Al Borges' FREE EMR......May 2005

I would like to hear comments... pros/cons...
of actual users of Al's EMR Project. ( I'm a non techie)

Ease of use
Integration with Dragon speak
Use of Macros

Are you totally paperless? What other
programs do you also need beyond Al's software
and Microsoft Word? (Lab, consults faxed from specialists,
X-ray reports, etc)

In the assesment section, are the diagnosis codes
kept up to date?
How easy is it to write an Rx with his software?

How does it compare to using other inexpensive
charting solutions?

What is the exit strategy to migrate data from
this to another software?

How easy is it to use with Tablet PC / Digital Ink?

How about document storage? And back up of data?

Version 4 comments from Al's February posting below:

I’m happy to announce that the MS Word EMR Project which was originally started last summer, has just been updated to version 4 and, well, it’s arrived into its “mature” stage, bug-free and updated with numerous features:

1) You’ll notice that instead of a simple ZIP file, it’s now an InstallShield EXE file. Unlike the ZIP file, the InstallShield executable will make a new file in your “Program Files” section of your computer and place a shortcut in both your Start menu and on your Desktop automatically.
2) It’s also grown from slightly under 5MB to 22MB.
3) The updated 50 page manual demonstrates its features completely, concisely, and is easy to read.
4) The overall *flow* of the various forms has been improved and simplified.
5) The scheduler, prescriptions, and SOAP notes are now completed and bug free.
6) The SOAP notes is formatted into 4 types dependent on sex and ethnicity.
7) The SOAP notes can now be printed out into any one of several formats- GoBinder, PDF, and PenOffice allowing “inking” using Tablet PC or Windows CE (s.a. Airpanel) devices. You’ll have to download trial versions of these programs to see how they work… the manual explains how to do this. Any glitches can be discussed at EMRUpdate.com.
8) It’s now LAN compatible- in the splash screen you can choose to tap your local backend files or your office’s common backend files.

This is a FREE program based on MS Word/Access 2000, whose main focus is to quick note generation, from SOAP notes to complex reports, prescriptions, scheduler with lists, etc., all in an easy to use Word front-end platform.

Nick is currently working on the upload/download section of EMRUpdate.com and although I’ve uploaded the setup file it may not appear until the weekend. Don’t bother downloading the “MSWordProjectEMR.zip” (version 3). Download the “MS Word EMR Project _ V4.exe” when it’s finally posted. Happy SOAPing…

Regards,
Al

Hi there!

As the developer, I'd like to answer some of the more technical aspects of your questions...

>>> Integration with Dragon speak

I just upgraded to DNS 8 two days ago and this software rocks! DNS works in both MS Word and in MS Access.

>>> Use of Macros

Hey, you can macro all you want while using the MS Word EMR Project. The only major issue is that you have to turn the security features to "low" to use the MS Word EMR Project. This could allow potential macro viruses to macro too... [}:)] so you should have good anti-virus software installed as well as a good firewall.

I use AVG (free) and Norton's antiviral softwares. For a firewall I use the free ZoneAlarm software.

>>> Are you totally paperless?

Heck, I'm not totally paperless. [:0] That's just my style...

Up to now the major problems have not been with software but with hardware. It's much easier to write down the detailed chart notes onto paper than to type the information in. Dictation was both costly and time consuming. I tried boilerplating, and in MS Word you can use macros and Word's autotext features to more rapidly fill in data... but that was not enough.

Over the past year we've discussed numerous new solutions on EMRUpdate, s.a.:

1) The use of Paperport for file storage.
2) The use of Dragon Naturally Speaking 8, the new upgrade that has leaped over its competition and its prior versions for voice dictations.
3) The use of container programs that accept just about any sort of scanned images as well as direct handwriting/doodling and stores charts in a "toilet paper roll" manner. We've discussed MS Word 2003, MS OneNote, GoBinder, Adobe PDF, and EverNote - all inexpensive, excellent products that need to be explored further and compared. One can use MS Word as a primary way (using Visual Basic) to get data into those containers.

All of these products will allow for a true paperless office. The discussions will continue here at EMRUpdate.com over the next year and or efforts will progress to the availability of powerful, easy to use inexpensive EMRs. You will see that you don't have to plunk down thousands of your hard earned dollars so as to end up with expensive EMR solutions plagued with similar input problems that have affected the lower end market. The MS Word EMR Project will be just one of many inexpensive, powerful solutions for those 85% of docs that are still not using EMRs.

>>> In the assesment section, are the diagnosis codes kept up to date?

The MS Word EMR Project has the diagnoses that I've used over the past 15 years, most upgraded to the most recent changes. If you wish to upgrade the MS Word EMR Project to the most recent complete ICD codes, all you have to do is to simply download the most recent specs and add them to the medlkup table in ZfileMDS_Scheduler.mdb. I'll need to update the manual to show how to do this- it's easy. I'll upload the most recent ICD list to the MS Word folder in the MS Word EMR Project in the next few days.

>>> How easy is it to write an Rx with his software?

Try it- it does prescriptions. Just send them to your default laser or inkjet printer.

>>> What is the exit strategy to migrate data from this to another software?

The backend tables are open and are written in MS Access. If you have MS Access on your computer, you can export the tables to the following standard data formats:

*.mdb, *.adp, *.mdw (MS Access formats)
*.txt (general text format)
*.csv (MS Excel format)
*.asc

>>> How easy is it to use with Tablet PC / Digital Ink?

I use both the MS Word and the MS Access portions of the software with a hardware solution called the Airpanel that uses Windows CE. If you aren't familiar with this hardware, the Airpanel is a dumbed down version of the Tablet PC. It doesn't do scanning or dictations, for example. (Microsoft didn't want to directly compete with its more lucrative Tablet PCs.)

Now costing about $300 on eBay, the Airpanel has been a boon for those of us that use them; they are a great manner to get wireless inside your office with a device that not only allows you to doodle into a OneNote type of document, but also does handwriting recognition very well right out of the box. Unfortunately, Microsoft couldn't make the profit that it wanted, so it scrapped this project last year.

>>> How about document storage? And back up of data?

I use Windows XP scheduled backup solution for backups.

Many of these tips I'll incorporate into the manual, either as part of one of the chapters and/or as a FAQ. Thanks.

Regards,
Al

>>> The MS Word EMR Project will be just one of many inexpensive, powerful solutions for those 85% of docs that are still not using EMRs.

I forgot to mention- the MS Word EMR Project is not inexpensive- it's FREE.

Al

Al, when I get MS Word, I'll download your software and try it.

What do you use for front office scheduling
and back office billing ?

I would like to hear comments from others who
actively use this software.

>>> What do you use for front office scheduling and back office billing ?

I do everything with MS Office. You can see some jpgs of the billing portion of the billing portion of my MS Access software in the manual that I uploaded to my download center a while back at http://briefcase.yahoo.com/alborgmd (look for the "MS Acces Files" section, then look at "Zfile MDS Manual Ch 10 11 appx".

You really can do almost everything you need with a good off the shelf programming software, s.a. MS Office. Some folks have also had very good luck with FileMaker Pro. Once you get past the glitter and hype of the more expensive EMRs, you'll see that either programming an EMR yourself or downloading a free or less than $1000 EMR can be a very good practical solution. If you eventually don't like it or need to change for whatever reason, you sure as heck will be less pained than if you had to do the same after putting out $12000.00 or more for a single license. Just something to think about...

>>> Al, when I get MS Word, I'll download your software and try it.

I know that you're saving up for your eCW or eMDs purchase , but if interested, you can purchase MS Word 2000 or 2002 on eBay for less than $25; check out this URL:

http://search.ebay.com/MS-works_W0QQsofocusZbsQQsbrftogZ1QQfromZR10QQsacatZ-1QQsargnZ-1QQsaslcZ2QQsadisZ200QQfposZQ5AIPQ2FPostalQQftrtZ1QQftrvZ1QQfsopZ1QQfsooZ1QQcoactionZcompareQQcopagenumZ1QQcoentrypageZsearch

What do you use for word processing?

Regards,
Al

I do have MS Word but that computer is being
serviced right now. I don't open my practice
for several months so I am still in research mode.

Thanks.

Al, I have no idea when I'm going to get my computer
back. So far been at Best Buy service center for
1 week. Is there a URL to see a demo of screen
shots?

Basic Demo:
Front office: Scheduling
Mid office: Patient Note
Showing different meaningful screen shots of macros, etc.
Incorporating the codes with the diagnosis
BackOffice: Billing statements

What have you found so far to document the fastest? Paper, then
scanning the paper? Type, voice, macros?

And how is this part of the project going?

"Up to now the major problems have not been with software but with hardware. It's much easier to write down the detailed chart notes onto paper than to type the information in. Dictation was both costly and time consuming. I tried boilerplating, and in MS Word you can use macros and Word's autotext features to more rapidly fill in data... but that was not enough.

Over the past year we've discussed numerous new solutions on EMRUpdate, s.a.:

1) The use of Paperport for file storage.
2) The use of Dragon Naturally Speaking 8, the new upgrade that has leaped over its competition and its prior versions for voice dictations.
3) The use of container programs that accept just about any sort of scanned images as well as direct handwriting/doodling and stores charts in a "toilet paper roll" manner. We've discussed MS Word 2003, MS OneNote, GoBinder, Adobe PDF, and EverNote - all inexpensive, excellent products that need to be explored further and compared. One can use MS Word as a primary way (using Visual Basic) to get data into those containers.

All of these products will allow for a true paperless office."

>>> Al, I have no idea when I'm going to get my computer back. So far been at Best Buy service center for 1 week.

Gosh, I hope that it was just a warranty repair, because otherwise you shouldn't waste your money repairing an hardware item that new sells for real cheap.

I used to build my own computers, but most recently I've found that the best purchases are "barebone" computers on eBay. They sell for less than the cost of fixing a computer; and definitely saves me time when implimenting a new system, since they come precomfigured. Fixing an old computer sucks...

You can purchase a 3.0 to 3.2 GHz P IV with 512MB ram, beautiful case with glowing colors, and all the fans, modem, integrated video and LAN for about $350 on eBay. I use the CD/DVD drives, floppy drive, and even the old hard disks (for backup) from the old system. I add a new 80-120 GB HD and it's ready to go. Alternatively, I'll purchase a refurbished Dell or Gateway. If you don't mind going to 2.8 GHz, it'll cost about $300. On eBay you can get Win XP Pro (academic version), no questions asked, for less than $99.

>>> Is there a URL to see a demo of screen shots?

I've focused on the full color e-manual which is now getting closed to 70 pages. The MS Access older uploaded manual is about 3 times that size. I used to have a Powerpoint presentations, but these are good for about a maximum of 10 slides before a viewer gets bored. With a manual one can flip through the garbage and get to the areas of interest faster. Although there are a lot of pages in both manuals, there are a heck of a lot of pictures!

>>> What have you found so far to document the fastest? Paper, then scanning the paper? Type, voice, macros?

All of the above- but my recent reintroduction to DNS8 has me blown away on how we can now document by speaking into a microphone with about a 98% accuracy... this is an incredible technology. Real time saver. Doodling still works too.

>>> And how is this part of the project going?

It's a matter of taking it day to day. My programming initiatives include-

1) A Satellite Forms Palm hospital capture applet (36 forms) needs to be upgraded to catch up to the newly released high rez screens. Satellite Forms also has a few bugs which have "broken" the program that last year was working flawlessly on the Palm 515 platform.
2) I'm currently finishing up the latest addition to the MS Word EMR Form- a calendar applet to schedule patients who have multiple visits.
3) I'm updating the MS Access EMR, fixing bugs that have popped up with the addition of new features.

Some days I just scan the 'net for ideas. Last night, for example, I found an article on using XML to send stuff to MS OneNote from Excel 2003... pretty cool (URL: http://www.mrexcel.com/tip078.shtml)! Naturally, the VBA code can also be used inside MS Word. What particularly caught my eye is the way that now you can set up a GUID indicator to add a note to the end of the "toilet paper" roll chart. This would make it easy to dump stuff into this container. Naturally, I would be interested in the non-Microsoft competitors, as I'd hate for MS to take over this IT area too, but well, if these new features continue to roll out, version 5 of the MS Word EMR Project will be done with Word 2003.

Generally the development of the MS Word EMR Project is a tedious road- sometimes slow steps are taken, but then other times the technology breaks lose. That's when it gets discussed here. The XML transfer into OneNote was a recent important addition by MS to OneNote in late 2004. OneNote has a long way to go, though.

Regards,
Al

Al, I've never used a macro before.

Look at this EMR demonstration.
Don't pay attention to the first stuff.
Pay attention when they click on
"Quick Click Exam" -- hurry and pause!
http://www.codonixnotes.com/swf/video.php

Can your EMR be set-up to create a template page
of macros to look just like their "Quick Click Exam"?
Visually, that looks fast and intuitive.

Also, I can't remember, can you insert a picture
in a note to draw over?

UPDATE: I've just used MS Word to type papers.
After a thorough search, this is the book everyone
I've talked to says is the best to really know it.

Al, it might teach you some useful "secrets" Price is $13 new

http://www.amazon.com/exec/obidos/tg/detail/-/0972425845/qid=1115274378/sr=1-1/ref=sr_1_1/102-8741424-8936169?v=glance&s=books

Lists of Tips in the book
http://www.mrexcel.com/sunshop/index.php?action=item&id=27&subid=


Here is a book on Acess that readers like
http://www.amazon.com/exec/obidos/tg/detail/-/0972425896/ref=pd_sim_b_2/102-8741424-8936169?%5Fencoding=UTF8&v=glance


Here is a forum for Microsoft Applications:
Access / Word / OneNote / Outlook

http://www.theofficeexperts.com/forum/

We've discussed MS Word 2003, MS OneNote, GoBinder, Adobe PDF, and EverNote - all inexpensive, excellent products that need to be explored further and compared.

These options look much more appealing than using MS Word.
Offers much greater functional organization.

MS OneNote 2003: (new version 2005 ???)
http://www.amazon.com/gp/product/customer-reviews/B0002HE2IW/ref=cm_cr_dp_2_1/102-8741424-8936169?%5Fencoding=UTF8&s=software

http://office.microsoft.com/en-us/FX010858031033.aspx
DEMO http://www.microsoft.com/office/onenote/prodinfo/demo.mspx

GoBinder 2005 Enhanced for Tablet PC's: Click the Demohttp://www.gobinder.com/notes.aspx?source=adwords-gobinder
New enhancements
http://www.gobinder.com/gobinder2005.aspx

Adobe PDF Which software ? ?
http://shop.pdf-office.com/

EverNOte Does not seem as robust as OneNote & GoBinder
Some reviews like its simplicity.
http://www.evernote.com/en/


Reviews
http://www.pcworld.com/news/article/0,aid,115737,00.asp
http://www.pcmag.com/article2/0,1759,1628061,00.asp
"GoBinder isn't as slick as OneNote"
http://www.pcmag.com/article2/0,1759,1628062,00.asp

>>> These options look much more appealing than using MS Word.

You can program MS Word with VBA, which is great. From there you can throw stuff anywhere; with the new SP1 release of OneNote, a good programmer will be able to use XML to transfer stuff to these canister products easily.

In Word 2003 you can turn on/off direct document markup, which kind of blurs the real differences between it and OneNote. With Word XP and below, you can use a product called PenOffice (cheap) to add markup to documents.

>>> "GoBinder isn't as slick as OneNote"
>>> EverNOte Does not seem as robust as OneNote & GoBinder

The race is on- these products will outshine each other in the coming year. Read the discussion that I started a while back called "GoBinder -> a "OneNote/Paperport" on steroids?". I'll go to the reference tomorrow, but I'm sure that they are reviewing the new SP1 version of OneNote.

>>> http://www.codonixnotes.com/swf/video.php

That's pretty cool, but for now I've put placing a website on hold, since I have nothing to sell. I've posted the MS Word EMR Project on this site as a favor to the EMRUpdate readers... One day I'll begin a web site, though... among other projects.

>>> Dreamboat on Word

This is an OK book- I already have it and have sapped all of its useful tips. I give it a 6/10. Once you download the MS Word EMR Project, or at least the manual, go to the last page for "references"... both book and electronic. There you'll find some really good stuff!

>>> Grover Park George on Access

Don't have this book. In Amazon it got great reviews... I'll look into that one further. There might be a tip there.

>>> RE: good websites

The Office Experts website seems pretty cool... never been there. There are tons of MS Access sites. Two of the best include "The Access Web" at http://www.mvps.org/access/ and Woody's lounge at http://www.wopr.com/cgi-bin/w3t/wwwthreads.pl?Cat=&C=2.

Regards,
Al

OneNote/GoBinder

Here is a program/screenhots of EMR using OneNote.
Its a nice start, but would have it organized much differently.
http://www.abletfactory.com/EMRToolkit/products.htm

Here are some challenges using Inkable EMR noted by Dr. Murdoch

For me, the goal of EMR is to provide more organized, more efficient, more outcome-oriented medical care. Codified/Granular data is not really feasible in an inkable EMR. Or not to the same degree as in

You do raise a key question - which medical information needs codifying ?

I'd say the key data is:
1) Past Medical History
2) Medication List
3) Demographics
4) Past Surgical History
5) Allergies
6) Reminders/Recalls/Tickler/
7) Problem List

Any others ?


If you used the templates in the above link, with each
note, you have to re-write the 7 items above to achieve a
higher billing code.

Would this be a solution?
Think of the standard Paper Chart with different tabs
where some of the information in Dr M's list can be under
the same tab. This information does not change much. I have
no programing background. Since OneNote allows copy drag paste
from one tab into another, I would think there would be a Macro
solution that would automatically bring the needed stuff from other Tabs into the note, namely history, meds, allergies. Or with everynote, these items automatically appear in the template. The meds/history/surgery/ lists would have data input from built in scan/scroll lists. Built-in meaning no pop-up window to deal with.
Having the usual pop-up window built right into the tab screen. Like for drugs, have something like this built into the Meds Tab
http://www.abletfactory.com/eScriptToolkit/
Thoughts?

The software in the link above is a good start. But lacks integration
of Dr M's 7 items and I'll add a scrolling database of CPT/ICD9 codes,
and Rx list.

See the Demo for a student and how their tabs look
http://www.microsoft.com/office/onenote/prodinfo/demo.mspx

I would envision the following using NoteOne.
THINKING OUT LOAD never having used this software or any EMR.
Click on a patients name and a screen appears with tabs on the right.
Just like a paper chart.
Tabs for Past Notes,Labs, X-Rays, Consult reports,Referals, Handouts, Phone messages, Diagrams,Demographics, A/R.

And medical staff can have their own set-up that clues them of
a new referral to work on, etc.

You click on the Labs tab, and there is a list of lab document links/pdf/etc that have been scanned in. Scanned documents
in their respective tabs. Click on the scanned link, and ink up the lab at will and then re-saved with changes made.

New visit note: (First click on past visit to quickly see what you did last vist)
HPI: use ink, voice, or type
Past Medical/Surgical history: if you want it included, touch
the word and they are imported from their respective tab.
Current Meds: touch the word and likewise the list is imported from
their tab. Nothing is imported unless you click the word to import.
{copy/drag/paste macro of info from tab to new note}

Document ROS and Physical Exam
with digital ink template, voice, or type,macros
Diagrams incorporated easily with a small tab for diagrams.
Touch a diagram and it appears in the note to ink over.

Assessment/Diagnosis with its code:
Go to medical history Tab and touch the words/codes
from their history and if new item, then add it with
a built in scroll of codes with search function.
The codes you touch are transported to the assesment
portion and to the Billing Sheet.

Plan: document with ink/type/voice
Any RX you go to Meds Tab where there is also a
database/organized by body system
of meds to choose from which also looks
for drug interaction. As you click on meds it puts
it in a digital Rx pad which is printed/faxed and also
documented in the plan which meds were Rx'ed.
Click on Handout Tab and click on handouts to print out.
Or if its a phone message/refill... documented in Phone messages tab
and faxed to appropriate Pharmacy.

Note is automatically saved in the Past Notes tab.

This is all thinking out loud how paper users use charts,
but taking that workflow system into an integrated EMR.
Is this doable?.

OneNote/GoBinder EMR solution such as this would be the KISS principle.
Any doctor who has used a paper chart would know how to do it.
Very little training involved. And inexpensive.
Think of how many are buying EMR's for $10,000. If a couple
of us chipped in a hundred bucks, we could get an expert programer
to build a CCR application that combines Al's MS Access/Word database into a OneNOte/GoBinder application as described above. We could
consider it a contribution to the community. Not for sale, but
downloaded freely.

What about CCR ?

Al, can your MS Word / OneNote integration be
built on the new CCR standards ?

----- Message from Fritz

The following links may be helpful. A CCR for a fictitous patient with the XML file is available for review.

Here is my bookmark for the XML document.

http://continuityofcarerecord.org/PreBuilt/johnDoqit.xml

Here is the HomePage for CCR org.

http://continuityofcarerecord.org/x6169.xml

I believe this site has a CCR simulator where you can create you own patient records or a link to the simulator.

This is where we've started to put together some of our database/table field structures.

Hope this helps,

Fritz Switzer
Microsoft MVP Tablet PC
www.abletfactory.com

---------------

Brendon writes:I look forward to the Dallas conference put on by the MRI group, I will have the programmer in charge of interfacing for our company attend also.

As to my points, I don't think any vendor has been storing there inforamtion in CCR format. Note I did not say XML, because that is as worthwile as saying Text, Doc, PDF Text, as it is just a document/data type. I really believe that the real issue is going to be back converting information or providing a on the fly tool to create said file when it is needed.

My other point was, just because you store your data in XML file format, or SQL (XML Schema Capable), or any other ANSI standard does not imply you are any better then another vendor when it comes to being prepared for CCR requirements.
Brendon Holt

>>> What about CCR ? Al, can your MS Word / OneNote integration be
built on the new CCR standards ?

It would be very difficult to run a billing program around MS Word or OneNote, but the MS Access program that I currently use in my office for billing already has a field structure for fields that are compatible with Medicare's "National Standard Format" field structure. The links that you've posted are very helpful- thanks. (and thanks to Fritz)

Microsoft/Bill Gates is involved in the both the HL7 and in the CCR initiative and has made this part of the future integration of MS Office/Infopath into healthcare. If it's going to be in MS Office, I'll be using/programming with it- you can be sure of that. Note the following URL: http://search.yahoo.com/search?p=microsoft%2C+health%2C+CCR%2C+HL7&prssweb=Search&ei=UTF-8&fr=my-vert-web-top&fl=0&x=wrt (this was a search for "Microsoft HL7 CCR Health". I posted an important white paper URL on Microsoft/CCR/HL7 here at EMRUpdate: http://www.microsoft.com/resources/casestudies/CaseStudy.asp?CaseStudyID=14931.

Interestingly, the article ends with a statement supporting the concept that this interconnectivity will in theory be relatively inexpensive and will be incorporated in their Infopath software:

"Because physicians' insurance reimbursements are dropping, they don't always have the capital to invest in elaborate EMR systems," says Blizzard. "With the CCR and InfoPath, we hope to provide doctors with a standard document and a toolset to communicate critical health care information about patients to other health care providers at very little cost."

Regards,
Al