# Presentation: 432246

## ELECTRONIC MEDICAL BUSINESS OPERATIONS SYSTEM (EMBOS)Progress & Productivity Update

**Dr. Otis Cosby, **
**Dan Cannon, Jessi Metcalf, **
**Melissa North, Steve Underwood**
**April 19, 2007**

## EMBOS Project Team

**	**_**Occupational Health Services**_	_Area of Expertise_
**Dr. Otis Cosby***		Medical Director
- Debbie Hurst		BE Representative
- Dr. Russ Reynolds		Psychologist & HRP
- Stan Roberts		Physician Assistant
- Patsy Shelton		X-ray & MOHIS Expert, Records
- Verilyn Smith		Human Reliability Program
- Becky Sproles		Scheduling
- Sula Thomas		Laboratory
- Nancy Underwood		Business Operations, Nurses
_**Information Technology**_
- David Caldwell		Applications Developer
**Dan Cannon***		Applications Technical Lead
**Jessi Metcalf***		Applications Developer
- Matt Morrell		Applications Developer
**Melissa North***		Project Manager
- Brian Ray		Database Technical Lead
- Terry Richardson		Applications Developer & MOHIS 			  Technical Lead
**Steve Underwood***		Technical Advisor
- ***present today**

## Why build EMBOS?

- Compliance with state and federal regulations regarding storage and retrieval of vital medical records (e.g., 10CFR 851.210)
- Requests for medical records continue to increase
- Medical record volume continues to rise
- X-rays (all hardcopy film) deteriorate with time
- Medical records must be kept long-term
- Costs to manage and store records continues to increase
- Duplication of effort is significant
- Current MOHIS system deployed 1994
- Technology refreshment necessary

**Notes:**
10 CFR851.210 
1/1/2007 implementation plan due
Requires medical records electronically available by 2015

NFPA 232, National Fire Protection Administration, Standard for the Protection of Records

DOE Order 440.1A, Worker Protection Management for DOE Federal and Contractor Employees, Section 18, Occupational Medicine, Item g (3)

_______________

Current system MOHIS

Cannot fully comply with 10 CFR851.210 

Limited ability to track patient information electronically
Paper-based
Input required by transcriptionist

Limited ability to streamline functions
Information capture, transfer, tracking, reporting

Deployed 1994
Technology refreshment needed

## EMBOS Goal

**Integration of **_[tools, technology & security ](slide16.xml)__to_
** ****streamline information capture and transfer **
**to create a comprehensive electronic **
**medical record (EMR)**

## EMBOS Integration

- Electronic Patient
- Medical Record and
- Clinical Services
- (Main & Satellite Facilities)
- Medical Business Operations

**Notes:**
CORE ...

Legacy records scanning (removed from slide)

## EMBOS Software Development Goals

- A Paperless Electronic Medical Record
- Web-Based / Browser-Based Interface
- Real-Time Data Capture and Retrieval
- Eliminate Duplicated Data & Streamline Processes
- Intuitive interfaces - Minimal Training Required
- Multi-Tiered, Modular, Component-Based Software Architecture
- Adherence to Standards (HL7, DICOM)
- Direct Updating of Select Medical Data (e.g., medical History and medications) through the *Patient On-line Medical Services* (POMS) web site

**Notes:**
A paperless Electronic Medical Record
Reducing the amount of paperwork that is processed through medical 
Significant reduction of paper with EMR

Reduces Patient cycle time through medical facility via
Online questionnaire
Real-time data capture

Real-time data capture – 
Transcribed data not necessary
Immediate notification of results to provider and patient

Eliminate redundancy

Reduce daily work schedule (medical chart) preparation time

Eliminate duplication
Reducing the amount of questions being answered by the patient by eliminating duplicate questions 
Duplication of questions across programs eliminated

Positive impact on health care providers

Timely retrieval (access) to needed information
Access to entire patient medical record at desktop (includes x-rays and scanned records)
Immediate notification of results - Allowing doctors to see patient’s questionnaire immediately with out waiting for transcription to enter information 
Allowing the doctors to see select questions depending on what they need to look at – for example a doctor can see all positive answers on a questionnaire

Standardization
Improves data validation
Provides consistent data capture and reporting 

Intuitive interfaces - minimal training required

Controlled patient updating of select medical data through a Patient Services web site

EMBOS Increases Productivity by:
Reducing patient medical record preparation time (this is time spent the day before or the day of getting the patient’s medical record together for the appointment) 

From Jessi - EMBOS Increases Productivity by:
Reducing transcription time by allowing easy real time data entry 
Allowing the doctor to have all of patients medical information in real time with just a few clicks of the mouse 
Reducing patient medical record preparation time (this is time spent the day before or the day of getting the patient’s medical record together for the appointment) 
Reducing patient time at Medical because the patient is allowed to fill out questionnaire on-line in the patient’s office 
Reducing the amount of questions being answered by the patient by eliminating duplicate questions 
Allowing doctors to see patient’s questionnaire immediately with out waiting for transcription to enter information 
Allowing the doctors to see select questions depending on what they need to look at – for example a doctor can see all positive answers on a questionnaire 
Reducing the amount of paperwork that is processed through medical 
Reducing the retrieval time of patient information

## Progress & Productivity

## Progress & Productivity (cont.)

## Progress & Productivity (cont.)

## Progress & Productivity (cont.)

## EMBOS Demonstration

- Dan Cannon & Jessi Metcalf

## EMBOS Software Demonstration

- Patient medical questionnaires
- Patient registration process
- Workflow through the medical facility
- X-Ray Workstation
- PACS sub-system overview
- Integration with EMBOS using HL7 messaging
- Medical Lab Workstation
- Psychology Lab Workstation
- Nurses Workstation
- Providers Workstation
- Scanning of paper records
- Patient Electronic Medical Record
- Medical reporting

## EMBOS Demonstration

- Questions and Answers

- Thank you!

## EMBOS Hardware/Software Environment

- _[Web application](slide4.xml)_
- Browser-Based – no client software to install & maintain
- Access from Remote Locations
- Secure Access and Data Transmission
- Microsoft © ASP.NET, C#, PL/SQL
- Oracle 9i © RDBMS (portable to other compliant databases)
- Moving to Oracle 10g with next release
- Reports in PDF format
- Operating system – Windows 2003 Server
- Voice Recognition COTS
- Badge Reader
- Signature Pad
- Scanning (Twain compliant)
- Touch Screen
- Digital Imaging
- Picture Archiving and Communications System (PACS)
- Digital Radiography (DR)

## PACS Integration to DR & EMBOS

- _[Planned integration with Digital Radiography – FY08](slide8.xml)_