University Hospital Aachen, Germany

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University Hospital Aachen revolutionises hospital management

With empty public coffers, falling revenues and increased competition, German hospitals are facing a massive shake-up. The University Hospital Aachen believes its long-term economic future is not best served by safeguarding vested interests and half-hearted concepts. The hospital's board has therefore developed a new operating structure representing a fundamental reorganisation of all medical and business procedures.

“Forcing all decision-makers to adopt a deliberately commercial attitude is a unique approach for health services in Germany,” said IT Director Volker Lowitsch. He says this kind of revolutionary business model can only be achieved using equally future-orientated software. Aachen is addressing this issue with a development partnership with international healthcare IT provider iSOFT. The two are producing a complete hospital management solution for every aspect of clinical procedure. Based on a service-oriented architecture (SOA), it seamlessly models and automates all processes of the new operating structure.

Aachen is aiming to maximise services with existing resources. The hospital has more than 30 individual specialist clinics, around 20 scientific institutes and 30 operating theatres. The 800 doctors and 2,000 nurses, among the 6,300 employees, treat some 45,000 in-patients and 120,000 out-patients annually. They also work with administration within flexible organisational structures and to stringent budgets, which is still a pipedream for the majority of similar-sized hospitals in Germany.

The new operating structure, developed in 2003 with business advisors Steria Mummert, is enabling Aachen to break radically with decades of tradition in hospital administration. “By 2009 we need to have increased our efficiency by 30% while maintaining at least the current quality to remain viable,” Lowitsch said. “This is only possible if we unify our treatment procedures, consolidate resources and apply hard-headed business sense at every level. The interests of individual clinics must come second to the success of the overall hospital, so everyone needs to optimise patient flows.”

The new business model has several key features. The individual specialist clinics are transferring most of their capacity to departments, offering treatments on a hospital-wide basis such as interdisciplinary intensive care wards and standard nursing units. This pooling is, however, just one element of a substantially more efficient use of resources. In parallel, Aachen has turned all organisational units into profit centres so every senior consultant must produce an annual detailed performance plan. The board then allocates staff, equipment, rooms, intensive care beds or surgical operating hours accordingly. Effectively, there is a line of credit which has to be paid for with the revenues earned by the clinic. There are no certainties any more. Resources are continually shifted between clinics on the basis of regular comparisons between theoretical and actual values.

Aachen hopes that this new structure will achieve eight-figure savings annually and is placing its trust in the IT department and new strategy. “Our approach is to have standard software for every pillar of the business, letting us unify our processes across all clinics,” Lowitsch said.

Conventional IT approaches not up to the job

It was absolutely clear to the IT directors that the full benefits of the new operating structure could not be achieved using conventional software solutions. Aachen is currently transferring the purely commercial IT processes from SAP R/3 to mySAP.com and the integration platform SAP NetWeaver. With this SOA model, all software functions are provided as services that can be quickly, simply and flexibly combined to form seamless, tailored and constantly adaptable process chains. A new business intelligence suite from SAS supports all planning processes with constantly updated analyses and projections. Because of the new business model, it was also decided to abandon the existing hospital information system and transfer the management of treatment procedures to an SOA solution.

The limits of the existing system were exposed immediately with the introduction of the new operating structure. It was clear that a workflow management system was needed since it was impossible to model and commercially manage multi-specialist units and interdisciplinary issues. “Let's not deceive ourselves, traditional hospital information systems are more or less enhanced accounting systems to which functions have been successively 'bolted on' and which have finally suffocated under their own complexity,” Lowitsch said. “Doctors have never felt comfortable with these systems because of their limited clinical value. We need a sustainable, intuitive system which puts the treatment of patients first; one that adapts to the peculiarities of the German health service and gives us all the functions needed without high-maintenance technical interfaces between medical and business functions.”

Aachen soon found that there was nothing available anywhere in the world that met its requirements; nor was it possible to buy and re-configure standard software to fully integrate with existing applications. In 2004, a search began for a software partner and, only after an intensive evaluation phase, a long-term strategic development partnership was agreed with iSOFT in May 2005. Aachen is providing the expertise of operating German hospitals of this size and future-proof management concepts, while iSOFT is translating the process models into corresponding IT services.

“After seeing LORENZO and its service-oriented architecture, it was clear that iSOFT’s concepts match our own and that it has a hospital management system equipped for the future. iSOFT also offered clear commitments to meeting very tight delivery specifications which were key in persuading people to approve our venture,” Lowitsch said. He says the decision was not only unanimous with the board, but was also supported by doctors, nurses and administration staff. Early on, the project group presented the opportunities and risks of the LORENZO project to a representative cross-section of the workforce. “This helped acceptance and understanding for the impending changes to the working procedures as well as everyone's willingness to collaborate actively in specifying the process requirements,” added Lowitsch.

Immediate added value forces user acceptance

Migration from the existing hospital information system to LORENZO started in mid-2005, with the transfer of all treatment data and the creation of an electronic patient folder (EPF). November 2005 saw the beginnings of the evaluation of the prototypes, and in March 2006 the new system was put into operation for the first time. Since then, doctors and nurses have had direct, 24-hour context-sensitive access to the new EPF functions for all pre- and post-operative clinics. Being able to access case notes for a patient’s entire life is a particular benefit. “LORENZO displays whole treatment procedures at-a-glance so doctors can now create individual illness-specific profiles. Time-consuming selection from a range of sources is no longer necessary,” Lowitsch said. "The solution has added noticeable value at a stroke, plus LORENZO delivers truly intuitive interfaces so training time is minimised.”

The next step is to introduce the doctor’s letters and discharge management within LORENZO and activate the clinical procedures from surgical procedures and ward administration to order, timetable and resource management. “Doctors will then get, for instance, a list of diagnoses and suggested treatments. Doctors and nurses will have all the data they need displayed automatically at the right time, 24 hours a day. No more order entries. We are expecting massive improvements in quality and increased efficiency.”

Aachen expects far-reaching benefits once the clinical and commercial IT processes are fully integrated. “In future, if a doctor wants to order an x-ray, LORENZO will automatically answer the key questions: how much will the procedure cost and how much budget is available? With integration of personnel resource planning, someone planning a surgical procedure will see at-a-glance who is on duty at the appointed time. This information gives us the basis we need to put into practice our motto 'Plan, book, pay' on a daily basis,” said Lowitsch.

Ideal-type operational business processes

Aachen is breaking new ground in the German health service. Clinic managers have decided to model and document all organisational and treatment processes using a process modelling tool and to export the information automatically into LORENZO. Lowitsch said: “This gives us a professional tool for workflow modelling, and for the first time we have the opportunity to define best-practice operational business processes from which the software automatically generates the necessary system settings.” The cost of system administration is drastically reduced, and Aachen has the flexibility to respond quickly to changes in legal and business requirements. It will also profit in other areas from this flexibility. Since LORENZO is based on open standards, Aachen can work with partners to develop new markets and realise further savings. Simply giving external doctors, rehabilitation centres and hospitals electronic patient folders alone could considerably increase the quality and efficiency of the entire treatment chain.

“An essential key to success is having a partner like iSOFT that not only has high-level expertise but also offers constant on-site presence,” said Lowitsch. “More important is the open, results-orientated dialogue between all those taking part, in which commitment and responsibility for the joint success of the project is always the top priority. This innovative, pioneering project for the German health service requires a lot of input and continued goal-orientated work. However, we are firmly convinced that we will achieve our ambitious goal, and our conviction is growing stronger every day,” he added. “LORENZO will make a decisive contribution in gaining the optimum balance between quality assurance and resource minimisation for our hospital. And, since it will introduce best-practice without compromise, then like our business model it therefore represents not only a viable solution for Aachen but also offers maximum benefit for other hospitals.”

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Related link: LORENZO