Cantonal SwissDRG Validation

Diagnostic related groups (DRG) are a worldwide known classification system for medical cases and mandatory for the validation of invoices for the cantos of Switzerland since 2012. The tariff structure SwissDRG has been introduced nationwide to finance inpatient care but the validation of the invoices for the medical cases is in the responsibility of each canton separately. Therefore, this study introduces an approach to resolve the conflicting requirements of cost & risk sharing and flexibility the cantonal health departments face, regarding their e-invoicing systems for the financing of inpatient care and the validation of invoices, which are based on the tariff structure diagnostic related group (DRG). To design a system resolving the conflict, the frame work design science with an inductive approach has been applied in this study. To collect data for the foundation of the solution a qualitative multi-method has been selected, as it relates to the study of artefacts and the involvement of an expert on tariff structures. The study shows, that with a centralised validation platform in a community cloud the conflicting requirements can be resolved. The validation platform contains the common business functionality of managing reference data and offers the validation steps required to e-invoicing systems of multiple cantons, as a SOAP based web service. The study points out that the level of standardisation in the process to validate invoices can be maximised, if the consuming e-invoicing system is distributed in the community cloud of the validation platform and has a standardised implementation of the web service.