In the future, the University Hospital of Tübingen will rely on the S4.health billing system from ATSP and RZV, which is based on SAP S/4HANA, thereby replacing IS-H from SAP.
The Tübingen University Hospital is one of the largest hospitals in Germany with around 1,600 beds. Since IS-H (Industry Solution Healthcare) from SAP 2030 is coming out of maintenance, IT managers in hospitals across Germany are currently in the process of selecting successor solutions for patient administration and billing.
The University Hospital of Tübingen has now decided to use the S4.health solution from the IT service provider ATSP, which works together with the IT specialist RZV, for patient billing in the future.
In 2024, the University Hospital of Tübingen has already converted the ERP system to SAP S/4HANA, an important step towards a modern, future-proof hospital IT landscape. With S4.health, the billing functions of IS-H can now be continued based on SAP S/4HANA. The usual functions remain as well as the user interface, now integrated into SAP S/4HANA.
Another advantage: Hospitals that use the clinical workstation system (KAS) ishmed as an SAP add-on from Oracle Cerner, which was originally delivered with IS-H from SAP, can also continue to use it for the time being. This offers hospitals the flexibility they need when transforming their hospital information system (HIS).
For many IT managers, replacing the billing and patient management software and the KAS at the same time is a considerable effort with a risk that should not be underestimated. Niels Rump, head of department for administrative and clinical applications at the university hospital, also sees it this way:
“Many follow-up solutions for patient billing are usually only available together with a clinical system. This increases the complexity and size of a project enormously”
Niels Rump, head of department for administrative and clinical applications at the university hospital
Successor for IS-H sought
Jochen Nething, team leader for the ishmed clinical workstation system and head of the “IS-H successor” project, reports: “We wanted a new billing solution after we knew that the maintenance of IS-H from SAP would expire in 2030. This timeline presents us with a challenge, also due to the large number of parallel IT projects.”
For this reason, the market was explored and spoken to various manufacturers. The contract with ATSP was concluded in June 2025. “At that time there were only two companies that offered the billing software as a separate module,” says Rump. “The overall package made the difference,” says Nething. “The collaboration with ATSP is very good, cooperative and committed. We have direct access to those who develop the products there,” Nething continued.
The changeover is primarily about a technological change for those responsible in Tübingen, with the billing processes initially remaining largely unchanged. They also want to keep the changes for users and thus the training effort as low as possible.
“The usability remains the same in the first step; we can largely continue to use the previous interfaces 1:1.”
Jochen Nething, team leader for the ishmed clinical workplace system and head of the “IS-H successor” project
In-house developments can still be used
Since the successor solution S4.health from ATSP and RZV is S/4HANA-based, in-house developments based on SAP can still be used, which protects the expenses incurred so far. A big advantage is the uncomplicated adoption of the existing complex billing rules. Reprogramming all of this is extremely time-consuming and the project can hardly be completed in the time available, explains Nething.
Preparations for the changeover begin in Tübingen. First, an IS-H readiness check was carried out, and at the beginning of the year those involved came together for workshops to exchange ideas. “We are now preparing our IT systems and the sandboxes for the test systems,” says Nething. Preparations for installing the first basic version will last until the end of 2025, and all billing types will be tested in 2026. The billing solution can go live at the end of 2026.
Around 12 to 15 employees are working on the project on the Tübingen Clinic IT side, reports Rump. System separation is a challenge. During the SAP S/4HANA conversion in 2024, the ERP system had to be separated from the SAP add-on ishmed, the clinical workstation system from Oracle Cerner.
“Now we’re going one step further and separating IS-H from ishmed. We have to decide what stays in the legacy system and what is moved to the new billing solution S4.health.” It is important that not only billing but also all clinical processes function smoothly in all variants. Since both were once developed together, the systems are closely linked to one another technically and procedurally.
Development cooperation
There is currently no installed solution from S4.health in Germany. “The same applies to other competitors as well,” notes Nething. However, he sees a great advantage in cooperation at an early stage. As with the university hospital’s SAP S/4HANA conversion last year, it is smart to get involved early in a development. This means you can work directly with the programmers. “We will have to give input, but we can also put the finishing touches together,” says Nething.
There will be several migration runs to convert the in-house developments, data and tables into S4.health. The plan is to convert the billing software over a weekend as soon as the preparations have been completed.
“We will coordinate the switch to the new billing world closely with the departments,” says Nething. With the new billing system based on S/4HANA, we are now at the beginning of a new lifecycle and will therefore no longer have to worry about it in the near future.
If at the moment it is “only” a matter of converting the existing solution for patient billing in Tübingen, the IT managers only want to decide on a new clinical system afterwards. Nething is also jointly responsible for the “Next HIS project”, the new clinical workstation system and hospital information system:
“Many providers are currently optimizing their solutions. Just like other clinics, we are exploring the market and observing which direction it is developing.”
Jochen Nething, team leader for the ishmed clinical workplace system and head of the “IS-H successor” project
