I. Navigation.

1. Pressing the ALT key and another key at the same time usually navigates to another place or to the menu, eg ALT + U brings down the "Utilities" menu (don't type "+"). Each screen is numbered with the number written on the delimiting border. ALT + screen number takes you to the following screens:
   • ALT + 1 Patient demographic
   • ALT + 2 Contact notes.
   • ALT + 3 Lab data
   • ALT + 4 Imaging reports.
   • ALT + 5 Consult/admission-discharge summaries.
   • ALT + 6 Procedures.
   • ALT + 7 Family history.
   • ALT + 8 Daybook.
   • ALT + 9 Unsent to MSP
   • ALT + 0 Sent to MSP
   • ALT + A Allergies
   • ALT + C Long term mediCations
   • ALT + D Disease Prevention and ManaGement
   • ALT + K LinKed documents
   • ALT + O Social History
   • ALT + P Problem list
   • ALT + D Select Doctor for desktop.
   • ALT + M Messages for log on users
   • ALT + S PreScriptions
   • ALT + V (to bring down View menu) then "I" to go to Interventions
   F10 highlights the menu. After pressing F10, the right and left arrows moves the cursor along the menu bar. The down arrow brings down the highlighted menu. Press the right and left arrows to move along from one drop down menu to another. Within a drop down menu, the up and down arrows moves the cursor to the desired selection. Pressing ENTER executes a highlighted menu item. Within a drop down menu, pressing the red colored letter in a menu item description instantly executes that selection without having to highlight it with the cursor. A selection ending with "..." indicates another drop down menu will appear.Technically, the TAB key should be used to move from one field in a screen to another. The old convention of using ENTER to do this works as well. SHIFT + TAB moves the cursor back one field. The arrow keys do not move the cursor between fields. The right and left arrow keys moves the cursor within a highlighted field.Any field in a form enclosed with "<" and ">" is indexed. New records can be found using indexed fields by:
   • Entering a "mask" (a number or a series of characters) to search for then press F9 to do the search. The record with a field which is greater than or equal to the mask is found. Eg a demographic screen for a patient can be found by entering the first and last name in the appropriate fields then press F9 in the last name field delimited by the "<" and ">" characters. If an exact match is not found, the next greater record is displayed. This is why it is often necessary to press F7 after F9 if a mask not exactly matching an existing record is entered. A mask can be any number of numbers or characters that will fit in the field and can be typed over an existing field without clearing the record first. If a field is typed over it is wise to enter a space at the end of the mask so that the remaining original characters or numbers don't confuse the search.Pressing F7 to find the previous record in sorted order.
   • Press F8 to find the next record in sorted order
   F5 clears the current record from memory to create a blank form for entry of a new record.F4 is the prompt key. Fields containing a tilde "~" in the description have an associated search list which can be invoked by pressing F4 when the cursor is in the field. For example, a list of all the registered physicians in B.C. is displayed when pressing F4 in the "Ref Doc Name~" field in the patient demographics.Prompt lists are searched by typing a mask in the field and pressing ENTER. A unique feature of MedOffIS is that some prompts can be searched by different fields (columns) in the table. By moving to another field horizontally in the table by using TAB or SHIFT+TAB, the table is instantly resorted in the order appropriate for the selected field. Eg the diagnostic code prompt can be searched by section, description or ICD9 number. If the cursor is in the section column, the list is sorted alphabetically by section with the description sorted alphabetically within each section. When the cursor is in the description column, the list is simply sorted alphabetically by description. When the cursor is in the ICD9 column, the listed is sorted numerically by ICD9 code.CTRL + END in any indexed field or any table selects the last record in the file based on the associated index.CTRL + HOME in any indexed field or any table selects the first record in the file based on the associated index.SHIFT + F10 inserts a new line into any table (a table is a scrolling list of lines containing various fields. Each line is a record. A form is a screen displaying one record containing many fields usually on more than one line).
2. ALT + Z in general "zooms" into the detail box on any table or form. This allows the display and/or entry of more data than would fit on one line.
3. SHIFT F10 in any table inserts a blank record. Most tables in MedOffIS do not autosave so any entries on such a new line must be saved with F2.
4. CTRL Backspace erases everything to the right of the current cursor position (as it does with most Windows programs). CTRL Home and CTRL End moves cursor to top or bottom of a text area or to the beginning or the end of an indexed field (eg. if the cursor is in the Chart Number field in Demographics, CTRL End with find the patient with the last chart number and CTRL Home will find the patient with the first chart number).

1. Indexed fields are
   • Chartno.
   • First name
   • Last name.
   • DOB
   • Home phone number
   • Insurance number.
   • Note 1.
   • Note 2.
2. Prompts available
   • List of all patients in demographics from last name field with current record selected. Can be searched by first name or by DOB by tabbing into respective field
   • List of physicians registered with the College of Physicians and Surgeons of B.C. from Ref Doc Name with current record selected. Can be searched by name, practitioner number, city or specialty code by tabbing through the fields in the selection list prompt.
3. Hot keys:
   • Type D1 or D2 then enter in any address field to insert default or alternate default city address (defined in Utilities,Edit Prompts and System).
   • CTRL + - (copy) then ALT + + (paste) to copy the address and home phone number of the patient on the screen to the clipboard then either clear the screen to enter a new patient with the same address or call up another patient to paste the address over the previous address. This is used to enter a new family or to change the address/phone number of a family already in the patient datafile.
   • ALT + F1 to popup a list of all the bills for the patient on the screen including invoices, unsent to MSP and sent to MSP. Bills are listed in ascending service date order.
   • CTRL + D print a summary of the demographic information.
   • CTRL + L popup a label dialog box
   • CTRL + F pops up a list of family members listed in family history section.
   • ESC returns to Daybook.
   • ALT + I pops up Invoice header form
   • ALT + L pops up Labels/Autotext for view only (Can be used as desktop phone list).
   • F12 to insert MSP medical card. If patient not registered in MedOffIS, information on the card is placed into the appropriate demographic fields. If the patient is registered in MedOffIS, the demographic record will be found and presented on the screen.
4. ALT + Z pops up detail form where next of kin and WCB claim number information can be entered.
5. The combination of first, middle and last names must be unique. If two patients with exactly the same name are to be registered, use the middle initial for one and the full middle name for the other.
6. The decimals and area code in phone numbers do not have to be entered by the user.
7. Four digit work local number can be entered after the work phone number
8. The space in the postal code will be automatically inserted after leaving the field. Also, capslock is on automatically for this field.
9. Health insurance numbers must be unique unless the dependant code is not "00" or the insurance number is blank. Health maintenance - enter the year, month and day (eg 2003.10.04) to recall the patient. The recall code can be any six alphanumerics.
10. Date of birth must be in year, month, day order (metric). It is not necessary to enter "20" in the year as the system will insert it for you. The default is to insert "19" when the year is greater than "11" and "20" if the year is less than or equal to "11". Be careful registering elderly patients as they may inadvertantly be given a birth date in the year 2000.
11. If there is no referral doctor, the Ref Doc Name field must be blank. Choose the referral doctor in the Ref Doc Name field by either:
    • Pressing F7 or F8 to select the appropriate doctor.
    • Entering all or a portion of the last name then press F9 to find the closest match. Narrow in on the correct name with F7/F8 if necessary.
    • Pressing F4 to popup the prompt list.
12. Last Contact refers to the date of the last time anything was saved for the patient (it cannot be modified by the keyboard).
13. Balance due reflects the outstanding balance of all private invoices for the patient (MSP and WCB accounts are not included in this total).
14. In the label dialog box, the number of labels to print can be specified in the first field. Press TAB to move to the label type radio buttons. Use 1 7/16 inch by 4 inch labels.
    • Long labels contain information needed on requisitions.
    • Short labels show information put on chart tabs for filing. The label is purposely short three lines from lining up with the next label. This is so the information can be justified to the top or the bottom of the label depending on where the chart tab is located. To justify to the top, press line feed on the printer three times after the label is printed. To justify to the bottom, press line feed three times before printing
    • Envelope labels put the name and address including postal code on a label
    • Referral label puts the name, insurance number and phone numbers into the Windows clipboard
    • OR booking pops up a form to enter OR booking information
    • Export dumps most of the demographic information to a file named C:\MOIS\DATA\PTINFO.ASC for custom import of data to a spread sheet or word processor
    • Press F2 to print or ESC to cancel
15. Alert information can be entered in the text box at the bottom of the screen. Place a [Y] next to "Show" to have the alert information popup everytime a booking is made.

1. In the Unsent to MSP screen, move the cursor to the "< >Complete" field. Press F4 to popup a list of all Unsent bills sorted first by doctor then by date then alphabetically by name. This is essentially a list of Unsent bill daysheets by doctor. Check that the billing is correct. Be sure that incomplete bills really are incomplete and can't be fixed yet.
2. Print the Complete Unsent Bills from the Reports menu.
3. Exit MedOffIS to the Windows desktop.
4. Backup MedOffIS (datafiles in use by MedOffIS cannot be backed up).
5. Re-enter MedOffIS to go to Utilities menu and Prepare Bills For MSP.
6. Go to the Utilities menu and select Teleplan Web
7. Teleplan Web -
• User name ttut---- (not case sensitive)
• TAB to password field and enter password (case sensitive).
• Click or tab to "Submit".
• If successful "Login result - Success" will appear in login text box and log text box in the main program area. The login window can be closed with the "Exit" button at the bottom or the "X" at the top right of the program window. If you wish, the login window can be minimized with the "-" at the top right or simply by clicking anywhere in the main program behind.
• Click on the radio button next to "Send and Receive" to select that option.
• Click on "Go" at the bottom.
• The log of the results of the selection will appear to the right in the log screen.
• To print the log, click on the radio button next to "Print Current Log" then click on "Go". The standard Windows print dialog will appear. Be sure the appropriate printer is highlighted and click on "Ok".
• Click on Exit to close the MedOffIS Teleplan Web program and return to MedOffIS.
• There is no automatic reconciliation with this method of submission (since the programs are separate and the one hand doesn't know what the other has done). To reconcile, go to the "Utilities" menu and select "Reconcile MSP Remittance".
• When remittance processing is complete, you will be asked to hit any key to continue (eg the spacebar).
• A dialog box asking whether or not you wish to print reconciliation information will appear. If "Ok" is selected, a text window will appear containing the reconciliation information (if any claims were reconciled). The MSP messages will be printed in the background. Select "Print" button at the bottom if you wish to print the reconciliation report.
• password must be changed every 42 days as per teleplan protocol. Ideally it is a good habit to change your password at the beginning of each new month. You may NEVER use the same password twice. TO CHANGE PASSWORD OR TO DO AN ELIGIBILITY CHECK YOU
  MUST GO OUT TO THE DESKTOP, LAUNCH YOUR BROWSER (GENERALLY WE HAVE SET UP AN ICON OF A BIRD) You must never do your transmission from this place!!
8. Two processes occur when receiving a remittance. Messages from teleplan, summaries of paid amounts for each practitioner, notice of the last cheque amount etc are printed to a text file. Reconciliation of each claim in the remittance then occurs. The text information automatically prints after processing but can be printed again from the Reports menu until it is overwritten by the next remittance. A remittance report for claims is not printed automatically.

Quick Summary for Teleplan transmission:

1. Check that unsent bills are correct.
2. Print "Complete Unsent MSP Records".
3. Exit MedOffIS (cannot perform backup while MedOffIS running as files in use are locked and will be skipped).
4. Backup.
5. Re-enter MedOffIS.
6. Prepare complete Unsent to MSP records for transmission (ie transfer them to SEND.DAT and Sent to MSP files).
7. Go to Teleplan to submit claims and retrieve remittance data.
8. Reconcile claims using the reconcile option in the Utilities menu.
9. Print reconciliation information if received.
10. At end of day, exit MedOffIS and backup again.

Possible Problems:

1. Remember to change Teleplan password on the first transmission of any month. The password only lasts 40 days. If you forget the password or make an error in typing it, you have only 3 tries to get it right before your account is revoked. The log will indicate whether or not the password is revoked. If it is, you must call Teleplan support (1.800.663.7206) and ask them to reset it. A temporary password will be given which will only work once so the password MUST be changed on the first use of the temporary password.
2. When you go to "Prepare Bills for MSP", an error is generated telling you that you have not sent previously prepared bills. If this occurs, there are two possibilities:
   1. You indeed may not have sent the claims either because you forgot to go to Teleplan or you tried to send them but there was an error such as an invalid password or the network was down. All that is necessary to be done in this instance, is to go to Teleplan and try to submit the claims.
   2. You did send the claims successfully but the Teleplan log file generated in the transmission process falsely indicated that the claims were not sent for some reason. This is a rare occurrence but is becoming more frequent since about the end of the year 2000. When acknowledgement of receipt of the SEND.DAT file is not received, MedOffIS does not erase the SEND.DAT file (so that in normal circumstances you can try to send it again). When SEND.DAT is not erased, it is not possible to prepare bills for MSP. Over-write is not allowed to protect the user from inadvertently preparing a new set of claims overtop of claims that have not been sent. If that was done a legitimate sequence number error would be generated. If the log file does not correctly acknowledge receipt of claims, it is necessary to manually erase SEND.DAT. You must be VERY CERTAIN that this is the problem. For this reason it is prudent to contact your support person before performing this procedure.
3. If you go to "Prepare Bills for MSP" shortly after preparing the previous batch when there are no complete records to prepare, sometimes an empty or "null" SEND.DAT file is created. It is listed in Windows Explorer as being of size 0 (zero) bytes. When there are some complete unsent claims to prepare, an error is generated telling you that you have not sent previously prepared bills (same error as in 2. above). The empty SEND.DAT file must be manually erased. This is potentially a dangerous procedure so generally it is advisable to contact your support person. Note that "SENT.DAT" contains all the sent to MSP records. This file is alphabetically very close to SEND.DAT. Accidental erase would completely wipe out your MSP claim history.

XI. Dealing With MSP Reconcialiation

1. REMEMBER that MSP will not pay for a claim that is OVER 90 days so it is imperative that you attend to your rebillings after each reconciliation is received.
2. Go to SENT TO MSP (ALT 0 (ZERO))
3. Clear screen with F5.
4. ALT F2 will bring up a selection list called "SENT TO MSP BY RECONCILIATION CODE". This list is sorted first by the first reconciliation code and then by the second reconciliation code.
5. The cursor will be flashing in the left most column which is the first reconciliation code. If that column is blank simply tab once over to the next column (the second reconciliation code) and type "F" (failed pre-edit) over the existing letter. Since this is a selection list and you have made changes over top of it, the ENTER key will search the list and take you to all the failed (F) bills, if there are any. If there are no F's type "R" in the second column and hit ENTER to find MSP refused claims. Using the arrow up and down keys, highlight a claim you wish to deal with. When you hit ENTER after not typing anything on the selected line, the selected claim will be put in the SENT TO MSP screen in front of you. Entering CTRL E or mouse clicking on the <EXP> button at the very bottom right of the screen will pop-up a message on the screen which translates the MSP explanatory codes indicating why this claim has been failed or refused.
6. A failed or refused claim can be resubmitted with necessary corrections, marked deleted or written off. NOTE: YOU CANNOT FIX A FAILED OR REFUSED CLAIM IN SENT TO MSP.
7. If you wish to resubmit a claim, enter F2 or click on the <RESUB> button on the bottom of the screen. This will copy the claim information to a new claim in UNSENT TO MSP where it can be edited. The new claim is automatically marked as incomplete by placing "IN" in the < >Complete field. After making the necessary corrections, remove the "IN" and save (with F2) the claim. Having to formally remove the "IN" ensures that the claim has been properly attended to, so it doesn't just get sent again with the same mistakes. If "IN" is NOT taken out, the bill will sit in UNSENT TO MSP til the cows come home!! Remember that changes to name, DOB or PHN for a registered patient must be made in the demographics area. Every time an UNSENT TO MSP claim is saved, this information in the demographics is pasted onto the claim.
8. If you decide that the failed or refused claim was a mistake and shouldn't have been sent in the first place (eg an accidentally duplicated claim or a claim that didn't meet MSP billing criteria), the claim can be DELETED in SENT TO MSP by entering SHIFT F2 or by clicking <DEL> button at the bottom of your screen. "D" will appear in the first reconciliation code indicating that the bill has been marked as deleted. Of course it is not actually deleted to protect an audit trail, but for purposes of reporting, it is deleted. The date that the claim was marked deleted appears.
9. If you choose to write off the claim in SENT TO MSP (ie you feel that the claim is deserved but not recoverable or not worth the effort to recover) enter CTRL W or click on the <W/O> button at the bottom of the screen. This will place a "Y" in the W/O field and the date that the claim was written off will appear to the right of the "Y".
10. To fix the next bill go to or stay in (depending on which option above you were performing) SENT TO MSP (ALT 0) and strike ALT F2 again to bring up the selection list. If the first (far left column) contains an "R" (for resubmitted) or "D" (for marked deleted), strike the SPACE BAR or DELETE key to remove the letter. ENTER will take you to the remaining failed or refused claims that haven't been dealt with yet. If there are no more F's appearing in the second column, overtype "R" (refused) then ENTER and you will be shown the remaining refused bills, if there are any.
11. If you have been paid for a claim which was sent in error, it is possible to direct MSP to remove (debit) the payment. This is necessary when the claim was submitted for the wrong doctor or the wrong fee code was used. Getting paid for the wrong fee code can sometimes result in the failure of an associated claim (eg billing an office visit rather than cryotherapy of a wart results in failure of the mini tray fee associated with treating the wart). With the claim that should be debited on the screen, enter CTRL F2 or click the <DEBIT> button at the bottom of the screen. If you confirm that you wish to proceed, another screen will appear in which to enter a 20 character or less reason for the debit which will be placed in the MSP Comment field in the new UNSENT TO MSP claim. This claim will also automatically have "E" in the submission code to direct MSP to debit the claim. There is usually no reason to go UNSENT TO MSP to make any changes to this claim. The system makes all the necessary changes for resubmission and debit and does NOT place "IN" in the COMPLETE field.
12. If a claim is failed or refused and you wish to resubmit the claim under a different doctor (or same doctor after the practitioner or payee number has been changed), entering F3 or clicking on the <Dup DT Doc> button will make a duplicate claim using the doctor which is currently selected on the desktop. Remember to mark the claim that was duplicated as "deleted" with SHIFT F2 so it is removed from accounts receivable. As with debiting a claim, the new claim in UNSENT TO MSP is not marked INcomplete so it is only necessary to go back to UNSENT TO MSP to edit other claim details.

1. Enter the Utilities menu the Edit Prompts and System.
2. A cascading series of screens appears with a number in the right upper border. On first entering the editor, the system variable screen is visible and has the focus.
3. Use ALT + Screen number to access any one of the screens.
4. In all but the System File Variable screen, a record must be found inorder to be edited. In forms, a record is found with the indexed field in the usual fashion with F7/F8/F9. In tables, enter a search "Mask" then press F9 (this is different from a selection list table where the mask is entered before pressing ENTER).
5. To edit a form or a table after a record is found, move to the field to be edited, make changes and save with F2.
6. To be sure that duplicate records are not added to a file via a form, enter the new item and press F9. If the record doesn't exist, clear with F5, enter the information then save with F2.
7. To make new records in a table, be sure the information is not already saved as described above. Press SHIFT + F10 to create a new line and enter the required information. Save the line with F2.
8. Do not remove the practitioner "NONE" from the B.C. Practitioners table.
9. ICD9 diagnostic codes must be unique.
10. Locums can be registered in the Registered Doctors form with the following steps:
    • Find the doctor for which the locum will be working.
    • Press CTRL + - to copy the doctor's name and address to the clipboard.
    • Clear the Screen with F5. Note that the Doctor No changes to a number one greater than the last doctor number in the system.
    • Press ALT + + to paste the address from the clipboard.
    • Enter the locum doctor's (assignee) name and practitioner number and the payee number of the assignor.
    • Save with F2.
    • Note that new payee numbers cannot be entered and that no doctors can be deleted (so be careful to get it right the first time!).
    • The address should be centered if necessary using the vertical line as the center point (usually not necessary if using paste since the original should be centered). Press INSERT to change from overstrike mode to insert mode if entering spaces to center.
11. Adding new users in Secondary Providers (must have administrative level account):
• Be sure form is cleared if adding a new user.
• Add user name which is usually last name, comma then first name. Entry is automatically uppercased
• Add user ID which is usually first initial and last name. Entry is automatically uppercased.
• Enter password. Must be 6 or more characters (alpha, numeric or special characters). Case sensitive.
• Enter user level. Attending physicians should have user level 400. Nurses, residents and other staff who must routinely author notes should have user level 300 and staff who don't routinely author notes (MOA's, lab/xray personnel) should have user level 200. If staff should not be able to view progress notes (eg filer), assign user level less than 200.
• Previous password can be just user's initials.
• Enter password set date (usually current date).
• Date of birth can be left blank but sex must be entered.
• Remaining fields are optional.
• Save the form with F2. Encrypt password with CTRL E then save again.
• Press F5 to clear for another new user or ALT F4 back to main program.
• Note - user information can be edited with administrative account. The user must be found using F7, F8 and or F9 in the usual manner (user name "mask" can be entered to speed the search is large number of users). Edit the information. The most common reason for edit is to reset a forgotten password. Remember to encrypt the new one (because the password is encrypted, administrators cannot simply look up the current password. The password must be entered again. The user should be reminded to change the password as soon a possible. This can be forced by putting a password set date of three months ago).
12. Editing system variables:
• Label port number must be between 1 and 3 and refers to the LPT port to which labels should be printed.
• Form port numbers also must be between 1 and 3 and refers to the LPT port to which OR booking cards are printed.
• Facility and Subfacility codes should be "00000" until further notice by MSP.
• Enter the address to be entered with CTRL + A in the demographic screen.
• The default location in MSP bills is either "O" or "H".
• A default diagnostic code can be entered if a specialty commonly uses one particular code.
• Enter the most commonly used fee item in the Default Fee Item field.
• Enter the second and third most common fee items in Fee Option 1 and 2 fields respectively.
• The Label String is printed at the bottom of Long Labels.
• Some reports print in compressed print. Enter the print compress ASCII string and the printer reset ASCII string for your printer in the corresponding fields. The default provided with the system works with most dot matrix printers.
13. The User Fee field is not used yet.

XIII. Electronic Medical Record

MedOffIS supports a robust electronic medical record allowing entry of data for the following topics:

1. Contacts and progress notes. Up to 4 ICD9 diagnostic codes and 3 billing codes can be entered for each visit. Each progress note can be up to 5120 characters. Using "Labels and Autotext", an unlimited number of templates/pre-made phrases, sentences, paragraphs or templates can be invoked in the progress note area. Each note is "stamped" with the currently logged on user name. Once a progress note is entered, it cannot be edited by anyone but the author (typists and MOA's have a user level which bypasses authorship so that the real author can later view and edit thereby applying the correct author). After five days from the date of service, contact information cannot be edited by anyone.
2. Lab data in a scrolling table with room for text entry for each item. Popup views limited to one or a specific group of tests can be invoked. In this way, flow sheets for tests such as INR and HgbA1c can be generated on the fly. Lab data with numeric results can be graphed. Several plot pairs such as systolic/diastolic BP and LDL/HDL are available.
3. Imaging reports
4. Past Procedures with a text area to include operative report
5. Consultations and hospitalizations with text area to include details of the visit or the complete text of consultations, discharge summary etc.
6. Family history. In fielded record format for relation and condition
7. Allergies
8. Long term medication list with start and stop dates and text area to include notes about such things as why the medication was started, plan for monitoring etc. Can renew any or all of long term medications with a few key strokes.
9. Interventions such as digital rectal exam, breast exam, vaccinations.
10. Prescriptions with text area to elaborate on instructions. Medications in the long term list and the prescription record can be chosen from a popup list containing a prescriptions drugs in B.C.. Drugs can be searched by generic or trade name. Unit cost and low cost alternative pricing is included. Prescriptions print with the attending physician's letterhead and patient demographic detail.
11. Problem list with stop and start dates and text area for notes such as treatment plan.
12. Free text area for notes of any type. Can contain up to 5120 characters.

As in the billing and daybook areas, the general format is a table (usually sorted with most recent on top) with a text area at the bottom of the table to show the detail of the row on which the cursor rests. Movement to the text area is done by typing ALT Z (for zoom). Hitting escape once moves the cursor back to the table. Each table/text area has a series of buttons at the bottom to indicate how some of the features are invoked. As with all tables in MedOffIS, a new row can be generated with SHIFT F10. A new row, once saved, resorts to it's proper location. It is not necessary to position the cursor to ensure proper order of appearance.

It is important to understand that the Daybook and the contact tables each view the same data file which is a single file of all contacts and the associated progress notes. The Daybook looks at this file sorted first by practitioner, then by date then by time. The contacts look at the same file sorted first by patient then by date. It is not possible to enter the contact area if a patient is not selected in the demographic form. If one moves from the contact table to the Daybook to look at the same record, changes made in the record in the contact area are updated and shown in the Daybook. Changes are also reflected in the contact table when moving there from the Daybook. Since the contact table and the Daybook operate independantly of each other, it is possible to work on a progress note from the contact table and go to the Daybook to make appointments for different patients on different days for different doctors. One can choose to enter progress notes either from the contact table or the Daybook, which ever the most efficient for the particular circumstance. A typist would likely choose to enter the Daybook for the day and doctor for whom she has a tape and simply move the cursor up and down the Daybook table to type the progress notes. A physician may do the same thing except in instances where it is necessary to peruse the chart while entering the note. In that case, pressing ALT F9 from the row in the daybook takes the user to the current contact in the contact table for the patient in question. This flexibility greatly facilitates data entry and viewing the data in the most efficient manner.

The following describes procedures for entering data or viewing each component of the EMR:

(Work in progress -There is a host of information regarding the electronic medical record component of this integrated application that will be added to this summary at a future date).

Scanning Documents to the Medical Record

There are two main ways to insert incoming document information into your medical record after scanning the document as an image (usually a multipage TIF or PDF file). One is to link the scanned document file in the "Documents" (ALT K) area. The other is to process the image file with "optical character recognition" software (OCR) and "copy/paste" the resulting text into the appropriate area in the record (eg Consults/Referrals, Procedures, Imaging Reports etc). The latter method is preferred because it is far more efficient in storage space and can be searched/reprocessed much more easily (e.g. in the creation of referral reports or printing a chart summary). However, some documents can't be converted to text if they contain handwriting, pictures, complex tables etc so choose linking if OCR will not capture sufficient meaning or detail. The steps to scan documents are as follows:

1. Place the document or documents in the automatic document feeder of the scanner.
2. Launch image scanning software such as ReadIris Pro and press the scan button. The pages should feed into the scanner. It is wise to watch for pages doubling up as they go through the scanner. With good scanning software such as ReadIris, you can grab the page that didn't feed properly and add it to the scanned multipage document after the automatic document feeder is finished. If this feature is supported by your software, it is likely that you can also reorder the late addition to insert it in the correct place.
3. If you are going to link the document, do not save it yet - proceed to the linking instructions below. If you are going to OCR the document, save it to a known location such as a folder in My Documents. This will not be the final resting place so it doesn't matter if this is saved to a local drive unless you intend to perform the OCR at another workstation in which case the document must be saved to a shared, network file folder. The filename is also not critical but it is wise to name it with the date (year/month/day) followed by a letter to distinguish it from other files you might scan the same day - e.g. "20051218a.tif". If it is a multipage document, make sure you choose the multipage option in saving.

Linking is done as follows:

1. Go to the document panel for the patient (ALT+K or go to the "View" menu). Enter the indexing information which includes document date, author, image type from the pick list, image file extension (TIF or PDF) and note. Save the record. Note that a unique document number is generated as well as a "URL" (unique resource locator) name. This name is also placed in the Windows clipboard.
2. Switch tasks back to the scanning software (with ALT+TAB or with the mouse). Choose the save file option (with most programs this is usually located in the file menu). If the document contains more than one page, make sure that the "multipage" option is used. With the file name / location selector that is associated with the save process, navigate to the designated folder for linked documents on the server. This is often named \Images\MOIS in your home directory but is user defineable when the software is setup. Place the cursor in the filename field and press "CTRL+V" to paste the name in the clipboard to this field. Click "Save" or "OK" (depending on the software). The process is now complete. You might want to test this from time to time by clicking the "View" button at the bottom of the MedOffIS document screen.

OCR is done as follows:

1. Open the OCR software after completing the scan process and saving the multipage TIF or PDF file. If you are using Omnipage Pro, a workflow should have been created to open an image file and recognize the image. This may be named something like "ImageToOCR". With Omnipage Pro, it is possible to put an icon on the desktop that automatically launches this workflow. The workflow should automatically look for the file to OCR in a preselected location such as "My Documents" or a folder on the server. Select the file and click "OK". The image will be processed. As soon as the first page is complete, you are ready to start. The OCR of subsequent pages will likely go faster than you can copy and paste the text so OCR is not a significant rate limiting step.
2. When the first page of the first document is ready, switch back to MedOffIS and create a record in the appropriate location (eg Consults, Procedures or Imaging Reports). This will include recording the date the event was performed, the author or location and a brief description of the event (eg "Chest Xray"). If the document is a consultation report, you may just have to find the record made for this event when making the referral. This record will have a referral date but no "performed" date which you can add now. The records created by referring are sorted to the bottom in the Consults table - you can go to the bottom using CTRL+END.
3. Return to the document and select the text either with mouse or holding the shift key down while using the arrow keys. It is not necessary to select headers that contain patient information as this is already present in the EMR. Press CTRL+C to copy the selected text to the Windows clipboard. Switch back to MedOffIS and place the cursor in the text area of the record you have created or found. Press CTRL+V to paste the information. Press F2 to save the text.
4. If the document contains multiple pages, it is necessary to go back to the OCR software and select the next page. Repeat the copy paste process described above only this time, paste the information at the bottom of the text previously saved. You can save some time by not saving until all copy/pasting is complete since you will not have to reposition the cursor to the bottom (remember, you can do this with CTRL+END) - however you may run the risk of having to redo the entire copy-paste process if you get mixed up as to what you have already done.
5. Repeat steps 1 to 4 if the multipage image file contains more than one patient document.
6. When all documents in the image file have been processed, close the OCR'ed image file (or application all together if finished for the day). With Windows Explorer, move the completed document to another folder (eg "Completed Scanned Images"). These documents can be saved as a record of the original. Destroying the original paper document should only be done after carefully considering the implications of this and the recommendations of the College of Physicians and Surgeons and medical protective insurer (eg CMPA).
   

Exporting diabetes data from MedOffIS to the CDM Toolkit

1. Be sure to select the appropriate physician as the MedOffIS desktop doctor. The physician must be registered with Toolkit, have a certificate on the current machine and have a valid toolkit userID and password.

2. Select the Utilities drop down menu, and then select Export, then Diabetes CDM Data.

The next screen will ask you for the population in which to use for the import and the timeframe in which to create the exporting file.

3a. If you choose All Docs:

You will export patient data for all of the diabetic patients from your practice into an XML file for uptake by the CDM Toolkit . Choose this option if you work alone in your office, or all of the physicians in your office have granted full access to each other within the CDM Toolkit and you share patients (no particular doctor is attributed to be the primary physician).

3b. If you choose current Doc:

Only the data for diabetic patients attributed to the current Desktop Doctor will be exported to the Toolkit. Choose this option if you work in a multi-physician practice where patients are designated as having a particular primary physician. This designation is done by the "Doctor" field in the patient demographic form.

4. Enter Date Range Inclusive:

This is the date range of observations to be exported. It is wise to overlap this range on consecutive exports because there may be a lag in entering data. For example, a test result whose collection date was in a previous date range may not have been entered into the database until a week after the end of the previous date range. The toolkit detects duplicate values (same test ID on same date) and does not enter them more than once so overlapping date ranges are safe. An overlap of one month is likely to be sufficient.

5. Once you click on the OK button, the XML file will be created and displayed for your perusal (XML is "human readable"). It is not likely you will find anything of interest other than confirming that you have logged in as a user that the toolkit will recognize and selected the appropriate desktop doctor.

6. Next, you will need to log into the CDM Toolkit at https://healthregistry.moh.hnet.bc.ca using your username and password that has been provided to you.

7. Once you have logged in, click on the Chronic Disease Management link. You will now be able to click on the Import Data link on the bottom left hand side of the screen in the General Navigation.

8. From the next screen, click on the browse button and navigate to c:/mois/program/cdmexpor.xml (note: you will only need to navigate to this file folder once since the toolkit has a "memory" of what you selected)

9. Click Open and the dialog box should close.

10. Finally click on the save button. In the next screen, look for any error messages. If you spot a serious error, please contact the Ministry of Health at 1(250) 952-1234. If you spot lines prefixed by "error" and ending with "rolled back", there likely is an error in the data value. This may occur through error in data entry (eg "typo") but may also occur because a legitimate value is outside of the range considered as valid by the Toolkit. Triglyceride values of less than 0.5, for example, will be considered invalid and result in roll back of all data submitted to the toolkit in this session. This by design and unfortunately may shut a patient out of the toolkit. The data ranges and consequences of "invalid" data may be reviewed by the Ministry at a later date.

Printing off work, return to work and other notes for patients and/or third parties

Any subset of the text in an encounter note can be printed either to the prescription or form printer. Use the mouse to highlight the text that you wish to print using the desktop doctor letterhead and the current patient's identifying information as a header. Press CTRL - (minus sign) to move this text to the Windows clipboard. Press CTRL N ("N" for Note) or click the button containing the letter "N" in the bottom right. A dialog box will popup asking to specify the prescription or form printer (the default is the prescription printer). Click or tab to "OK" and the text will print.

Note, you can add pre-typed text using the "label and autotext" function. Press F4 (prompt) anywhere in the body of the encounter note. A selection list of "label and autotext" entries will appear. Select the desired entry (eg "OFF WORK GENERIC NOTE" - these are all defined and entered by the user in the "Edit Prompts and Autotext" function in the "Utilities" menu). Press enter or double click the selection and the text associated with entry will be added to the encounter note beginning at the cursor location when the F4 key was pressed.

Also note that since this process involves printing the Windows clipboard as the note contents, it is possible to print text from any computer source customized with your letterhead and the patient identifying information. For example, specific patient advice can be copied from any text source outside MedOffIS, then printed by returning to the encounter note and pressing the "N" button or CTRL N.

XIV. WCB Reporting

WCB E-form 8 and 11's can be submitted by MedOffIS to WCB via Teleplan. The forms travel along with the bill for the form, and all other bills that are transmitted with Teleplan. All claims with the Insurer Code (which most often contains the code for province) "WC" are transferred to WCB by MSP. MSP will not accept claims/reports for transfer to WCB unless the patient has a valid (but not necessarily paid up) BC PHN. MedOffIS constructs the WCB reports in a file which is linked to the file of contacts. As noted in the section above, contacts can be entered from either the patient contact table or from the Daybook (remember that patient contacts and the Daybook are just different views of a single file; what is entered in one area is viewable in the other albeit in a different format). WCB reports cannot be entered for patients not registered in the patient demographic file. This is because information in the demographic file such as address and PHN is necessary to construct the report and the associated bill.

With the cursor on a saved contact, pressing ALT W pops up the E-form to enter visit information other than the clinical information portion of the E-form. If ALT W is pressed on a row in the contacts or Daybook which is not yet saved, nothing will happen. The clinical information portion of the E-form is not entered on the popup form but is extracted from the progress note area. With this method of data entry, all patient contacts can be viewed and processed mostly in the same way and location. The only difference between a WCB and non-WCB visit is the popup form that allows entry of non-clinical information area aspects of the form (such as prior problems, diagnosis, indicator whether or not off work, current restrictions, estimate of time to return to the work place in any capacity etc). When a form is saved, a "W" appears at the right of the row for the contact (either in the patient contact or Daybook view). This serves as an indicator for the presence of an E-form but does not indicate whether or not the E-form is complete. Incomplete E-forms can be saved (checking for completion only occurs when generating a bill for the form) so that the form can be partly completed by the MOA to be later completed by the practitioner.

When a new form is popped up with ALT W, parts of the form are filled with WCB related data on the Patient Detail portion of the demographic form (ALT 1 then ALT Z to "zoom" to detail). The patient detail information includes claim number (complete with two letter prefix), area of injury (with suffix to indicate anatomic area - right, left, bilateral or not applicable), nature of injury, date of injury, employer location and employer address/telephone. Note that the second employer address and employer telephone are not mandatory fields). The information which is pre-filled in the form can be overwritten to allow for submitting a form for another but not so frequently visited injury. Furthermore, information in the pre-fillable areas can be changed then saved to the patient demographics in instances where a mistake has been observed or when it is desired to update the demographics to a new and in future, more commonly assessed injury. The update is performed by pressing CTRL U.

The procedure for completing and billing a WCB E-form is as follows:

1. A saved contact must be present for a patient registered (ie has a chart number) in the demographic file. For those using the Daybook, a saved contact will nearly always be present as part of the normal process of booking patients. For those not using the Daybook for scheduling, the contact may be saved as part of the process of completing the form. Saving the contact can be done either with the Daybook (be sure the correct practitioner and date are selected in the Daybook) or from the contacts (be sure the correct practitioner is selected on the desktop). Generally, it would be easiest to generate a contact for a form in the non-scheduling environment by using the contact table. To do this:
   1. Find the patient demographic form in the usual manner for doing this.
   2. With ALT Z enter the WCB specific information in the details box). Save the information
   3. Press ALT 2 to go to the contact table. There a scrolling table of all saved contacts for the patient can be seen most recent on top.
   4. Create a new row for a contact with SHIFT F10 (not necessary if there are no previous contacts - the cursor will already be on a cleared new row).
   5. Enter the date of the visit. Tabbing through a blank field will enter today's date.
   6. Enter the time (hour and minutes) if you wish or leave it to default as zeros by tabbing through the first two fields.
   7. Enter the type of visit or leave it to the default (usually "R" for regular visit but can be any other alpha character such as "F" for followup, "S" for same day booked visit, "C" for complete examination etc) by tabbing through it.
   8. The doctor field cannot be entered in this view - the practitioner selected on the desktop (top right) will be applied at the time of first save. Thereafter, the practitioner cannot be changed. If the wrong practitioner was selected, the entire contact has to be deleted and a new row generated.
   9. The note field generally is filled with the reason for the visit as would be entered in a daybook, eg "sprained right ankle".
   10. If known at this time, enter the ICD9 code that would be used for billing the visit portion of the contact billing (eg 844 for strained knee).
   11. The contact can be saved at this point. It is possible to ALT Z to the text area to type the progress note before saving the contact. However, by not saving the contact before doing the typing, it is possible that all entered information for the visit could be lost if one has to navigate to other areas of MedOffIS eg to print a label or update another patient's information, or if such navigation occurs accidently.
2. Once a contact row is saved, it doesn't matter which order the E-form information and progress note is entered. The following 2 steps can be done in any order:
   1. ALT Z to text area and type progress note (the information to appear in the clinical information box in the form)
   2. ALT W to the popup E-form. If patient detail WCB information was entered, it will be pre-filled. If not, enter it now as you proceed through the form.
3. When in the form, it is best to TAB through the fields. This is the standard method for navigating through any form in any operating system. ENTER can be used to move through most of the fields but when a text box is entered, further typing ENTER will generate unwanted blank lines in the text box. Note that ENTER (new paragraph) is not recognized when the information is passed on through Teleplan. Complete the fields as follows.
1. Employer address 2 and telephone are not mandatory.
2. The "Who rendered first treatment" field is not mandatory. It is meant to indicate whether or not another practitioner saw the worker beforehand, eg did the patient go to an emergency department or was a Chiropractor or Physiotherapist seen before seeing the physician. It is not necessary to indicate whether or not the worker was seen by the first aid attendant at the worksite.
3. The "Family MD" field is a "radio button" (standard Windows data entry type where a dot indicates which option is selected). Once in this field, use the right and left arrow keys to select the correct option then move on with TAB.
4. "Prior/other Medical Problems" is a text box that can be left blank if there are no significant prior problems or if the box had been completed on a previous form.
5. "Diagnosis" is a text field.
6. Indicate whether or not the worker was disabled from work since injury or the last report. The date the worker went off work is entered in the next field. Note the tilde which indicates that a prompt is present - in this case a calendar. When in the calendar, PAGE UP and PAGE DOWN moves to the previous and nextmonth repectively.
7. If the worker is not currently capable of performing full duties full time, indicate the restrictions which prevent the worker from perfoming them in the "Current Restrictions" text box. WCB and the employer can determine what if any duties are appropriate and available given this information. Specific detail to aid in selecting these duties is helpful.
8. "Time to return to the work place" (in any capacity) is a radio button.
9. If worker is ready and appropriate for a rehabilitation program indicate (C) for Work Conditioning Program or "O" for other program (such as Occupational Rehabilitation, Hand Clinic, Medical Rehabilitation etc). A brochure can be obtained from WCB which outlines what is done in these programs.
10. Estimate of MMR (date of maximal medical recovery) is helpful in managing the worker's recovery be setting expectations to all parties for what is a reasonable recovery period for the diagnosed condition.
11. The bottom row contains billing information. Note that "19937" and "19940" is now used for E-Form 8 and 11 respectively and pays a premium over that which is submitted on faxed paper forms. Claim number is not mandatory because it is often not known on early visits.
12. When the desired amount of information is entered (remember that incomplete forms can be saved at any time) press F2 to save. A report number will appear in the top left of the form. This is a sequential number to uniquely identify all WCB reports in the data file. It won't be used by the user in normal circumstances. If the form is believed to be complete and it is time to bill it, press CTRL B. If an incomplete mandatory field is found, an error message will be popped up and a bill will not be generated. If the form is complete, a "B" will appear in the bottom right of the form. The complete form can be printed, if desired for the paper chart, by pressing CRTL P. Only complete forms can be printed. If one navigates immediately to unsent to MSP, the bill for the form can be seen. It is saved so nothing needs to be done. This navigation is not necessary but reassuring in the early stages for some.
13. Leave the form by pressing ESC or navigating to another area in MedOffIS directly with the hot keys or mouse. Note that when you leave the form with ESC, you are returned to the contact row and a "W" now appears on the right if a form was saved. Whether or not the form is complete, a bill for the WCB can now be generated with CTRL B if the ICD9 diagnostic code has been entered. CTRL B is used routinely for all office visits by those who use the Daybook. When a "W" in the right most field is detected, MedOffIS generates a WCB bill (ie with "WC" in the insurer code, DOB, Sex, Addr 1, 2,3 and 4 completed etc). If there is no "W", an MSP bill is generated. It follows, therefore, that a WCB form must be saved first before billing the visit portion of a WCB visit. If the Feecode field is blank, the default feecode (entered in the edit system/prompts area) is used. For family practitioners, this is usually set to 00100. If a feecode for the visit other than the default is desired, enter the feecode before pressing CTRL B. When pressing CTRL B, the contact row is saved so it is not necessary to press F2 as well.

These instructions may appear at first glance to be complicated but once the logic is understood, the process is quite simple. Persevere!

Appendix A - Setting up MedOffIS

1. Copy runtime files to the root (DF32 directory and it's subdirectories). A licence is required for each block of 4 users.
2. Copy MedOffIS and it's subdirectories (Data and Programs) to the root.
3. Environment variables are critical for normal operation of MedOffIS. They are set in a file named DFENV.CFG in the MedOffIS programs directory. The drive letters and directories can be changed for any kind of setup. The order of the variables is important. The MedOffIS data directory must be first, followed by the MedOffIS program directory. The order of the remaining variables is not critical. Data location can be specified as a drive letter/directory path or a UNC name such as \\servername\datadirectory. If a drive letter is used, it can be mapped prior to running MedOffIS by using the NET USE command - usually in the form NET USE S: \\DataComputerName\DriveName /Y. The /Y switch stops the user from being prevented with a confirmation screen which Windows will present if the drive was already mapped (which is usually is after being set by the previous launch). A password to connect to the drive can be added after the drive name and before the switch. NET USE can also be used to map printers eg., NET USE LPT2: \\DataComputerName\PrinterName /Y. If spaces occur in the printer name (good practice to name printers and drives with 8 character or less names without spaces), quotes can be placed around the computer name/ printer name combination eg. "\\DataComputerName\Printer Name" /Y. All NET USE commands should be placed before MedOffIS is invoked with DFRUNCON.
4. To setup printers to use for prescriptions,forms, labels and reports, go to Utilities -> Edit Prompts and System File. In the Local Variables window, edit either the port names or device names. Ports can be used if the printer supports character based printing - eg LPT1: (be sure to include the colon at the end) or \\computername\printername. For Windows only printers or to take advantage of some Windows printing features such a printing to a fax modem, specify the device name in the device fields. This should be the name of the printer as it appears to Windows which is not necessarily the name given in Windows Printer setup (strange isn't it?). A good way to determine the printer name is to select Print... in Word an look at the printer names displayed there. Entering a colon for device name results in printing to the default printer. This can be used as a last resort if it is difficult to figure out the printer name
5. Launching MedOffIS:
   1. Only two files need to be modified for most installations. DFENV.CFG was discussed above. A batch file named START_APP.BAT starts the execution process. This batch file calls another batch file called MOISSTRT.BAT which doesn't need to be altered. It is called with 5 parameters which are specified by comments in the START_APP.BAT file.
   2. A shortcut to the start_app.bat file in the MedOffIS programs directory is placed on the desktop. Note that shortcuts to batch files in Win9x and WinNT/2000/XP are not interchangeable. Using a shortcut created in Win9x for WinNT/2000/XP can result in erratic behavior. Do not name the shortcut "MOIS" as this will cause a "MOIS Already Loaded" error. The short cut to MedOffIS on Win2000/WinXP computers should uncheck "quick edit" otherwise the mouse doesn't influence the location of the cursor or execute any commands.
6. Backup is simple. PKZIP and PKUNZIP are put in the \Windows or \Winnt directory so they are in the default path. Batch files for daily data and monthly data and program backup are provided. The batch files require parameters to specify the data and destination directories. Previous backup files in the destination directory are renamed one by one so that a new zip file can be created and the old are retained (10 for daily backup and 4 for monthly backup). A shortcut to the batch files is put on the desktop. The PIF is set to not close on completion so that any errors that occur may be visible. No workstations should be running MedOffIS when the backup is done. Files are locked when in use and are not backed up by most programs (open file agents are available on server backups but are expensive to license). MedOffIS has an internal timer so that after about 1 hour of inactivity, the program shuts down. This makes scheduled, middle of the night backups possible. A workaround for the problem of file locking is to create a batch file that copies the critical files (*.dat, *.vld, *.hdr) to a temporary location then use PKZIP to backup the copied files. Windows will copy files that are opened by MedOffIS but not locked. The .DFR file in the datafile which controls the locking and user count is always locked when a MedOffIS client is open. Datafiles are only locked at the instant of save or delete. This means that the copy file technique can fail if it happens to want to copy a file which at that moment is being edited with save or delete. Windows will stop all copying after it encounters a lock. Of course, if such a batch file is being constructed always specifically name the full path of the files of the backup directory. If one depends on a change directory command to work, then execute erase *.*, unexpected disastrous results might occur if for some reason the directory change was unsuccessful.
7. MSP provides local telephone numbers to connect to Teleplan sponsored limited internet in most communities. These numbers can be found in Teleplan help files on the internet. Setup a dialup connection with the parameters specified by Teleplan.
8. Recovery from backups. Always make a copy of all files in the data directory before fiddling with the files, no matter how corrupted they may appear to be. Restore all the data files to the \MOIS\DATA directory using PKUNZIP (eg PKUNZIP D:\MD00 *.* or PKUNZIP D:\MSYS00 MOIS\DATA\*.*. After this restore, all indexes (files with extension K?) must be recreated. To do this, go to a command prompt. Set the Dataflex environment variables by executing the batch file "SM.bat" in the MOIS programs directory. Change to the \DF32\bin directory. Type DFSORT -A at the command prompt then enter. All files will be indexed. Errors that occur are in the DFSORT.LOG file in the data directory. Specific bad records, if any exist, are listed in a file with the bad file name and .BAD extension.
9. Peculiar behavior of the data. Always start with SCANDISK then resort the data files as per the above instructions. It is very rare to have to do this. Almost always, a hardware failure or serious system problem such as a virus is the cause. Properly functioning computers run MedOffIS for years with virtually no attention (one site ran MedOffIS for more than 5 years with no support whatsoever!). MedOffIS runs very well in console mode (with DFRUNCON) on Win2000 and WinXP. This is because console mode operates with Windows memory management, not a DOS extender which appear to be poorly supported in the newer Windows operating systems.

WL Clifford, M.D., CCFP, FCFP
November 22, 2005.