integrating paper documents into sap with dms and content server christian hoeninger - 3707

Integrating paper documents into SAP with DMS and Content Server

Christian Hoeninger - 3707

2

Provide Document Management Solutionfor incoming patient documents

based on

existing SAP and scanning capabilitieswhile limiting the requirement of

process re-engineering and training

The Project

3

Content Integrating paper documents into SAP with DMS and Content Server

• Preliminary Analysis

• Project Definition

• System Components

• DMS & Patient Management

• The Process in Detail

• DMS Maintenance

• Statistic/Numbers

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• DMS Maintenance


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Target Areas

Primary focus on claim-related documents in the departments

Other organizational areas for future integration• Clinical Services• Clinical Research & Clinical Programs• Accounting• Human Resources• Document Control (Quality Control)

Other organizational areas for future integration• Clinical Services• Clinical Research & Clinical Programs• Accounting• Human Resources• Document Control (Quality Control)

• Credit & Collection• Sales

6

Findings

• 11,000+ supply orders per month• 4,000 new patient files per month• 3,300 patient files retrieved per month• 24 minutes of work to retrieve and re-file one

patient file• 1,300+ person hours per month used for patient

file retrieval and re-filing

Pre-Analysis in Sales

7

Findings

• 4,000 new patient files per month• 7,000+ patient files retrieved per month• 10 - 15 minutes of work to retrieve and re-file one

patient file• 1,700+ person hours per month used for patient

file retrieval and re-filing

Pre-Analysis in Credit & Collection

8

Pre-Analysis Result

… for patient file retrieval and re-filing in

• Sales 1,300+ person hours/month = 7+ FTEs

• Credit & Collection1,700+ person hours/month = 9+ FTEs

• Keep 4 FTEs in “Opportunity to Cash” for document retrieval and re-filing

• Add 1 FTE to scanning department

Potentially free up 11 FTEs

• Keep 4 FTEs in “Opportunity to Cash” for document retrieval and re-filing

• Add 1 FTE to scanning department

Potentially free up 11 FTEs

9







• DMS Maintenance


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Project Definition

• The approach3.3.

• Benefits/KPIs2.2.

• Definition of high level requirements– Functional– Non-Functional– Global

1.1.

• Documents to be scanned• Document types• Document attributes

4.4.

11

Functional Requirements

• Convert paper documents to electronic form

• Electronic retrieval and display of documents

• Printing of electronic documents

• Enhance disaster recovery and business continuity planning through electronic document repository

• Support access to legacy documents (Medicare documents)

• Deliver system with acceptable document retrieval times

• Ability to search for documents, exchange contents with business partners and provide electronic attachments for claim submission

• Scalable to meet future growth

• Compatible to future “Data and Document Archiving”

• Capable of handling ~ 3,000 new documents/day

12

Non-Functional Requirements

• Minimize business process re-engineering / need for user re-training

• Inject little overhead into existing business processes to get documents converted to electronic form

• Improve cycle time of Billing & Collection through electronic access to patient data (decrease time required to file a claim or respond to a question on a claim)

• Ensure security and regulatory compliance for HIPAA (Health Insurance Portability and Accountability Act)

• Free valuable human resources from manual file handling and documentation

• Free valuable floor space that is occupied by bulky file cabinets• Provide patients with product support information in convenient

format/s

13

Global Requirements

• Utilize existing SAP capabilities

• Leverage existing scanning capabilities

• Use of proven SAP technology and interfaces

14

Benefits/KPI

• Decrease in manpower required to manage, store and retrieve paper documents, which will lead to substantial labor costs savings

• Decrease in the time it takes to file a claim or respond to a question on a claim, which will decrease the time it takes to collect receivables

• Enhance the ability of the business to deal with issues, questions or concerns related to a claim “on the spot”, which will result in increased customer satisfaction and decreased time to collect disputed receivables

• Decrease the need for floor space required to support the massive paper file cabinets, which should lead to more efficient use of existing office space

• Makes available disaster recovery techniques that would not be possible with the former paper intensive approach

15

The Approach

• Use of “standard” SAP DMS functionality

• Automate document creation/entry

– by using barcoded coversheets

– by using barcode recognition technology

• Automate document check-in (secure storage)

• Use of SAP’s Content Server as document repository

• Use of existing scan hardware and software

16

• Patient, payor, physician, regulatory documents across O2C business process

Documents to be scanned

Incoming documents including

• Mail• Print• Fax• Email attachments

Incoming documents including

• Mail• Print• Fax• Email attachments

17

Patient Document Types

P17 PWO

P18 Single Case Neg. Form

P19 Ten Month Letter

P20 Sign. Proof of Delivery

P21 Vol. Waiver of Benefits

P22 Eligibility letter

P23 Purchase Order (ext)

P24 Medical Claim Form

P25 AOB/WPR

P26 EOB

P27 HIPAA Privacy Notice

P01 ABN

P02 AOB/Info sheet

P03 Authorization

P04 Blood Sugar Log

P05 Chart/Doctor Note

P06 CMN

P07 C-Peptide Report

P08 Dietician Report

P09 FA Appl. Form

P10 HbA1C’s Report

P11 Insurance Corresp.

P12 Physician Corresp.

P13 Patient Corresp.

P14 LMN

P15 Medicaid Progr. Rep.

P16 Prescription

P90 Miscellaneous

P91 Unclassified

P92 Sales Order

P93 Shipper

Converted from legacy system(480,000 documents)

18

Document Type Attributes

Sca

n d

ate

Ori

gin

al/

Cop

y

Box n

um

ber

Sale

s ord

er

nu

mb

er

Deliv

ery

docu

men

t

Au

thori

zati

on

nu

mb

er

Payor

gro

up

Pri

mary

payor

Seco

nd

ary

payor

Valid

fro

m d

ate

Valid

to d

ate

Cate

gory

Fre

e f

orm

field

Cla

im n

um

ber

Batc

h n

um

ber

Dep

osi

t d

ate

Date

rece

ived

P01 ABN (Advanced Benefits Notice) BP02 AOB/Info Sheet P03 Authorizations BP04 Blood Sugar Logs P05 Chart/Doctor Office Notes P06 CMN (Certificate of Medical Necessity) AP07 C- Peptide Reports P08 Dietician Report P09 Financial Assistance Application P10 HbA1C's Report P11 Insurance Company Correspondence (Inbound only) P12 Physician Correspondence P13 Patient Correspondence P14 LMN or LON (Letter of Medical Necessity) AP15 Medicaid Patient Progress Report P16 Prescriptions BP17 PWO (Physician Work Order) BP18 Single Case Negotiation Form P19 Ten Month Letter P20 Signature Proof of Delivery P21 Voluntary Waiver of Benefits P22 Eligibility Letter P23 Purchase Order (ext.) P24 Major Medical Claim Form P25 AOB/WPR P26 EOB P27 HIPAA Privacy Notice

Document characteristics stored in SAP-generated index tables

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• DMS Maintenance


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System Components

SAP R/3 4.6C

DMS

SAP R/3 4.6C

DMS

Existing ScanningEnvironment

Existing ScanningEnvironment

Standard Network Printer Standard Network Printer Standard Network PrinterStandard Network Printer Standard Network Printer Standard Network Printer

Par

t o

f E

xis

tin

g N

etw

ork

- A

tta

ch

ed

fil

e s

tora

ge

pro

vid

ed

by

EM

CC

ele

rra

sy

ste

m

Par

t o

f E

xis

tin

g N

etw

ork

- A

tta

ch

ed

fil

e s

tora

ge

pro

vid

ed

by

EM

CC

ele

rra

sy

ste

m

Scan Pool -Images

Content Server(Cluster)


SAP DB ofContent Server

21

System Components (cont.)

• SAP R/3 4.6C• Content server:

– Dell PowerEdge 6400 servers (clustered)– OS: Microsoft Windows 2000 Advanced Server

• Content Server version 6200

• SAP DB 7.2

• EMC Symmetrix as attached file storage for SAP DB and Scan Pool

• Scan software: LibertyNET from Liberty IMS• Scanner: Bell & Howell Copiscan 8000 PLUS

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• DMS Maintenance


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Link from DMS to Patient Management

CV01N – Create DocumentCV02N – Change DocumentCV03N – Display Document

John Doe

Custom object link to Patient Management


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Link from DMS to Patient Management (cont.)

CV04N – Find Document



25

Link from Patient Management to DMS

• PatientDocument

• CreateCoversheet

• PatientDocument

• CreateCoversheet

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• DMS Maintenance


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The Process in Detail

Create coversheet for documents in SAPCreate coversheet for documents in SAP

Availab

le n

ext

day

Send documents to scan stationSend documents to scan station

Scan documentsScan documents

Upload scanned documentsUpload scanned documents

Access scanned documents via SAPAccess scanned documents via SAP

1.1.

2.2.

3.3.

4.4.

5.5.

Receive documents

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SAP R/3 4.6C

The Process in Detail - Create Coversheet

DMSCreate Document Info Record

Create Document Info Record

Print coversheetPrint coversheet

Create coversheet(ABAP)

1.1.

1.1.

1.1.

Standard network printer

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Creating Coversheets – Patient Screen

• Transaction ZCOVER is used to create coversheets

• Create Coversheet

1.1.

30

Creating Coversheets –Coversheet Screen

Document typeattributes

Document typeattributes

1.1.

Documenttypes

Documenttypes

John Doe

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• Highlight document type

• activates the document attribute sub-screen

Creating Coversheets – Coversheet Screen

1.1.

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Type-dependent attributes become available for input

• Black text indicates optional input fields

• Blue text indicates required input fields

• stores attribute values

Creating Coversheets – Coversheet Screen

1.1.

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Attribute values stored in table control

1.1.

John Doe

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• to verify document attributes

• to print coversheet and to create

Document Info Record in background


1.1.

John Doe

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Creating Coversheets –Preview

Documentattributes

Documentattributes

StaticDMS barcode(code 128)

StaticDMS barcode(code 128)

Generateddocument key

(code 128)


(code 128)

Who createdcoversheetand when?

Who createdcoversheetand when?

1.1.

100086444 - John Doe

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Creating Coversheets –Print

Output device supports barcode

Output device supports barcode

1.1.

Any frontendprinter

Any frontendprinter

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Link between Coversheet and DMS

1.1.


(barcodecode 128)


(barcodecode 128)

=

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Creating Coversheets – Print/Create Document Info Record

• Document type

• Document number

• Document part

• Document version

• Description

• Document status

• User

1.1.

Coversheet program creates document info record in background

• Document

classification

John Doe• Link to patient master

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SAP R/3 4.6C

The Process in Detail –Send Documents to Scan Station

DMS

Existing scan environment





Place coversheeton top of document


1.1.


1.1.

1.1.

2.2.

40

Send Documents to Scan Station

2.2.

• QC - Check if document is complete

• Odd or small documents, e.g. post it notes, need to be copied first before sending for scanning (only standard size paper is accepted)

• No staples, tape, rubber bands, or paper clips

• Documents are placed in the “Scanning Box”– Coversheet on top– Place paper face up

• Document(s) collected and delivered to central scanning area

• Documents are scanned into Scan Pool before 8:00 PM• Documents are loaded into SAP daily at 8:00 PM

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SAP R/3 4.6C

The Process in Detail –Scan Documents

Par

t o

f ex

isti

ng

net

wo

rk-

atta

ched

fil

e st

ora

ge

pro

vid

ed b

y E

CM

Cel

erra

sys

tem

Scan Poolfor images

Scan document

Scan document

DMS








1.1.


NFS mounted

1.1.

1.1.

2.2. 3.3.

42

Scanning - Filename

3.3.

CoversheetCoversheet

Scan poolScan pool

+ scan date + box ID = filename

43

Scanning - Scan Pools

3.3.• 5 scan pools are available

• Scan Pools are NFS mounted and reside on EMC Celerra system

44

Scanning - Scan Pool Folders

3.3.

• inprocess - The load program moves all files (with a valid filename) from folder SCPOOL to folder INPROCESS. After the move process has been completed, the program starts to upload the documents from folder INPROCESS

• lerrors - The load program moves a file (with correct filename) to folder LERRORS if the upload to SAP was not possible:

– Content Server was down– No network connection to Content Server– Scan Pool was not mounted to SAP– Document Info Record was locked– Document Info Record already has an original attached

• loaded - A document that was loaded successfully will be moved to folder LOADED

• ferrors - The load program moves scan files to folder FERRORS if the filename is invalid. A filename is invalid if one of the filename attributes does not meet the interface specification

• scpool - Documents are scanned to folder SCPOOL

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SAP R/3 4.6C

The Process in Detail –Upload Scanned Documents

Par

t o

f ex

isti

ng

net

wo

rk-

atta

ched

fil

e st

ora

ge

pro

vid

ed b

y E

CM

Cel

erra

sys

tem

Scan Poolfor images

SAP DB

Scan document

Scan document


DMS






Document upload(ABAP)

Check-in imageCheck-in image



Store imageStore image

1.1.


NFS mounted

• Read documents from scan pool

• Link image to Document Info Record

• Update document attributes

• Store images on Content Server

• Read documents from scan pool

• Link image to Document Info Record

• Update document attributes

• Store images on Content Server

1.1.

1.1.

2.2. 3.3.

4.4.

4.4.

4.4. 4.4.

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Document Upload Program – Selection Screen

Scan Pool 1 - 5Scan Pool 1 - 5

Delete file after upload

Delete file after upload

Number of upload attempts

Number of upload attempts

Store original filename in

long text

Store original filename in

long text

Filesize (Minimum)

Filesize (Minimum)

Storage categoryStorage category

4.4.

Move error file back to

scan pool

Move error file back to

scan pool

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Document Upload Program – Update of DIR

Scanned document

4.4.

Attach originalAttach original

Add long textAdd long textUpdate description

Update description

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Document Upload Program –Update of DIR (cont.)

Scanned document4.4.

Rename originalRename original

Update description

Update description

Check-in originalCheck-in original

49

Document Upload Program –Update of DIR (cont.)

Scanned document

4.4.

Add scan dateAdd scan date

Add box numberAdd box number

50

Access Scanned Document –Patient Screen

5.5.

• Transaction ZDOCS is used to retrieve patient documents

• Display Patient Documents

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Access Scanned Document –Document Display Screen

5.5.

DMS info ANDclassification data

on one screen

John Doe - 100086444

52

Display layouts

are available for

each document

type

Access Scanned Document –Doc. Display Screen (cont.)

5.5.

John Doe - 100086444

53

John Doe -


E.g. Layout for P01- ABN

• Only document type specific attributes are displayed

5.5.

54


5.5.

Display document

detailsJohn Doe - 100086444

55


5.5.• Display Document Info Record

• Display Original

John Doe - 100086444

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5.5.

Display original

Supported file

formats:

• TIFF

• PDF

Patient: John Do

John Doe

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Access Scanned Document –CV04N – Find Document

“CV04N – Find Document” can

also be used to retrieve patient

documents

Search by Document

Data

5.5.

58


5.5.

“CV04N – Find Document”

can also be used to retrieve

patient documents

Search by Attributes

59




patient documents

Search by Object Link

5.5.

60



patient documents


5.5.

To view a document:

• Highlight a document

• Click

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• DMS Maintenance


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Document Info Records sometimes never get an original attached

DMS Maintenance

• Printer was out of toner• Barcode was not readable• Coversheet was created by mistake or incorrect

• Printer was out of toner• Barcode was not readable• Coversheet was created by mistake or incorrect

How is that possible?

How to fix that?

How often does that happen?

• ~ 2 % of all Document Info Records• ~ 2 % of all Document Info Records

• Purge program for DMS administrator• Purge program for DMS administrator

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DMS Maintenance – Purge Program

Selection screen

DIR wascreated in date

range “X” and hasno original assigned

DIR wascreated in date

range “X” and hasno original assigned

DIR is morethan “N” days

in DMS and has no original assigned

DIR is morethan “N” days

in DMS and has no original assigned

64

DMS Maintenance – Purge Program (cont.)

Documents aremarked for deletion

Documents aremarked for deletion

Set deletion flag on selected documents

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• DMS Maintenance


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Statistic/Numbers –Performance

• Scan performance (Scanner Bell & Howell Copiscan 8000 PLUS)– 70 pages/minute (duplex)– 240 dpi resolution– 3 seconds to convert a scan document into PDF format– Current environment/process allows up to 5,000 documents to be

processed per day

Statistic is based on data collected in the first 5 months

• Document upload– 1.5 – 2 seconds per document (update DMS + document check-in)– 2,000 documents per hour

67

Statistic/Numbers –Growth Rate

Statistic is based on data collected in the first 5 months

• 40,000 new documents/month– or ~ 1,800 documents/day

• Growth rate of SAP tables– 125 MB/month linear

• Growth rate of SAP DB– 40,000 new documents/month– 180 KB average filesize (~ 3-4 page PDF file)– ~ 7 GB growth/month

68

Statistic/Numbers –Document Retrieval

Before DMS

• Sales: ~ 24 minutes/document• Credit & Collection: ~ 10 to 15 minutes/document

… for retrieval and re-filing

Before DMS

• Sales: ~ 24 minutes/document• Credit & Collection: ~ 10 to 15 minutes/document

… for retrieval and re-filing

With DMS

• ~ 3+ seconds to retrieve a list of documents assigned to a patient

• ~ 3+ seconds to display a document in a viewer

With DMS

• ~ 3+ seconds to retrieve a list of documents assigned to a patient

• ~ 3+ seconds to display a document in a viewer

Thank you for attending!Please remember to complete and return your evaluation form following this session.

Session Code: [3707]

70

Appendix

71

Content Server - Hardware

• 2 Dell PowerEdge 6400 servers (clustered) with the following hardware specifications:

– Quad PIII/700MHz Xeon processors– 4GB RAM– AMI PERC2/DC RAID controllers– 2 – 9GB SCSI drives – RAID1– 6 – 36GB SCSI drives – RAID5– Microsoft Windows 2000 Advanced Server

72

Content Server – Attached File Storage

• EMC Symmetrix as shared storage

– for SAP DB

– for Scan Pool

• Fiber connection between Content Servers and EMC Symmetrix

allows the operating system to see the

storage space as a native drive to the server

73

Content Server – Version

• Control of Content and Cache Server in CCMS – Computing-Center-Management-System

CSMONITOR

– Version 6200– Build 168– pVersion 0046

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Content Server – Content Repository

• Transaction CSMONITOR – CCMS Monitor

75

Content Server – SAP DB

• SAP DB 7.2

– 7 DEVSPACES with 25 GB each– Logfile 10% of DB, 17.5 GB– Resides on attached file storage system– Has capacity of 64 terabytes

76

• Scan workstation– 1 GHz processor– 256 MB RAM– 20 GB Ultra ATA hard drive– KoFax card (device controller)– Microsoft Windows 2000

• Scan software– LibertyNET from Liberty IMS

• Modified to support multiple barcodes and to output PDF file format

• Scanner– Bell & Howell Copiscan 8000 PLUS– Scans 80 pages/minute (duplex) with 200 dpi

Scan Station

77

Content Server Backup

One full backup after installation and configuration

• Although standard practice dictates that the operating system itself is backed up on a periodic basis, it is not necessary here.

– the environment is static– will very rarely change

– very little reason to be concerned about the OS

78

SAP DB Backup - Strategy

Due to the amount of data the database will contain, it is not practical to run full backups on a daily basis. The following backup schedule has been defined for DMS:

– Monday Full– Tuesday Incremental– Wednesday Incremental– Thursday Incremental– Friday Incremental

Backups are not required on weekends, since scanning is only performed Monday through Friday

79

SAP DB Backup - Setup

• Configure backup medium in Database Manager– Migration mode (with checkpoint)

• recovered data is consistent in itself; log files are not required to be restored

• Enable auto-logging– This is required because once the log file becomes full, the

database will cease to respond to requests until they have been archived

• Create batch file to launch backup medium from the Database Manager command line interface

• Use Task Scheduler to launch batch process after business hours

80

SAP DB Backup – Batch Files

… are located on D:\Batch, on both servers in the cluster Mondayfull.bat@ECHO OFFCD D:\BACKUPSDEL *.* /Qdbmcli -d SDB -u control,control -uUTL -c backup_start Monday_full MIGRATIONEXIT

Tuesdayinc.bat@ECHO OFFdbmcli -d SDB -u control,control -uUTL -c backup_start Tuesday_inc MIGRATIONEXIT

81

SAP DB Backup - Jobs

• Monday’s job deletes the previous week’s backup files– to control storage capacity– allows for recovery of the database (previous week) without

having to restore data from tape

• All backup files are also written to tape, to address any file corruption issues that might occur (Veritas)

Job name LocationMonday_full D:\Backups\Monday_full Tuesday_inc D:\Backups\Tuesday_incWednesday_inc D:\Backups\

Wednesday_incThursday_inc D:\Backups\Thursday_incFriday_inc D:\Backups\Friday_inc

Job name LocationMonday_full D:\Backups\Monday_full Tuesday_inc D:\Backups\Tuesday_incWednesday_inc D:\Backups\

Wednesday_incThursday_inc D:\Backups\Thursday_incFriday_inc D:\Backups\Friday_inc

integrating paper documents into sap with dms and content server christian hoeninger - 3707

Documents

patient file retrieval

incoming patient documents

paper documents

electronic documents

ftes slide

project slide

display of documents

new patient files