MedOffIS History

The Medical Office Information System began in 1990 as a simple program to support basic medical office functions such as billing to MSP, private billing, demographic record and recall. . It is written in Dataflex, a powerful 4th generation database language widely used around the world and one of the first such languages to support object oriented programming. The author is a family physician in Prince George, B.C. By 1995, a scheduler was built in to the system from which bills to MSP could be generated. In 1996, electronic medical record capabilities were added. The scheduler became an integrated part of the contact notes portion of the EMR thereby avoiding duplication of data.

MedOffIS is now used in more than 110 offices in BC. Many sites are clinics supporting multiple doctors. Due to the powerful database language in which it is written, large databases can be maintained with rapid access and no corruption/loss of data. One clinic has over 130,000 registered patients seeing about 150 patients per day, seven days a week and notices no appreciable degradation of performance over that of when the application was first installed. The database supports a robust data file locking/transaction processing system which enables efficient multiple user access over a network. The DOS/Windows NT console mode version of dataflex is now used since it is so fast even on legacy computers and provides excellent performance on dialup remote access. Despite being a "DOS" character application, the fully object oriented Windows 32 bit code allows for drop down menus, multiple open "windows" for all aspects of billing and the EMR which are each accessable with a single mouse click or key stroke. A windows version is currently in progress which will continue to use the same hot keys and navigational rules. A web enabled ASP version is planned for the more distant future. Character based and Windows GUI applications will be supported concurrently on a single network since the Dataflex languages can all support the same database files. This will allow for continued use of legacy computers which makes installation of workstations in each examining room cost effective.

MedOffIS Features

  1. Data files to support the following:
    • Patient demographics, next of kin, recall information, family members, WCB claim data. Up to 999,999 patients with unlimited billing and EMR entries of any type possible. Instant random access (no detectable lag) for any patient even on 486 cpu.
    • Contact (progress notes) viewable in date order in the contact section or in the scheduler. Notes can be written from any number of user defined templates. Any portion of the note can be used to generate off work/sick notes which print on the prescription printer. Associate encounter templates to any progress note. Currently templates for CHF and Diabetes supported.
    • Laboratory data. Constrained views possible limited to individual lab test (eg Hemoglobin), lab test category (eg hematology) or user defined clusters of lab tests (eg diabetic lab profile). Look up of all available lab tests supported by the local lab system. Normal ranges included for each test and abnormal/absurd values flagged. All lab entries with numerical values can be plotted instantly on a color Windows graph with a single mouse click. There are several multiplots as well such as systolic/diastolic BP, LDL/HDL cholesterol and AST/ALT. Graphs show horizontal lines representing upper and lower limits of normal. Pediatric heights, weights and head circumference plot against latest CDC 5th, 50th and 95th %ile smoothed curves (ages 0 to 36 months and 2 to 20 years).
    • Imaging reports
    • Consults and hospital admission/discharge. Referral letter text area associated with the referral and referral letter report with list of problems, allergies, long term medications, past procedures generated by single mouse click or keyboard entry.
    • Procedures including text area for operative report
    • Family history (fielded so that searches can be made on either type of relative or on condition)
    • Allergies (also fielded for substance/medication and reaction). Allergies popup prior to printing any prescription.
    • Long term medication list with date start and if appropriate, date stopped. Text box for notes on each medication. Look up of all medications supported by Pharmacare by brand or generic name including unit cost and low cost alternative pricing. Also has a user defineable formulary lookup preloaded with Pharmacare covered medications. Method for rapid renewal of any or all of the active medications.
    • Prescription record for every prescription and text note available for each prescription. Medication lookup as above. Method for duplicating previous prescriptions with single key stroke. Can resort medications by name and date to view prescription history for each medication
    • Medical interventions of various types (eg immunizations, digital rectal exam, counseling) in standardized input.
    • Social history list with "sensitivity" indicator to suppress printing of sensitive items
    • Problem list with start and stop dates, text area for treatment plan/notes. Also has "sensitivity" indicator to prevent printing selected items
    • Disease prevention and management area to enter an intial assessment and list of custom encounter forms for conditions such as diabetes, congestive heart failure and hepatitis C. This is designed to accomodate and unlimited number of conditions without complicating the data structure or slowing access to data.
    • Linked documents of any type (multipage image files, Word documents etc) indexed by date and author. Text information can be associated with the document.
    • Scheduler (Daybook) - supports more than 100 providers, any appointment interval down to one minute, status bar to view day at a glance. Status bars for all doctors or one selected doctor viewable in scrolling list of all past and future appointments. Progress notes can be entered via the scheduler. MSP billing can be done directly from the scheduler. Appointments color coded depending on visit type
    • MSP billing data. Supports all aspects of MSP fee for service and alternate payment billing including rebilling and note records. Lookups for ICD9 codes (sorted on the fly by description, category or code), all registered medical practitioners in BC (sorted either by name, billing number, city or specialty code) and all MSP fee codes (sorted on the fly by description or code number). Most of BCMA non-insured codes also included. Submission of claims to MSP via the internet supported.
    • Private billing with unlimited transactions for each invoice. Unlimited entry of third party payors for insertion into invoice header or for generating mailing labels.
  2. Numerous reports including the following
    • Account summaries and accounts receivable for MSP and private billing for any date range.
    • Payments for any date range.
    • Patients by billing fee or diagnostic code.
    • Appointment and billing daysheets.
    • AND or OR search for up to 6 problems (eg smokers with diabetes and hypertension).
    • Patients who have had a certain procedure.
    • Health maintenance audit for any patient presenting appropriate lab values (or their absence), procedures (such as immunizations, pap, colonoscopy) and imaging studies (such as mammogram) depending on patient's age, sex and past medical history/risk factors.
    • Visits by provider for any date range sorted by diagnostic code.
    • Female patients by time from last pap and mammogram (for appropriate ages).
    • Age/sex register for active patients in the practice.
    • Specified lab tests for any date range sorted first by patient name
    • Specified prescription or long term medication drug names (or portion of names) for any date range sorted by patient name (eg can print all prescriptions containing the text "STATIN" for any date range to see who is on lipid lowering medication in that family of drug)
    • CHF, Diabetes and Hepatitis C flow sheets (exceed MOH requirements for billing chronic disease management). Diabetes related data can be exported in XML format to the BC Ministry of Health Chronic Disease Management Toolkit.
  3. Search the database on the screen for any xray, problem, procedure, prescription or long term medication.
  4. "Alert Policy" module where any number of user "rules" can be specified and run individually or as a group eg list all diabetic patients who have not had a HGBA1C done in the last 6 months, list all individuals over the age of 65 who have not had a once in a lifetime pneumococcal vaccinations or list all females age 18 to 69 who have not had a hysterectomy and have not had a papanicolau smear in the last 2 years. Policies can be checked against the entire practice or a specified group of policies can be checked for the currently selected patient with one key stroke.
  5. Lookup, system defaults and user maintenance area. All lookups including MSP explanatory codes, BC practitioners, diagnostic code, fee codes, third party payors, progress note templates, phone and web address lists etc.
  6. Logon security enforced. All staff have userid/password and user level assigned. Passwords must be 6 or more characters and changed regularly. Last three passwords must be unique. Stored passwords are encrypted. Only users with suffiently high user level can "author" notes. MOA's can type notes but authorship assigned only when doctor saves note. Only original author can change "signed" notes. Notes cannot be created more that 30 days from date of service and cannot be changed more than 5 days after date of creation. This security enforced by a proprietary algorithm which makes it impossible to alter these rules by changing the system date.
  7. Access to EMR data logged. Patients can be provided a report of all accesses of EMR data for any date range on demand. Report specifies what part of the EMR has been accessed and also logs printing of EMR related reports.
  8. Rapid, encrypted and compressed backup using 7z compression and 256 bit AES encryption. If thousands (millions?) of computers were amassed to generate 10 billion passwords per second and this processing power is doubled every 2 years, it is estimated that it would take on average, 40 years of continuous work to crack one backup. This means backups can safely be taken off site either physically or electronically. Ten years of billing ($200,000+/yr), 4 years of complete EMR and scheduling for practice of 2000 patients and all lookup data can be backed up in a 6 mB file due to continuous data compression at runtime and efficient relational database design. Complete system restore in event of total hardware failure takes 5 to 10 minutes. No user over last 16 years has lost single record of data for any reason, including hardware failure and fire.
  9. Gestational age, BMI, Body Surface Area and cardiac risk (Framingham) calculators. BSA, BMI and cardiac risk calculators can be populated with data from the patient database and value exported to database for viewing and reporting.

MedOffIS System Requirements

  1. DOS, Windows 3.11, Windows 9x, Windows ME, Windows NT, Windows 2000 or Windows XP (Home or Professional). Windows XP Professional preferred operating system
  2. 386 processor with 4mB RAM (minimum). (PIII or PIV processor with 256 to 512 mB RAM recommended).
  3. 14" VGA monitor (17" or 19" SVGA LCD recommended).
  4. 1.2gB hard drive (20 - 40 gB recommended).
  5. Modem or internet connection required for MSP billing (If modem is used, USRobotics 56K recommended)
  6. Ethernet card for networked systems or those who wish to submit claims to MSP via high speed internet.
  7. Printer supporting DOS and/or Windows printing.
  8. Optional second dot matrix printer connected to LPT2 for dedicated label printing (1 7/16" X 4"). Zebra label printers supported.
  9. Optional third printer for printing prescriptions, offwork/sick notes etc. Star thermal prescription printer is supported
  10. RW CD-ROM / DVD, Zip Drive or tape drive recommended for convenient backup
  11. Wireless networking can be used especially when using the EMR but should only be done under the guidance of a network professional well versed in the security issues of wireless technology.
  12. Peer to peer or client/server networking supported. For 1-3 physicians using less than 8-10 workstations, peer to peer networking using a WinXP client as data share can work very well with minimal hardware and networking overhead. 30 or more clients can operate in an inexpensive peer to peer network using modern, sophisticated network drives (note that there are diminishing returns with increasing numbers of clients in a peer to peer setting due to the difficulty of managing workstations without a server).

MedOffIS Pricing

Single user system - $2400.00 for MedOffIS installation, setup teleplan and backup and basic training sufficient to enable an experienced office assistant to use this particular system. Additional training for clinics with diverse staff, MOA's with limited computer or billing experience and physician's using the EMR is billed at $45.00/hour after basic instruction.

Multi-user system - $300.00 for each additional workstation.

All systems require a Dataflex Runtime License from DataAccess Corporation. Licenses cost about $350.00 Cnd for blocks of 4 users and are included in the prices above.

Support - $100.00/hour as needed (most sites need no support for MedOffIS from year to year). There is no annual license fee for MedOffIS. Cost for updates depends on complexity of software changes. Most updates over last 10 years range from $250.00 to $850.00 and have been required about every 18 months to keep up with MSP and WCB changes in addition to adding new features. Pricing is similar to the open source software model where users pay for tangible value added installation and support.

MedOffIS Contact

William L. Clifford, M.D., CCFP, FCFP
239 North Kelly Street
Prince George, B.C. Canada V2M 3E6
Tel: 250.562.9212 / Pager: 250.613.4567
email: bill(dot)clifford(at)northernhealth.ca