient data objectspecifically in the patient record.
For this purpose, you can select the relevant filter options in the configuration of the user-interface building
blocks (UIBBs). Note that the use of filter options is only relevant if numerous different values are to be expected
for the respective option.
Example:
If there is only one institution on your system or if cross-institution patient management is not selected, it is not
relevant to use the filter option Institution.
The following rules apply for the filter options:
The system always displays all filter options. If there are no distinguishable values in a filter option, the system
displays the filter option as inactive.
If you filter according to a filter option, the system automatically adjusts the number of hits in the other filter
options.
Only values of a filter option that exist in the UIBB are available.
If you filter, the system shows a corresponding filter icon in the relevant column in the overview display. The
system also shows the Clear Filter function which lets you undo filtering. Moreover, in the filter option the
system replaces the general term (for example, document category) by the selected value.
Filtering in different filter options (for example, document category and documenting OU) is additive.
When you exit the patient record, the system automatically clears filtering.
Example:
If there is only one institution on your system or if cross-institution patient management is not selected, it is not
relevant to use the filter option Institution.
ISHMED_MISC01: Patient Record - Indicators (New)

Function Clinical System Functional Extensions 6 (ISHMED_MISC01), you can set indicators for patient objects
and display an overview of all objects of a patient for which an indicator is set.
You can set a user-specific indicator for an object as follows:
Click the hotspot in front of the icon in the relevant column in the various UIBBs. The system displays a
selection dialog with the indicators you have defined in the system (see also Release Note General Basic
Settings).
Click the icon and choose the Set function to set another indicator for an object if an indicator is already set for
this object. Note that the system can only offer the indicators that you have not set for the object already.
Click with the right mouse-button on the object row and choose the indicator using the relevant entry in the
context menu.
You can delete a user-specific indicator for an object as follows:
Click the hotspot or the indicator set for an object.
Open the context menu for an entry and delete the indicator using the relevant entry.
Moreover, you can choose the Details function for entries by clicking the icon next to the indicator. The system
displays a temporary screen area (popin) with all indicators set for the object.
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A separate UIBB is provided for objects that have set indicators. The UIBB displays the objects with set
indicators, grouped by indicator. If an object has multiple indicators, this object is contained several times in the
UIBB. Note that the system displays objects with set indicators independently of the selected selection period. In
this UIBB, you can delete the indicator from the context menu.

You can use the program RN1REMOVE_SIGNS to clear the indicators for one or more users. This program
automatically deletes indicators for objects that have been canceled in the meantime and are thus no longer
displayed in the patient record.
You can schedule the program to run at regular intervals to clear obsolete indicators.
ISHMED_MISC01: Patient Record - Object Search (New)

Function Clinical System Functional Extensions 6 (ISHMED_MISC01) you can perform a search in the patient
data within the patient record using the TREX search engine provided by SAP.
The main settings are already configured with the software delivery. To use the search in the patient record, you
need to make the following additional settings:
Set Up RFC Destination for TREX:
Create the RFC destination in the Configuration of RFC Connections function (transaction SM59). Then enter
this destination in the Implementation Guide under SAP NetWeaver Search and Operational Analytics
SAP NetWeaver Enterprise Search TREX Set TREX Destination and choose Execute.
Create Search Connectors:
In the Implementation Guide choose SAP NetWeaver Search and Operational Analytics SAP NetWeaver
Enterprise Search Modeling, Administration and Monitoring Open Administration Cockpit and choose the
Modeling function. Under the software component you find the application models delivered with the standard
system. Select one of these application models at a time and choose Actions Create Connector. The
following application models are available:
o Documents: N1PREC_DOCUMENTS
o Diagnoses: N1PREC_DIAGNOSES
o Progress entries: N1PREC_PROGDOC
o Clinical orders: N1PREC_CORDERS
o Services: N1PREC_SERVICES
o Medication orders: N1PREC_MEORDERS
Note that you need to re-index the data for the search at regular intervals. To do this, select an appropriate
indexing interval (for example, once daily). This means that data that has recently been created, changed or
canceled may not be found (correctly) in the search, since indexing cannot be carried out on an ongoing basis
for reasons of performance.
However, since the patient record usually always shows the current data when accessed (provided that an
appropriate configuration and start selection period is set), this is not an issue.
Example:
The physician performing the service creates findings. These findings are displayed immediately in the userinterface building block (UIBB) Documents where they can be viewed directly by the care unit physician.
After the index has been created, a UIBB is provided for the search in the patient record in which you can search
for medical terms in the indexed data. Besides the normal search, you can also use the advanced search,
favorites for the search, and so on.
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You can also enhance the search with your own objects. To do this, you need to create the application models
and connectors described above. You also need to create an appropriate implementation in the Business Add-In
(BAdI) BADI_ESH_IF_OBJECT_DATA, which will index the data.
See also
For general information about Search and Classification TREX, see the SAP Library under SAP NetWeaver 7.0
EHP 2 SAP NetWeaver by Key Capability Information Integration by Key Capability Search TREX 7.1
for SAP NetWeaver 7.0.
For more information about the search, see the Implementation Guide under SAP Healthcare Industry-Specific
Component Clinical System Patient Record Set Up Search for Patient Record.
ISHMED_MISC01: Patient Record - Enhancement Possibilities (New)

function Clinical System Functional Extensions 6 (ISHMED_MISC01), the following enhancement possibilities
are available in the patient record.
Business Add-Ins (BAdIs):
o ISHMED_PATIENT_RECORD for general enhancements in the patient record
o ISHMED_PATIENT_RECORD_CONFIG to determine the configuration for the patient record
Layout enhancement:
For information about structures (for the purpose of enhancement via append) and the Web Dynpro
components, see Release Note ISHMED_MISC01: Patient Record - Create Configurations (New)
The following structures are available for you to enhance the single object display:
o Diagnoses: RN2CLIO_DIAMOV_DETAIL
o Clinical orders: RN2CLIO_CORDPOS_DETAIL and RN2CLIO_ANF_DETAIL
o Services: RN2CLIO_SERVICE_DETAIL and RN2CLIO_NRSSERVICE_DETAIL
o Medication orders: RN2CLIO_MEORDER_DETAIL
You can use the enhancement logic in Web Dynpro and in the patient record to enhance or change existing view
on the data and incorporate your own components into the record.
See also
More information about enhancing the patient record is available as a PDF file in the download area of the
i.s.h.med web site.
PLANNING
General
ISHMED_MAIN: Planning - User Parameter N1PTSWTM (New)
function Clinical System (ISHMED_MAIN) the user parameter N1PTSWTM is available in the i.s.h.med planning
grid.
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You use this user parameter to control whether the system should display the appointment time in the tooltip in
the i.s.h.med planning grid when the cursor is moved over an existing appointment.
Note that this modification is only effective if you use the i.s.h.med planning grid version 7.6.6 or higher.
See also
This user parameter is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
ISHMED_MAIN: Planning - Change Reason Query (Changed)

Function Clinical System (ISHMED_MAIN) an additional security prompt concerning the change reason for the
appointment is available in the appointment editor area.
If a change reason had already been entered for an appointment change, this change reason was not
transferred as the new change reason the next time the appointment was edited. Instead, the system initialized
the Change Reason field and transferred no change reason.
The system will now display a query at this point, with which a change reason which you have already entered
can be transferred for a new change.
See also
ISHMED_MAIN: Planning - Display Locked Scheduling Type (New)

function Clinical System (ISHMED_MAIN) the system will display a time period of the i.s.h.med planning grid in
red, if a time slot and planning authority exist for this (the scheduling type has the lock indicator set).
You should note, however, that, depending on the authorization object IS-H: Authorization for Appointment
Planning (N_AMB_DSP) it is still possible to book an appointment.
See also
The display of a locked scheduling type is also available with SAP enhancement package 5 for SAP ERP 6.0,
Industry Extension Healthcare (IS-H 605), Support Package 03.
SURGERY SYSTEM
Surgery Planning
ISHMED_MAIN: Surgery System - Calculate Surgery (Enhanced)
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Function Clinical System (ISHMED_MAIN) enhancements are available for the Calculate function in the
Surgeries view type and the Surgery Scheduling view type in the clinical work station.
The Calculate function now also takes into account expiring and ended surgeries.
In the OR plan you use the Calculate function for a date in the future to close gaps in the plan. This means you
can optimally use the room capacity. The planned end of a surgery is also the planned start of the next surgery.
The calculation of the appointments is always oriented towards the beginning of the planning authority of the
planning organizational unit for a room. The surgeries are organized seamlessly so that there can be no time
slots which are planned several times, and any free time slots occur at the end of the day.
If fixed appointments exist in the OR plan, these are not moved by the Calculate function. These fixed
appointments are anchors for subsequently planned surgeries.
If the system cannot resolve an overlapping of surgeries, it will display an information message.
In the current day program the planned surgeries are processed in their given sequence. If surgeries are
delayed, you can use the Calculate function to adapt the appointments of the surgeries which have not yet
started to suit the current situation. The system will rid the OR plan of overlapping and bring all appointments
which can no longer be realized up-to-date.
The Surgeries view type has been enhanced by process flow control.
To achieve this you must configure the time for the process flow start (room entry) and the process flow end
(room exit) in surgery scheduling customizing. As soon as the room entry time is set for a surgery, this surgery is
recognized as being underway. The provisional end is calculated from the room entry plus the planned duration
from the appointment. The provisional end of the surgery which is underway is the earliest possible start for the
subsequent surgery.
As soon as the room exit is set the surgery is considered to be ended.
If you have activate the Business Function ISHMED_SCD, you define the times in i.s.h.med customizing under
Industry-Specific Component Clinical System -> Surgery System -> Surgery Scheduling -> Surgery Scheduling:
Times.
If you have not activated the Business Function ISHMED_SCD, use the customizing table N1SSWSTM via
transaction SM30.
The following columns have been adapted or enhanced in the Surgeries view type:
Time: Planned start for appointments room entry time if existent
Duration: Planned duration for appointments, actual duration (difference between room entry + room exit) is
existent
Planned Duration: Planned duration from appointment
Room Entry: Time from time stamp for room entry
Room Exit: Time from time stamp for room exit
The process flow start time, the planned duration and the process flow end time of a started surgery are used for
the Calculate function. There are various situations:
A surgery has started but has not yet ended.
The provisional end of this surgery is calculated from the process flow start time plus the planned duration. The
Calculate function searches for all plannable subsequent surgeries and reschedules their appointments so that
no overlapping remains. The appointment of the first subsequent surgery is the same as the provisional end of
the surgery which is currently underway. Fixed appointments are retained. The sequence of the appointments
is also always retained.
A surgery is ended.
Using the actual end time the Calculate function can seamlessly arrange the subsequent surgeries and, if
necessary, reschedule them. You should note that appointments can not be rescheduled in the past. The
earliest planned start time is the system time.
Start of day
If the first surgery of the day does not start as planned, the Calculate function will recalculate the surgery
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appointments. The system moves the time of the first surgery of the day back to the system time. If necessary,
the system then reschedules all subsequent surgeries according to this surgery.
Consideration of Fixed Indicator

If you call the Calculate function and the OR plan contains an appointment with the Fixed indicator, this fixed
appointment is not rescheduled. As long as the calculated new start times of the previous surgeries are before
the start of the fixed surgery, the system reschedules these and the sequence is retained.
You should note that the following situation can arise when a surgery with a subsequent fixed appointment is
started:
Surgery A planned from 10:00 11:00
Surgery B planned from 11:00 12:00, this appointment is fixed.
Due to a delay in the process flow surgery A does not start until 11:15, i.e. after the planned start of the fixed
appointment of surgery B.
The system will switch the sequence in the display as follows:
Surgery B planned from 11:00 - 12:00, fixed
Surgery A started at 11:15.
Automatic Call of Calculate Function

In certain situations the system calls the Calculate function automatically. This means no special user interaction
is necessary to adapt the OR plan to the new situation in the following actions:
Changing an appointment
Canceling an appointment
Creating a new appointment in the plan (also Drag & Drop)
Additionally the system executes automatic calculation during the following actions:
Start Surgery
Set Room Entry or Room Exit Time Stamp (when called from the current view)
You can activate and deactivate this automatic action in the selection variant of the Surgeries view type. The
Execute Automatic Calculation option is available for this.
OR Plan Sequence
The process flow of the day program for surgeries is oriented towards the sequence, which is supported by the
list display of the Surgeries view type. The planned sequence of the surgeries must also be retained in the
process flow, if rescheduling is not explicitly triggered by user interaction.
In the Surgeries view type the sort order is determined using the Time column with the planned surgeries and for
started surgeries with the actual start time. In situations where great delays would lead to major rescheduling the
system always automatically calls the calculation function, regardless of the settings in the selection variant of
the view.
If the system cannot execute an automatic rescheduling due to missing calculations etc., it will display a
corresponding information message.
Call
The system always executes the Calculate function for all operating rooms displayed in the Surgeries view type.
Report RN1OP_CALC
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The report RN1OP_CALC is available for the execution of the calculation function in the OR plan. You can
schedule this report periodically, for example, in order to execute OR plan calculations if relevant actions are
made outside of the Surgeries view type. The report has the following selection parameters:
Institution
Planning Organizational Unit
Date From/To
The system always recalculates all appointments in the operating rooms for which planning authority for the
planning OU.
You can call the customizing table N1SSWSTM using the transaction SM30 or in customizing under IndustrySpecific Component Clinical System Surgery System Surgery Scheduling Surgery Scheduling: Times.
Here you enter the time stamps which you use for the documentation of the room entry and room exit. Using the
Status column you can define for the "Room Entry" event, that the room entry is documented using the time from
the Start Surgery function.
You can also assign several times for both events. You should note that the last time set is always relevant.
See also
This enhancement is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
OR Documentation
ISHMED_MAIN: Surgery System - Call Surgery Work Station (Enhanced)
Function Clinical System (ISHMED_MAIN) enhancements are available when you call the surgery work station
for predocumented surgeries:
The organizational unit (OU-related) parameter OP_MON_ACT has been enhanced by the value "I".
If you, as the system administrator, set the value of the parameter for an OU to "I", the system displays the
surgery work station and not the surgery monitor for a surgery as previously. Until now the surgery monitor was
called for surgeries which already have a document assigned, if the surgery work station had not ever been
called before.
In order to be able to call documents which were created outside of the surgery work station in the surgery work
station, base items of the DOCUMENT base item type must adapted.
In the Filter Values for BAdI group frame you enter "SURG" in the Before Execution field.
The system opens the default implementation EI_ISHMED_BASEITEM_DOCUMENT, which means that existing
documents of a document category for a task are called, even if they were not created within the surgery work
station.
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See also
Calling the surgery work station for predocumented surgeries is also available with SAP enhancement package
5 for SAP ERP 6.0, Industry Extension Healthcare (IS-H 605), Support Package 08.
ISHMED_MAIN: Surgery System - Team Entry Times (Changed)

Function Clinical System (ISHMED_MAIN) the system automatically fills the To Date and To Time columns when
saving the team entry, if the From Date and From Time are filled. The system will transfer the value of the From
Date into the To Date. It fills the To Time with 00:00.
Note:
If the From and To times are 00:00, the system will interpret the personnel commitment period as initial. If only
the To Time is 00:00, this means that the To Time is still initial.
See also
ISHMED_SCD: Surgery System - Surgery Scheduling Status Tolerance (Enhanced)

function Clinical System Situation Based Clinical Documentation (ISHMED_SCD), the OU-related parameter
N1PTDLY is available in surgery scheduling. You can use this parameter to define tolerances (in minutes) within
which a deviation from the planned value does not lead to status change.
The OU parameter N1PTDLY defines a time interval that is used as the tolerance range for the change of a
surgery's status in surgery scheduling. The status of a surgery is highlighted in color in surgery scheduling.
If, for example, you enter the value 10, this means that a status which indicates a delay will only be set after a
delay of 10 minutes.
You have planned a surgery for 10:00. You can select from the following options:
This surgery is started at 10:05. In the graphical display of the Surgery Scheduling view type, this surgery is
displayed with the color status for "Surgery Started", since its start was delayed only by 5 minutes and the
tolerance limit is 10 minutes.
If this surgery is started at 10:15, it will be displayed with the "Process Flow Start Delayed" status as of its
start.
The value of the parameter also concerns the "Planned Start Delayed" status as well as "Planned End Delayed"
and "Process End Delayed".
The OU parameter N1PTDLY has been introduced. Maintain this parameters for the organizational units on
which planning has taken place. The default value is 0.
See also
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This enhancement is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry Extension
NURSING PROCESS DOCUMENTATION

General
ISHMED_SCD DE: Nursing Complex Procedure Score (PKMS) (New)
This document concerns nursing complex procedure scores (German: PKMS), which are relevant for the country
version Germany only. As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (ISH 606), business function Clinical System Situation Based Clinical Documentation (ISHMED_SCD) functions for
deriving the nursing procedure complex score (PKMS) and future billing-relevant OPS codes are available within
the Nursing Process Documentation component.
Based on the nursing diagnoses, nursing problems, and nursing goals documented by the nursing staff and the
nursing procedures and interventions entered within the nursing process documentation, the corresponding
nursing complex procedure scores are automatically derived. PKMS is a scoring system defined specifically for
nursing as of OPS 2010, which can be used to evaluate the highly complex treatment of patients in normal care
units/wards.
PKMS is used to map the nursing outlay and case cost calculation of highly complex care in the G-DRG system.
The system derives the corresponding OPS codes from these nursing complex procedure scores. It uses the ISH procedure rule P10, which has been available since October 2010, to generate the OPS code.
PKMS documentation and the associated OPS codes are not revenue-relevant for 2010 and 2011. These
procedures will provisionally be a DRG consideration from 2012 onwards.
PKMS is currently only relevant in Germany.
In conjunction with the introduction of PKMS the corresponding i.s.h.med functions concerning the nursing staff
regulation (NSR) have also been enhanced by the resulting newly created level of nursing care A4.

PKMS derivation is based on existing nursing diagnoses, nursing problems and nursing goals as well as nursing
procedures, which are already stored in the system as basic catalogs.
You must connect these basic catalogs with the new basic catalogs for PKMS reasons as well as for PKMS
procedures.

The PKMS functions, such as for example PKMS derivation, are activated exclusively by the activation of the
corresponding business add-ins (BAdIs).
For the daily derivation of nursing complex procedure scores you must reschedule the background report PKMS
Classification (R1_NRS_PKMS). Based on the entered nursing documentation, this report calculates the PKMS
score for each patient each day.
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In Customizing under Industry-Specific Component Clinical System Nursing Process Documentation

Nursing Complex Procedure Scores (PKMS) execute the following steps:
You must activate the BAdIs listed in customizing, which are relevant for PKMS entry and PKMS derivation.
You must create the following basic catalogs:
o Catalog category "PKMG - PKMS Reasons"
o Catalog category "PKMI - PKMS Procedures"
Alternatively you can create both basic catalogs by importing the available BC sets included in the delivery.
If you do not only use PKMS basic catalogs which were available as a BC set in the delivery, but have also
created your own PKMS basic catalogs, you must make the relevant adjustments to the BAdI reason rules and
BAdI procedure rules. The sample source code of these BAdIs is oriented towards the sample catalogs which
exist as a BC set.
You must make a connection between the nursing diagnoses, nursing problems and nursing goals with the
correlating PKMS reasons.
You must make a connection between the nursing procedures and the correlating PKMS procedures.
You may need to enhance the service master file with services which are required for PKMS derivation and the
generation of the OPS codes.
You must activate the IS-H procedure rule P10 for generating the OPS codes.
If this has not already been done, you must store the level of care NSR A4 in the system (as a rule this should
already have been done).
You can find more information on the above mentioned customizing activities in Customizing under IndustrySpecific Component Clinical System Nursing Process Documentation Nursing Complex Procedure Scores
(PKMS) System Adjustments to Be Made.
See also
You can find information on the relevant changes to the service master file and the customizing of the procedure
rule in SAP note number 1517181 from October 2010.
MEDICATION
Medication Master Data
ISHMED_MAIN: Medication - Drug Administration Base Item (New)
function Clinical System (ISHMED_MAIN), the Drug Administration base item type is available.
You can use the new base item type to create tasks in the documentation work station, which enable the
documentation of the provision and administration of drugs.
If the corresponding action is stored, base items of the Drug Administration type can also be configured for tasks
for the documentation of emergency events.
Integration
You can use the base item type in the Ward documentation work station, the Outpatient Clinic documentation
work station and the Surgery documentation work station components.
You define base items in the Manage Templates customizing activity (N2WLD).
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ISHMED_MAIN: Medication - Master Data and Settings (Enhanced)

function Clinical System (ISHMED_MAIN) you can determine tolerance times for the deviation from a planned
time for drugs where administration is time-critical..
For this purpose there are two new fields available on the Inpatient tab page in the master data of the drug
catalog. If you have set the Time-Critical Drug checkbox, you can use these fields to enter a number of minutes
as the maximum tolerated time difference before and after the planned time of an administration.
If a tolerable time difference is maintained for the administration of a time-critical drug, and this tolerance time is
exceeded in the documentation of an administration, the system checks whether a reason for the time difference
is documented in the administration documentation. If this is not the case, the system displays a message.
If no maximum tolerated time difference is maintained for the drug concerned, the BAdI N1ME_READ_PARAM
is called and the parameters N1ME_TIM_BEF and N1ME_TIM_AFT are read. If one of these values is unequal
to 0, these values are used to enforce the check of a time difference during the administration documentation.
The existing parameters for the time difference ZZMINBSCH and ZZMINASCH are no longer queried.
Other Enhancements
The report RN1ME_END_EVENTS also ends PRN medication main events if these have a status other than
the first "Confirmed" status.
You can use the work area of the authorization object N_1USRPREF to control the user-specific presettings
areas in which a user should have the corresponding authorizations.
The info block N2CLIO_IB_ME_ORDER_DATA is available for the clinical overview in the documentation work
station. This implements the display of an order in just a few columns, which summarize data from several
fields of the order. The system displays all active orders, including saved and suspended orders, providing
they are valid at the time of display.
ISHMED_MAIN: Medication - eMAR (Enhanced)

Function Clinical System (ISHMED_MAIN) the following enhancements are available for administration
documentation:
In the chart the system displays administered medication events of infusions or nutritional solutions with the
status "Administration Started" if they have not explicitly been documented as removed and their calculated
end time is no more than 12 hours in the past.
The system will also generate events for cycle times at 00:00, whereby the times 00:00 and 24:00 have been
grouped together to make one time.
In case of mixed infusions, which must be administered time-critically, you must enter a reason for any time
difference in the administration documentation.
The dose difference reason for infusions which are administered in several individual bags, is no longer
necessary in every case during the documentation of the administration of the first bag. A dose difference
reason is only necessary if less than the ordered quantity was prepared and there are therefore not enough
preparations available for the ordered infusion. Furthermore a dose difference reason is also necessary if you
document the infusion as removed and the overall quantity differs from the ordered dose.
The system will also calculate the scrap quantity for the ingredients of infusions for drugs which are dispensed
in packages. Users can generally also enter entire packages or entire packages and remnants of opened
packages as the scrap quantity.
On the Ingredients tab page a column with the drug description is available in drug administration.
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In the administration documentation for mixed drugs which are prepared in the OU fields are available for the
reasons for a time difference and a dose difference.
In the administration documentation the Not Administered indicator is also available for compounds prepared
in the OU.
In the administration documentation for standard drugs the sytem always displays the information on the last
administration.
When you suspend an infusion order, a rate of the "Interrupt" type is created for the flow rate. If the current
user has no EmR set, the system presets the EmR for this interruption with the EmR who was entered as
being responsible for the status change.
In case of PRN medication with a drug which cannot be dosed precisely the system displays no planned and
actual quantity in the administration documentation, even for the first event which contains the quantity to be
administered, which is relevant for inventory management.
In order to be able to display the "Administration Started" status in the chart, you must have installed at least
chart version 6-05-16.
ISHMED_MAIN: Medication - Order (Enhanced)

Function Clinical System (ISHMED_MAIN) the following enhancements are available:
You can also use a sliding dosage without a duration determined at the time of the order. When you switch to a
sliding dosage the system presets the sliding dosage and cycle information of the order, providing these have
previously been filled, if no such dosage definition exists. If you switch back to a normal dosage, the order is
preset from the first existing sliding dose regulation.
In case of PRN medication orders there is also a checkbox available for an immediate dose. If you select this
for a PRN medication order, the system creates an initial medication event to be administered, in addition to
the PRN medication main event for the day. Following administration this drug dose is included in the daily
overall dose.
When you create a new order with the "Immediate Dose" status set, the system always uses the actual time for
the immediate dose event, providing the order start lies in the past. For orders with a start time in the future,
the system will still use the start of the order as the time for the immediate dose event.
In the chart the system displays all mandatory check conditions in the quick info text of the order and the
events.
In the order dialog the "Order Description" column now has an input help and is locked against further
processing once the order has been activated.
The generation of the event description for mixed drugs now takes the relevant solution into account. It lists all
ingredients of the mixed drug in a sequence defined according to the ingredients.
Previously the entry of initially suspended orders required several steps and status changes, whereby the
predating of the suspension date to the start of the order was no longer possible.
The Activate Suspended function is now available in the order dialog for entering such orders, which activates
a newly created and, as yet unsaved, order and automatically sets the suspension start date to the order start
and adapts the change history accordingly..
The system now also automatically updates the chart in the order dialog as well as in order processing in the
documentation work station during every save, as well as during temporary saves.
ISHMED_MAIN: Medication - Order Templates (Enhanced)

In order templates, the dose calculator behaves as follows:
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If the dose calculator is preset in the flow rates, you can leave the planned duration for rates blank in the order
templates. If a dose calculator is preset here (with data which requires patient data, i.e. rate by weight or BSA)
the duration can be left blank and the other rate durations are no longer calculated.
As soon as a dose calculator with a reference to patient weight or height is filled in a template, the planned
durations of all rates are removed. If a planned duration is subsequently entered somewhere in a rate of the
"normal rate"/"start rate" type, the dose calculator is reset in all rates of the "normal rate"/"start rate" type, and a
status message (information) is displayed, informing the user that the dose calculator has been reset.
The Transfer to Template function is also available in the order dialog and in order processing of the
documentation work station. You can use this function to transfer an entered order as a new template in a new
template group to be created. The function opens the template group maintenance function, enables the
processing of the template created from the order and, upon exit, returns you to the order dialog or the
doumentation work station.
The Add to Favorites function is available in the search dialog. You can now assign templates to yourself by
selecting a template and choosing Add to Favorites.
Mixed drugs can be created directly in the template group. The following functions are available in the Change
Template Group dialog (transaction N1ME_TMPL) for this:
o New Infusion
o New Compound
o New Nutritional Solution
The Copy Template function is available for copying a template within a template group. You use this function,
for example, to store several dosage variants of the same mixed drug in a group or duplicate an order used
multiple times in a therapy profile.
The copy receives all data, details and names from the original and can then be adapted accordingly.
When using copies, you should note that each template can have a description which is independent of the
order text and can be used in the search to differentiate between variants for orders for the same drug. This
description is created in the details on the Template Data tab page.
Medication Order
ISHMED_MAIN: Medication - Bar Code in Administration Process (New)
function Clinical System (ISHMED_MAIN), the Bar Code Scan Selection function is available.
You can integrate this function in function variants of the Occupancy, Order and Event view types.
Calling the function opens the dialog for entering patient and event bar codes, which can be transferred into the
worklist of the Drug Administration dialog or quick administration once the scan procedure has been completed..
You then complete the provision and administration documentation as usual in the Drug Administration dialog.
The Bar Code Scan Selection function is also available in the Drug Administration dialog, to enhance the worklist
during the documentation process, i.e. execute a subsequent selection. You can also use the bar code scan
subsequent selection in the Documentation work station in tasks with the Drug Administration base item type.
If the system which produces the bar codes within its workflows does not use the i.s.h.med event number for
identification, you can program the determination of an i.s.h.med event number using the data contained in the
bar code in BAdI ISHMED_ME_CONVERT_BC.
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ISHMED_MAIN: Medication - Views in Clin. Work Station (Enhanced)

In the Medication Orders and Medication Events/Nursing Services view types, as well as in the compressed
view of the order dialog, the system uses the Compare tooltip to symbolize the infusion type Intermittent
Infusion.
The Medication Orders and Medication Events/Nursing Services view types display the actual status in the
Bed/Room fields and not the planned status, providing the patient has a planned transfer.
You can use the Create Emergency Event function (previously: Ad Hoc Administration) to add an extra
administration for an ongoing order. To do this you select an order or event in the Medication Orders or
Medication Events view type of the clinical work station, and call the Emergency Event function. If the order
type permits this, you will receive a message window offering you a choice of documenting an extra
administration for the selected order or creating a separate emergency administration as previously.
In the Occupancy view type of the clinical work station the system will indicate, in the "Changes to Order Exist"
column with the quick info text Changes to Order Exist, if at least one order with as yet unconfirmed changes
exists for this patient.
The column implements a hotspot, which branches to a view of the Medication Orders view type, where the
Display Orders with Change Attribute indicator must be set in the selection variant.
Confirm Changes to Orders:
In the Medication Orders view type you confirm the changes to the orders via multiple selection and calling the
Confirm Changes function. Furthermore, the hotspot in the "Changes to Order Exist" column has been modified
in this view type so that the changes to the corresponding order are immediately confirmed when you click.
In order to sort the changed orders so that the previous and new orders are displayed directly below each
other, the "Original ID" column is available. It contains the same ID for all orders of an order sequence, which
results from order changes.
ISHMED_MAIN: Medication - Drug Search (Enhanced)

As of SAP enhancement package 6 for ERP 6.0, Industry Extension Healthcare (IS-H 606), Business Function
Clinical System (ISHMED_MAIN) you can use a phonetic algorithm to index drug names (mnemonic, drug
description, generic name and brand name) and agent names using the central index table, to enable a phonetic
search. Using phonetic search algorithms, the drug search will also find results if the search term is not
completely orthographically correct. For example, if "Oxidozyn" is entered, the search will also find drugs with
"Oxitocin" in the name.
Indexing according to the Regensburg Phonology is the algorithm which is available as standard.
Enhancements in the Search and Result Display:
The drug search for order templates displays the description of the template in the "Description" column. If this
does not exist, the order description appears, if this is also blank, the mnemonic is displayed.
For the template group, the system displays the description of the template group in this column and, if this is
blank, the short name of the template group.
The column header of the "Mnemonic" column has been changed to "Key" so that the contents are also correct
for template groups. The unique short name is displayed here for template groups.
In future the system will also automatically search for a search term entered in the drug search in the template
group names. This means the system can also find template groups, even if the user does not know any of the
names of the drugs contained, but does know the name of the group.
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Enhancements in User-Specific Presettings:

In the user-specific presettings a selection list is available in the Search Mode and Procedure group box, which
lists the phonetic search algorithms which are available in the system. Here you must select a procedure with
which the system processes during a phonetic search.
You use the Start with Phonetic Search checkbox to control whether the system should principally always start
the phonetic search procedure first, or whether the system should first execute a standardized search.
In the user-specific presettings the Display Favorites checkbox is available in the Automatic Display of Search
Results group frame on the Results tab page. You can control whether the system displays the drug favorites
of a user and the templates assigned to him when the drug search is called as a hit list.
In the drug search results list and in the name column in the chart, the system displays either the drug
mnemonic or the drug description, and the template group name or the template group description for order
template groups. You can control the display on the Results tab page in the Drug Labeling group frame using
the Key or Label checkboxes.
You can sort the drug favorites in the results list regardless of the sort order determined in the results list. The
Use Sorting Behavior checkbox is available on the Results tab page in the Favorites group frame for this. If
you select this checkbox, the system sorts the drug favorites in the same way as the other results in the results
list. Otherwise the system will sort favorites according to their priority and template group alphabetically.
In the search presettings you can store a classification system which is then used as the classification system
for result checking. This setting is relevant for customers who have several classifications assigned to one
drug in their drug master, but wish to group the search results by only one specific classification system. The
selected classification system is stored on the Search tab page in the Search Restrictions group frame in the
Classification System checkbox. This field is still used to preset the classification system on the Complex
Search tab page of the search dialog.
You can determine that the search term should also be used for template groups. On the Search tab page in
the Enhance Search Criteria group frame select the Search Using Template Group Name checkbox.

The phonetic search is only available if you have indexed the dataset using a phonetic search procedure. The
phonetic index is subsequently executed automatically in the background. The first time you wish to use the
phonetic search you must execute report RN1ME_BUILD_SRCINDEX with the COMMIT checkbox selected, in
order to re-index the dataset.
In order to be able to automatically use the search term for template names, you must index all existing tempate
names. To do this you call the report RN1ME_BUILD_SRCINDEX with the execution option Initially Index
Template Groups. As of SAP enhancement package 6 for SAP ERP 6.0, Industry Extension Healthcare (IS-H
606) indexing for changed or created template groups is executed during saving.
You maintain the search algorithm in customizing for i.s.h.med under Industry-Specific Component Clinical
System Medication Drug Search Maintain Phonetic Search Algorithms.Here you define which algorithms
should generally be available and used during indexing.
PATIENT TRANSPORT SERVICE

General
ISHMED_MAIN: Patient Transport Service - Subsystem Connection (New)
function Clinical System (ISHMED_MAIN), the Business Add-In (BAdI) Transfer Transport Order to Subsystem is
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available. You can use this BAdI to transfer transport orders to subsystems.
The BAdI is available to you in the enhancement spot ES_ISHMED_PTS. The system will runs this BAdI each
time a transport order is saved. In this BAdI you can implement calls of web services, which are provided by a
subsystem, in order to transfer transport order data to the subsystem.
See also
The subsystem connection is also available with SAP enhancement package 5 for SAP ERP 6.0, Industry
Extension Healthcare (IS-H 605), Support Package 06.
CHARTING
General
ISHMED_SCD: Chart (Enhanced)
function Clinical System Situation Based Clinical Documentation (ISHMED_SCD) a new version of the chart with
enhanced functionality for the chart interface is available for download.
You can scroll exactly one day forward or one day back using two new pushbuttons.
If you display data of the medication and nursing modules or nursing process documentation, the system
displays the texts in shortened form, in order to use the maximum display area for the data. The complete names
are available via tooltips for each row or using a button for generally toggling the text display for the entire
display.
The Emergency pushbutton is available. If you have integrated a medication graph in the chart display, you can
use this button to hide all other graphs, in order to only display the medication graph. This provides a fast
overview of the patient's current medication orders. If you choose this button again, the other graphs are
displayed once again.
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RELEASE NOTES

SAP ERP 6.0, INDUSTRY EXTENSION

ADD-ON SUPPORT PACKAGE 46

ISH_MAIN DE: Comparison of Geographical Areas (New) ..................................................................................... 24

ISH_MAIN CH: Adjust Revenue Accrual for SwissDRG (Enhanced) ...................................................................... 57

ISH_MAIN AT: Communication Procedure P321 (Changed) .................................................................................. 78

General .................................................................................................................................................................... 100

ISH_CV_CN: Enhancement of Patient Master Data (New)

ISH_CV_FR: Comm.: RSF - Standardized Invoice Message (Changed)

ISH_MAIN: Business Function SAP Patient Management (Changed)

ISH_MAIN AT: NWATPARAM - Parameter SCO_KOMP (New)

ISH_MISC1: Business Function ISH_MISC1: Business Function SAP (Changed)

ISH_MISC1: Enhancement in Employee/Physician Data Maintenance (New)

ISH_MISC2: SAP Patient Management Legal Process Adoption 2 (Changed)

ISH_MISC3: SAP Patient Management Legal Process Adoption 3 (New)

SAP AMBULATORY CARE MANAGEMENT

ISH_AMBULATORY DE: Blank Form Printing (New)

Effects on System Administration

ISH_AMBULATORY DE: PPA Billing Field ID 5011 (Changed)

ISH_AMBULATORY DE: PPA Billing Field ID 4126 (New)

ISH_AMBULATORY DE: PPA Billing Field ID 3119 (New)

SAP PATIENT MANAGEMENT

ISH_MISC3: Accommodation Costs - Indicator for Additional Nursing Charge (New)

ISH_CV_FR: Defining Nursing Home Cases (EHPAD) (Enhanced)

depending on their level of care.

ISH_MISC1: Enhancement in Employee/Physician Data Maintenance (New)

ISH_MISC1: Search for Employee/Physician by Specialty (New)

Service Master Data

Clinical Work Station

ISH_CV_FR: Readmission of a Patient (New)

ISH_CV_FR: PMSI Model 2011 (Changed)

Online Connection to Grouper

ISH_MAIN: Patient Telephone Number Valid Throughout Case (New)

Creating new movements:

ISH_MAIN: Avoiding Unintentional Patient Master Data Changes (New)

ISH_MAIN CH: Insurance Verification (Changed)

ISH_MAIN CH: Swiss Healthcare Smart Card (Changed)

ISH_MAIN DE: German Electronic Health Card (Enhanced)

ISH_MAIN AT: EKVK - Alphanumeric Card Number (Changed)

ISH_MISC3: Places of Birth and Death (New)

ISH_MISC3: Accommodation Costs - Indicator for Additional Nursing Charge (New)

Patient Master Data

ISH_MAIN DE: Comparison of Geographical Areas (New)

ISH_MISC1: Store Postdischarge Phys. for Future Hospital Stays (New)

ISH_MISC1: Search for Employee/Physician by Specialty (New)

ISH_MAIN DE: Checks When Entering a Referring Physician (Changed)

ISH_MISC1: Store Postdischarge Phys. for Future Hospital Stays (New)

ISH_MISC1: Search for Employee/Physician by Specialty (New)

General Case Processing

These enhancements are available as of:

Care Unit Management

ISH_MAIN SG: DRG Data Exchange with 3M Codefinder (Changed)

Effects on System Administration

ISH_MAIN DE: Nursing Complex Procedures - Documentation Support (New)

ISH_MAIN DE: OPS 2010 Psychiatry - Documentation Support (New)

ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: MHLS (Changed)

ISH_MAIN SG: DRG Data Exchange with 3M Codefinder: Exits (Changed)

Effects on System Administration

Basic Medical / Nursing Documentation

Effects on System Administration

ISH_AMBULATORY DE: Report for Checking Outp. Coding Guidelines (New)

ISH_CV_FR: Clinical Work Station - Occupancy View Absences (New)

ISH_MAIN SG: Enhancements to Medical Documentation (New)