Abstract:
A portable touch-sensitive system for capturing Electronic Medical Data (EMD) to create Emergency Medicine Electronic Medical Records (EMRs) that includes Graphical User Interface (GUI) menus adapted specifically for collecting and reporting medical assessments in the Emergency Room (ER) environment. For navigation, the GUI menus use text objects that can be selected, opened and moved among multiple states using simple operator pen gestures. The resulting EMR content is fully accessible without scrolling, opening or closing windows, or changing menus, making it possible to capture, in real time as the patient is talking, a EMR that fully conforms to the predetermined EMD requirements of an Emergency Medicine EMR specification.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application is filed pursuant to 37 C.F.R. §1.53(b) and claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 61/381,028 filed Sep. 8, 2010 and entirely incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    This invention relates generally to Electronic Record Management (EMR) systems and more particularly to an EMR system with a touch-sensitive Graphical User Interface (GUI) adapted for real-time recording and reporting of Emergency Medical Data (EMD) in the Emergency Room (ER) environment. 
         [0004]    2. Description of the Related Art 
         [0005]    Many Electronic Medical Records (EMR) systems are currently known and used in the medical services industry. Some of these systems are useful for certain medical specialties but generally lack many of the practical features required for utility in the hospital Emergency Room (ER) setting. EMR systems are still relatively recent in the art and, while evolving, there remain many clearly felt problems. There are template and open-ended charting systems having customized client criteria. Ease of implementation varies dramatically depending on chart design, prior ER computerization, record flow, actual time required to document the record and quality of training. 
         [0006]    The physician documentation part of existing EMR systems is cumbersome and difficult to use. In certain settings and particularly in the ER, physician documentation is known to cause so much delay in effective patient care that many ER physicians are forced to chose between EMR data collection and life-saving patient care, often obliging the ER physician to use less effective paper charting that is later uploaded into the EMR system after its timely utility to other EMR system users is lost. 
         [0007]    Currently, most EMR systems are stationary, obliging the ER physician to either push a large computer on a cart or take notes on paper and input the information in the computer at a later time. The few EMR systems implemented with a portable client computer employ Graphical User Interfaces (GUIs) that make data entry cumbersome because of the many scrolling and window opening and closing operations required to support the Emergency Medical Data (EMD) entry process. 
         [0008]    These EMD entry procedures are also burdened with one or more government regulatory specifications for an Emergency Medicine EMR that set forth a number of predetermined EMD requirements, such as the guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) promulgated by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Department of Health and Human Services (DHHS). These guidelines are entirely incorporated herein by reference and are often used as a companion document to the DHSS CMS publication entitled “1997 Documentation Guidelines for Evaluation and Management Services,” which is entirely incorporated herein by reference and is available at https://www.cms.gov/MLNProudcts/Downloads/MASTER1.pdf. These detailed regulatory requirements must be navigated by the physician and/or the scribe while also navigating the system user interface to enter information when distracted by the busy ER environment. 
         [0009]    The medical services art is replete with proposals for EMR system improvements for many purposes, including insurance cost optimization (e.g. U.S. Pat. No. 7,379,885 issued to Zakim), patient diagnosis and monitoring (e.g. U.S. Pat. No. 7,409,154 issued to Putnam et al.), automatic EMR update and maintenance (e.g. U.S. Pat. No. 7,464,043 issued to Dussia), automatic integration of disparate databases (e.g. U.S. Pat. No. 7,707,047 issued to Hasan et al.), ER cost control (e.g. U.S. Patent Application No. 2003/0,069,756 published by Higgenbotham et al) and many others. Many practitioners have proposed solutions to one or more of several well-known deficiencies in the EMR system arts but, until now, little attention was given to the problem of regulation-compliant EMD entry and review in the busy ER setting that may delay effective patient care to the point where the ER physician must choose between compliant EMD collection and life-saving patient care. 
         [0010]    For example, in U.S. Pat. No. 6,154,750, Roberge et al. disclose a method and system for navigating hierarchical database views that supports efficient entry, review, and updating of data using a navigation display. Roberge et al. teach a useful method for the entry, review and update of data in a hierarchically-organized database but neither consider nor suggest solutions to the specific problems of EMD entry and review in the ER setting. 
         [0011]    In U.S. Pat. No. 6,347,329, Evans discloses an EMR system having a patient data repository in communication with the point of care system that captures patient data, such as patient complaints, lab orders, medications, diagnoses, and procedures, at its source at the time of entry using a touch-screen graphical user interface (GUI) or pen-based portable computers with wireless connections to a computer network. Evans does not consider the ER environment as his teachings require a permanent (wireless or wired) connection between the point-of-capture elements and a patient data repository. Evans neither considers nor suggests solutions to the specific problems of EMD entry and review in the ER setting where such communications are often erratic and unreliable. 
         [0012]    In U.S. Patent Application No. 2008/0,242,953, Dew et al. disclose an automated system for guiding a user&#39;s examination of a patient and for generating a transcript. Dew et al. teach a useful method for efficient production of compliant EMRs but neither consider nor suggest solutions to the specific problems of EMD entry and review in the ER setting. 
         [0013]    In U.S. Pat. Nos. 6,684,276 and 7,461,079, Walker et al. disclose a patient encounter EMR system that includes pre-populated, diagnosis specific templates, selective, specialty-specific master databases, and anatomic specific databases and templates to afford comprehensive, accurate and compliant medical documentation that captures patient data concurrently with the clinical patient encounter session. Again, Walker et al. teach a useful method for efficient production of compliant EMRs but neither consider nor suggest solutions to the specific problems of EMD entry and review in the ER setting. 
         [0014]    In U.S. Pat. Nos. 7,225,131 and 7,499,862, Bangalore et al. disclose an EMR system that uses a flexible multimodal interactive environment for entering medical information into a computer device. But effective operation of Evans&#39; invention requires a synchronized combination of at least two modes of user inputs into the EMR system, which does not consider nor suggest solutions to the specific problems of EMD entry and review in the ER setting where more than one user input mode may not be readily useable. 
         [0015]    There remains a clearly felt need in the art for effective solutions to the specific problems of EMD entry and review in the ER setting. The EMD problems are so acute that they have engendered a nation-wide industry of ER Scribes who are especially trained to assist ER physicians with EMD documentation compliance for patient ER visits. The duties and specialization are so demanding that a single ER scribe can assist only one ER physician per shift. 
         [0016]    These unresolved problems and deficiencies are clearly felt in the art and are solved by this invention in the manner described below. 
       SUMMARY OF THE INVENTION 
       [0017]    This invention solves these Emergency Medicine Electronic Medical Record (EMR) management problems by introducing, for the first time, a portable touch-sensitive EMR client system that includes a gesture-operated Graphical User Interface (GUI) adapted specifically for collecting and reporting the Emergency Medical Data (EMD) needed for proper medical assessments in the Emergency Room (ER) environment. The method and system of this invention arose from the unexpectedly advantageous observation that providing a portable EMR client with a gesture-optimized GUI and independent local processing that is optimized according to an Emergency Medicine Electronic Medical Records (EMR) specification (such as, for example, the Medicare Coding and Reporting Guidelines) can resolve many of the well-known problems of compliant EMD entry and review in the ER setting. 
         [0018]    It is a feature of the system of this invention that the GUI includes gesture and handwriting recognition features optimized for use with tablet computers. 
         [0019]    It is another feature of the system of this invention that the user may use an electronic pen to tap and slash menu items displayed on a touch screen as command gestures sufficient to complete and record the compliant EMD. 
         [0020]    It is another feature of the system of this invention that the GUI uses text objects as menu items for navigation. The text object can be selected, opened and moved among multiple states by means of pen gestures; e.g., click for positive, slash for negative, second click on a selected object to open a panel. 
         [0021]    It is a purpose of this invention to provide for EMR input and storage in real time. The inventors recognized that a lot of information is thrown at the EMR system user rapidly and randomly during ER history taking. For example, the patient may tell the user something that belongs in Social History while the user is recording the patient&#39;s History of Present Illness (HPI), perhaps forcing the user to take paper notes for later input or lose time changing windows and miss some of the information. The system of this invention organizes all of the history entry on the same GUI menu, allowing the user to quickly follow EMD from the patient in any sequence. The assessment report is generated instantaneously as the user taps on the GUI menu items (e.g., text words) and may be reviewed by the user upon simply touching the GUI menu so that the user&#39;s EMD entry speed is limited only by the patient&#39;s reporting speed. 
         [0022]    The system of this invention preferably provides extensive content specific to Emergency medicine that is easily accessible and organized in GUI submenus linked to textual menu item objects to map the real world thought processes of the ER physician. 
         [0023]    For the first time, the system of this invention provides a GUI that is adapted for immediate use by ER scribes with limited medical knowledge. The system of this invention is the first EMR system that provides for ER scribes as users and allows both the physician and ER scribe to share patient charting activities in real time. 
         [0024]    It is an advantage of the system of this invention that it operates without any browser delays because it is a hybrid system that is separately connected to a remote server (e.g., by the Internet). The remote server EMD synchronization permits simultaneous access by multiple users to the most current version of an EMR chart in progress. However, the local selection of menu item text objects within a local GUI menu is independent of the remote server connection. Thus, when the local computer loses connectivity, the user may continue EMD entry without GUI menu delays. 
         [0025]    In one aspect, the invention is a machine-implemented method for capturing Emergency Medical Data (EMD) in accordance with an Emergency Medicine Electronic Medical Records (EMR) specification comprising a plurality of predetermined EMD requirements in a client computer having a local processor for accepting commands and data, a local memory coupled to the local processor, and a touch-screen coupled to the local processor and local memory for displaying at least one of a plurality of Graphical User Interface (GUI) menus each having one or more menu items and for detecting operator gestures linked to one or more displayed GUI menu items, including the steps of (a) producing for display by the touchscreen one or more of the plurality of GUI menus each having one or more menu items, (b) transferring commands and data to the local processor responsive to one or more operator gestures received at the touch-screen, and (c) modifying one or more menu items in a GUI menu responsive to captured EMD with respect to a predetermined EMD requirement, whereby EMD conforming to the EMR specification are captured and stored in the local memory. 
         [0026]    In a preferred embodiment, the invention is an Emergency Medicine Electronic Medical Records (EMR) system for capturing Emergency Medical Data (EMD) conforming to an Emergency Medicine EMR specification comprising a plurality of predetermined EMD requirements, including a client computer having a local processor for accepting commands and data, a local memory coupled to the local processor, and a touch-screen coupled to the local processor and local memory for displaying at least one of a plurality of Graphical User Interface (GUI) menus each having one or more menu items and for detecting operator gestures linked to one or more displayed GUI menu items, where the local processor includes processing for producing one or more of the plurality of GUI menus each having one or more menu items for display by the touch-screen, processing for generating commands and data responsive to one or more operator gestures received at the touch screen, and processing for modifying one or more menu items in a GUI menu responsive to captured EMD with respect to a predetermined EMD requirement, whereby EMD conforming to the EMR specification are captured and stored in the local memory. 
         [0027]    The foregoing, together with other objects, features and advantages of this invention, can be better appreciated with reference to the following specification, claims and the accompanying drawing. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0028]    For a more complete understanding of this invention, reference is now made to the following detailed description of the embodiments as illustrated in the accompanying drawing, in which like reference designations represent like features throughout the several views and wherein: 
           [0029]      FIG. 1  is a schematic diagram illustrating an exemplary embodiment of the Emergency Medicine Electronic Medical Records (EMR) system of this invention; 
           [0030]      FIG. 2  is a schematic diagram illustrating an exemplary embodiment of the touchscreen element showing the Graphical User Interface (GUI) display and the gesture input elements of the exemplary embodiment of  FIG. 1 ; 
           [0031]      FIGS. 3A-B  are schematic diagrams illustrating the appearance and operation of the Word Selection command element of the GUI menu display and gesture command system of the exemplary embodiment of  FIG. 1 ; 
           [0032]      FIGS. 4A-B  are schematic diagrams illustrating the appearance and operation of the Word Deselection command element of the exemplary embodiment of  FIG. 1 ; 
           [0033]      FIGS. 5A-B  are schematic diagrams illustrating the appearance and operation of several alternative Free Text Input elements of the exemplary embodiment of  FIG. 1 ; 
           [0034]      FIG. 6  is a schematic diagram and description of a Physical Exam Page element of the exemplary embodiment of  FIG. 1  showing exemplary body system menus; 
           [0035]      FIG. 7  is a schematic diagram illustrating an exemplary embodiment of the EMD capturing method of this invention; 
           [0036]      FIG. 8  is a schematic diagram illustrating an exemplary embodiment of the gesturing command and data input method of this invention; and 
           [0037]      FIG. 9  is a schematic diagram illustrating an exemplary embodiment of the Computer Program (CP) product of this invention. 
       
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
       [0038]      FIG. 1  is a schematic diagram illustrating an exemplary embodiment  20  of the Emergency Medicine Electronic Medical Records (EMR) system of this invention. Embodiment  20  includes a client computer  22  having a local processor  24  that is coupled by a command and data bus  26  to a local memory  28 . Client computer  22  also includes a touch screen  30  coupled by a command and data bus  32  to a touch screen controller  34 , which transfers commands and data between touch screen  30  and local processor  24  by way of the command and data bus  36 . Touch screen controller  34  is also coupled to local memory  28  by the command and data bus  38  to permit direct communication under processor control. Local memory  28  stores programs and data such as, without limitation, the exemplary Emergency Medical Data (EMD)  40 , the exemplary group of program objects  42  representing instructions for testing EMD  40  for compliance with a plurality of predetermined EMD requirements that compose an exemplary Emergency Medicine EMR specification and the exemplary group of program objects  44  representing one or more of the plurality of GUI menus for display or for generating commands and data responsive to one or more operator gestures detected at touch screen  20  or for modifying a menu item in a GUI menu responsive to EMD  40  in view of an EMD requirement in program objects  42 , for example. Program objects  40 - 44  are preferably embodied as C++ framework class instances, for example, and may be embodied as suitable instances of any other suitable object-oriented framework classes known in the art, for example. Finally, the WiFi modem  46  is coupled to local processor  24  by the command and data bus  48  to permit local computer  22  to exchange commands and data with the remote server computer system  50  in the usual manner. Note that remote server computer system  50  need not be coupled to client computer  22  to facilitate capture of EMD  40  as all necessary system elements reside within client computer  22 . Client computer  22  is preferably embodied as a Motion Computing C5v Tablet PC, for example, and may be embodied as any other suitable tablet computer adapted for medical use known in the art, for example. 
         [0039]      FIG. 2  is a schematic diagram illustrating an exemplary embodiment of touchscreen  30  showing the Graphical User Interface (GUI)  52  that is adapted to display a GUI menu  54  having several menu items exemplified by the menu item  54 A and to accept input from touch contact with GUI  52  by, for example, the pen  56 A. The operator may present to GUI  52  an operator gesture exemplified by the slash stroke gesture  58  formed by moving a pen  56 B in contact with touch screen  30  to describe slash stroke  58  across a displayed menu item  54 B substantially as shown. Gesture  58  is said to be “linked” to menu item  54 B by the spatial coincidence of the operator gesture and the menu item display. Touch screen  30  accepts any operator gesture detected by the touch-sensitive surface of touch screen  30  and transfers the data to touch screen controller  34  for conversion to commands and data under program control ( FIG. 1 ). Other useful operator gestures include the tapping gesture  60  presented by tapping a displayed menu item  54 C with a pen  56 C, for example, and the handwritten text gesture  62  presented by moving a pen  56 D to form text in contact with a displayed menu item  54 D, for example. Each of these operator gestures results in the transfer of one or more commands or data from touch screen controller  34  to local memory  28  or local processor  24 , for example ( FIG. 1 ). According to a preferred embodiment, a proper slash stroke gesture requires the operator to approach the menu item with the pen until a menu item box is encountered, touch one end of the menu item box at left or right, and slash horizontally across the vertical centerline of the menu item box. 
         [0040]      FIG. 3A  is a schematic diagram illustrating a preferred embodiment of the Word Selection command element of this invention using the History menu  64 A. History Menu  64 A includes many textual menu items exemplified by the Fever menu item  66 . When the operator taps on Fever menu item  66 , the color changes to green, for example, to indicate the generation of a first selection command linked to Fever menu item  66 . Additionally, as shown in  FIG. 3B , the selection of Fever menu item  66  causes the addition of the “Fever” text  68  to an EMD record  70  in local memory  28  ( FIG. 1 ) reflecting a positive Fever history. Finally, the color of the History Menu Icon  69 , for example, preferably indicates when the EMD captured during the interview satisfy all predetermined EMD requirements of the Emergency Medicine EMR specification (e.g., when Medicare Level 5 Coding is satisfied). An auditory signal to the operator is also useful for this purpose, for example, as is any other suitable indication readily available to the operator. 
         [0041]      FIG. 4A  is a schematic diagram illustrating a preferred embodiment of the Word Deselection command element of this invention using History menu  64 . History Menu  64  includes many textual menu items exemplified by the Sore Throat menu item  72 . When the operator slashes through Sore Throat menu item  72 , the color changes from black to green, for example, to indicate the generation of a second deselection command linked to Sore Throat menu item  72 . Additionally, as shown in  FIG. 4B , the deselection of Sore Throat menu item  72  causes the addition of the “No Sore Throat” text  74 A to an EMD record  76 A in local memory  28  reflecting a negative Sore Throat history. Menu items with no logical pertinent negatives are preferably locked, for example, to prevent any response to the slash stroke gesture. A selected or deselected menu item can be returned to neutral (unselected) with a second slash stroke through the selected menu item. The color is returned to, for example, black and any associated text entry in the EMD is deleted. 
         [0042]      FIGS. 5A-B  are schematic diagrams illustrating the appearance and operation of several alternative Free Text Input elements of system  20 . In the History menu  64 B of  FIG. 5A , the “Poor Appetite” menu item  78  is selected by a tap gesture (not shown), which commands system  20  to change the color of menu item  78  (e.g., from black to red) and opens up a submenu window with a text entry menu item  80 . The operator may tap the arrow  82  on the right side of menu item  80  to open a larger text entry area (not shown) for more space if needed or may use handwriting or speech-recognition tools to enter text in menu item  80 , for example. As shown in  FIG. 5B , the resulting “Poor Appetite” text  74 B can be reviewed in the EMD record  76 B. Text  74 B includes the parenthetical text entered in menu item  80  substantially as shown. 
         [0043]      FIG. 6  is a schematic diagram and description of a Physical Exam menu  84  embodiment of the GUI menu of this invention showing menu items linked to exemplary body system menus that conform to the exemplary Medicare Emergency Medicine EMR specification incorporated herein by reference above. For example, the “CON” menu item  86 A links to a plurality of menu items  88  associated with a general examination menu (CONsultation). Similar GUI icons are shown linked to groups of menu items associated with a cardiovascular examination menu (the CV menu item)  86 B, an ear, nose and throat examination menu (the HENT menu item)  86 C, an eye examination menu (the EYES menu item)  86 D, a genitourinary examination menu (the GU menu item)  86 E, a hematologic examination menu (the LYMPH menu item)  86 F, a musculoskeletal examination menu (the MUSC menu item)  86 G, a neurological examination menu (the NEURO menu item)  86 H, a psychiatric examination menu (the PSYCH menu item)  86 J, a respiratory examination menu (the RESP menu item)  86 K, and a skin examination menu (the SKIN menu item)  86 L, for example. After selecting all abnormal menu items individually with the appropriate operator gestures, the operator may tap the NORMAL menu item  90  to default all remaining menu items to a “normal” selection command, for example. Finally, the color of the Physical Examination Menu Icon  92 , for example, preferably indicates when the EMD captured during the examination satisfy all predetermined EMD requirements of the Emergency Medicine EMR specification (e.g., when Medicare Level 5 Coding is satisfied). An auditory signal to the operator is also useful for this purpose, for example, as is any other suitable indication readily available to the operator. 
         [0044]      FIG. 7  is a schematic diagram illustrating an exemplary embodiment  94  of the EMD capturing method of this invention. In the first step  96 , one or more of a plurality of GUI menus is produced for display to the operator on touch-screen  30  ( FIGS. 1-2 ). In the next step  98 , commands and data are captured and transferred to local processor  24  responsive to operator gestures detected by touch-screen  30  ( FIGS. 1-2 ). In the following step  100 , a menu item display is modified by system  20  to communicate to the operator any additional commands or data required (in view of the captured EMD) by a predetermined EMD requirement defined in the Emergency Medicine EMR specification (e.g., the Medicare coding requirements referenced herein above). This menu item display modification may be embodied as, for example, a new submenu display, a color change in a menu item display, an audio signal, locking or unlocking of one or more menu items, or any other useful menu modification suitable for the purposes of this invention. In the step  102 , the captured EMD is tested to determine if the captured EMD is sufficient to complete an EMR that conforms to ALL predetermined EMD requirements defined in the Emergency Medicine EMR specification (e.g., the Medicare coding requirements referenced herein above). If the test in step  102  fails, the process proceeds back to step  96  as shown. If the test in step  102  succeeds and the EMD is found to be complete in the context of an applicable Emergency Medicine EMR specification, then the next step  104  is performed to produce an indication to the operator showing the captured EMD as sufficient to complete an EMR that conforms to the applicable Emergency Medicine EMR specification. 
         [0045]      FIG. 8  is a schematic diagram illustrating an exemplary embodiment  106  of the gesturing command and data input method of this invention. Method  106  is a loop that starts at the step  108  to test for a detection of a tap gesture linked to a menu item displayed on touchscreen  30  ( FIGS. 1-2 ). If step  108  succeeds, then the step  110  sends a selection command to system  20  for the linked menu item and the loop returns to step  108  as shown. If step  108  fails, then the loop proceeds to the next step  112 , which tests for a detection of a slash stroke gesture linked to a menu item displayed on touch-screen  30  ( FIGS. 1-2 ). If step  112  succeeds, then the step  114  sends a deselection command to system  20  for the linked menu item and the loop returns to step  108  as shown. If step  112  fails, then the loop proceeds to the next step  116 , which tests for a detection of a hand-written text gestures linked to a menu item displayed on touch-screen  30  ( FIGS. 1-2 ). If step  116  succeeds, then the step  118  sends text input commands and data to system  20  for the linked menu item. If step  116  fails, then the loop returns to step  108  as shown. Method  106  may also include steps (not shown) for detecting human speech linked to a menu item and responsively sending text input commands and data to system  20  for the linked menu item, for example. 
         [0046]      FIG. 9  is a schematic diagram illustrating an exemplary embodiment  120  of the Computer Program (CP) product of this invention. CP product  120  includes an optical data storage surface  122  adapted for the computer-readable storage and recovery of commands and data. For example, the program file  124  stored on surface  122  may include program means for directing a client computer system to transfer a menu item selection command to the local processor responsive to a slash stroke gesture linked to a displayed menu item. As another example, the program file  126  stored on surface  122  may include program means for directing a client computer system to produce and display one or more of a plurality of GUI menus. As yet another example, the program file  128  stored on surface  122  may include program means for directing a client computer system to produce and display a normal, positive or negative body system status submenu responsive to the context of captured EMD. 
         [0047]    The system of this invention provides solutions for the most particular challenges of ER documentation, including, for example, bedside documentation, ease of use, real time documentation, depth of content, multiple patients, patient registration delays, use with scribes, interface delays found with browser based programs, system integration, data retrieval for questions/answers and research, local customization, and cost control. 
         [0048]    Bedside documentation: The system of this invention is adaptable to advanced tablet computer systems including handwriting recognition, electronic pen technology, dual batteries for hot swapping, rubber casing to reduce heat, suspended hard drive to withstand falls, splash resistance and a quick release dock for charging and using as a desktop computer. The system is completely portable and the user need not use a mouse or sit down. 
         [0049]    Ease of use: The system of this invention requires no computer skills and virtually no training. Within ten minutes of receiving the client computer, the user will be able to start seeing patients and even have fun charting. The revolutionary interface eliminates all cumbersome navigation techniques. All the user need to do is tap and slash words with the user&#39;s electronic pen and the user&#39;s charting will be done for the user. 
         [0050]    Real time documentation: The system of this invention recognizes that during history taking a lot of information is thrown at the user at a fast rate and in random order. For example, the patient may tell the user something that belongs in Social History while the user are recording the user&#39;s HPI, forcing the user to take paper notes for later input or lose time changing windows and miss some of the information. With the system of this invention all the history is on the same page and the user can follow the patients wherever they go. The report is generated instantaneously as the user tap on the words and the user can check it as the user go along by just touching the screen. There is no delay in the interface: the user&#39;s limiting factor will be the user&#39;s patient&#39;s speed as a historian. 
         [0051]    Depth of content: The system of this invention provides extensive content that is specific to emergency medicine and is easily accessible. The user chooses when to stay superficial and when to go deep. The information is all there but instead of cluttering the surface, it is organized in panels contained within the words. The system makes full use of the three-dimensional potential of a computer as compared to paper. This allows for a simple surface interface with a large amount of underground information all organized in a logical and accessible way. The information is organized to match the thought process of the physician in a real world environment. 
         [0052]    Multiple patients: The system of this invention provides an easy to use tracking board that allows the user to go back and forth between patients. The tracking board will notify the user of the user&#39;s progress on each patient, letting the user know when x-rays and labs are back. 
         [0053]    Delays in patient registration: The system of this invention allows the user to start charting on a patient before they are registered. This temporary record is then merged to the permanent patient chart once registration is completed. 
         [0054]    Use with scribes: The system of this invention is endorsed by Scribe America, the largest and most experienced scribe company in the United States. The system incorporates suggestions from scribes around the country to make the system scribe friendly. The resulting system can be used immediately even by someone with limited medical knowledge, like a new scribe, for example. 
         [0055]    Browser interface delays: The system of this invention offers all the benefits of a browser based programs, such as real time data synching and off site access, while being able to run at a speed that is not dependent on the server connection. The user will never be delayed by a lost or slow connection. The system will remain quick and responsive even if the user loses the WiFi connection while moving from room to room or if the hospital system slows down because of high usage. 
         [0056]    System integration: The system of this invention is designed to integrate with the existing ER systems for patient registration, labs, x-ray and the hospital medical record. The system of this invention is useful as an add-on physician EMD documentation module to the user&#39;s current EMR system or as a stand-alone system. The system is a cost-effective and high-value alternative to expensive voice transcription programs, outdated paper products and existing EMR systems not adapted to the ER environment. 
         [0057]    Data retrieving for Q/A and research: The system of this invention allows the user unmatched flexibility in tracking whatever information the user chooses. The system can be adapted to provide reports that comply with the specific demands of the user&#39;s institution. 
         [0058]    Clearly, other embodiments and modifications of this invention may occur readily to those of ordinary skill in the art in view of these teachings. Therefore, this invention is to be limited only by the following claims, which include all such embodiments and modifications when viewed in conjunction with the above specification and accompanying drawing.