Patent Publication Number: US-2015088533-A1

Title: Computer-based system for automating administrative procedures in an office

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 09/227,406, filed on Jan. 8, 1999, which claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 60/070,884, filed Jan. 9, 1998. U.S. patent application Ser. No. 09/227,406 is hereby incorporated by reference, as if repeated herein in its entirety, including the drawings. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention is directed generally to the field of office automation, and in particular to a computer-based system for automating administrative procedures in a medical office. In accordance with particular embodiments of the invention disclosed herein, various administrative procedures that would otherwise require substantial manpower to complete are instead performed by an integrated computer system that performs those administrative procedures in an efficient, cost-effective manner. As a result, substantially less manpower is required to run a medical office, thereby reducing overhead costs. 
     It is well-recognized that the single largest expense in a medical office is personnel, and that the processing of documents generates the majority of the labor in a medical office. As service providers, however, physicians and medical office staff should ideally be spending their time on patient care, and not on document management. Time lost to administrative duties is all the more critical in view of the trend towards managed health care, leading to reduced medical fees but increased overhead costs. 
     There are literally hundreds of medical software applications available today. The majority of these applications deal with billing, scheduling, medical records, and most recently, outcome management. In addition, there are report generators, online services, and efforts to move towards a so-called “paperless office.” While such tools can be helpful, none of them directly address the most costly component of medical office overhead—labor hours. 
     There is therefore a need to reduce the manpower required to complete office administration tasks typically required in a medical office, such as tape transcription, chart preparation, report generation, and forms generation. Embodiments of the present invention meet that need. 
     SUMMARY OF THE INVENTION 
     The present invention is directed to a computer-based system for automating administrative procedures in a medical office. In accordance with an embodiment of the present invention, a computer-implemented method for automating administrative procedures in a medical office is provided. Such a method includes the steps of maintaining a database including provider information, patient information, and document management information; using the database to automatically generate management reports identifying tasks to be performed on a given day; automatically generating reports associated with the tasks to be performed, populating the reports with information from the database as appropriate; and supporting off-site performance of one or more administrative tasks, including managing electronic information exchanges with off-site service providers. 
     In accordance with another embodiment of the present invention, such a system includes a control module in communication with an administrator module and a tape management module, as well as a database accessible by the administrator module and the tape management module. The tape management module can advantageously be configured, for example, to manage outsourcing of tape transcription. In a variation on this embodiment, a provider module is configured, for example, to generate reports directed to the needs of service providers (e.g., daily task lists, workload reports, chart locations, tape transcription status, record review status, etc.) as opposed to administrative staff, thus enabling the system to be geared towards the providers themselves in a way not typically found in existing medical office software. 
     In accordance with another embodiment, a computer-implemented subscription service for automating administrative procedures in a medical office is provided. In providing such a subscription service, one or more medical offices are provided with an office automation system including a communications interface for receiving data electronically. A service center receives a request for office administration services from such a medical office, processes the request, and electronically transmits information relating to the processed request to the office automation system at the requesting medical office. Services that can be provided in this manner include, for example, tape transcription, chart preparation, record review, report generation, and forms generation. 
     These and other embodiments are described in detail below. Persons in the field of medical services will appreciate that embodiments of the present invention enable providers of medical services to streamline administrative operations in a way not possible with prior medical software applications, allowing for significant reductions in overhead attributable to administrative staffing requirements. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a block diagram illustrating a computer-based system for automating administrative procedures in a medical office in accordance with an embodiment of the present invention. 
         FIG. 2  is a block diagram illustrating an embodiment of the present invention wherein a system such as that shown in  FIG. 1  is in communication with a remote transcription service. 
         FIG. 3  is a block diagram providing a detailed view of a control module of a computer-based system for automating administrative procedures in a medical office in accordance with, for example, the embodiment shown in  FIG. 1 . 
         FIG. 4  is a block diagram illustrating an embodiment of the present invention wherein a system such as that shown in  FIG. 1  is in communication with a remote transcription service and a plurality of remote personal computers. 
         FIG. 5  is a block diagram illustrating an embodiment of the present invention wherein a plurality of client computers configured with computer-based systems for automating administrative procedures in a medical office in accordance with, for example, the embodiment shown in  FIG. 1 , are in communication with a server computer. 
         FIG. 6  is a block diagram illustrating an embodiment of the present invention wherein a plurality of computers configured with computer-based systems for automating administrative procedures in a medical office in accordance with, for example, the embodiment shown in  FIG. 1 , are in communication with a subscription service center. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The present invention is directed generally to computer-based systems for automating administrative procedures in a medical office. In accordance with particular embodiments of the invention, various administrative procedures that would otherwise require substantial manpower to complete are instead performed by an integrated computer system that performs those administrative procedures in an efficient, cost-effective manner. As a result, substantially less manpower is required to run a medical office, thereby reducing overhead costs. In addition, systems configured in accordance with the present invention enable providers and/or office administrators to become more independent from support staff than is possible in a typical medical office. 
     Referring now to  FIG. 1 , in accordance with a first embodiment of the present invention, a office automation system  10  for automating administrative procedures in a medical office includes a control module  12  in communication with an administrator module  14  and a tape management module  16 . In addition, office automation system  10  has access to a database  18 . In the illustrated embodiment, control module  12 , administrator module  14  and tape management module  16  comprise software modules coded in, for example, the C++ programming language. Alternatively, suitable code can be readily generated using a facility such as Visual FoxPro®. 
     An example of a system implementing features of the embodiment shown in  FIG. 1 , as well as features of other embodiments described herein, is the MillerMed Utilities™ application available from MillerMed Software, Inc. of Bonsall, Calif. The MillerMed Utilities™ application is described further in MillerMed Utilities: The Antidote for an Organization, User Manual for Windows95 (MillerMed Software, Inc. 1998), the disclosure of which is incorporated herein by reference. 
     Database  18  can reside on the same computer as control module  12 , administrator module  14  and tape management module  16 , or database  18  can alternatively reside on a separate computer (e.g., a database server). Where database  18  is remote from the other components of office automation system  10 , it may be beneficial for performance reasons to provide a local data store for temporary storage of information read from, or to be written to, database  18 . Likewise, in the embodiment shown in  FIG. 1 , administrator module  14  and tape management module  16  access database  18  through control module  12 . Alternatively, administrator module  14  and/or tape management module  16  can be given direct access to database  18 . 
     Office automation system  10  can be implemented on virtually any type of general purpose personal computer (PC) having adequate processing power. One suitable hardware configuration includes a Pentium®-class or comparable IBM-compatible PC having at least 16 megabytes of RAM (random access memory). To take full advantage of visual and aural information that can be provided to a user of office automation system  10 , the PC should have a Super VGA video card and a sound card. Similarly, to take full advantage of certain outsourcing features that can be provided in accordance with variations of the embodiment shown in  FIG. 1 , the PC should include a modem and/or a network interface for communicating with other computers. Finally, the PC should be coupled, either directly or indirectly, to at least one printer for report generation. In view of the different types of reports typically required in a medical office, it may be desirable to have both a laser printer or high-quality ink jet printer (e.g., for printing medical forms) and a dot matrix printer (e.g., for printing triplicate forms). 
     In the embodiment shown in  FIG. 1 , control module  12 , administrator module  14 , and tape management module  16  each reside on the same computer. Persons skilled in the art will recognize, however, that a wide variety of architectural arrangements are possible to meet the particular needs of any given implementation. For example, a client-server type of arrangement may be desirable for even a small to moderately-sized medical office. In such an implementation, office automation system  10  can be installed on an applications server in communication with a plurality of client computers over a local area network (LAN). Such client computers can be used by a variety of office personnel, such as service providers (e.g., doctors, nurses) and administrative personnel, to access system functions. Similarly, database  18  can reside on a central server computer accessible by a plurality of different office automation systems  10  in remote locations. This type of arrangement is especially useful where a medical practice has a number of branch offices, thus allowing patient and administrative information to be economically shared by all of the different offices. 
     The embodiment illustrated in  FIG. 1  is preferably implemented to maximize the use of features and capabilities provided by existing off-the-shelf software applications. For example, administrator module  14  can interface with known word processing applications, such as Microsoft Word® or Corel WordPerfect®. Database  18  can be implemented using known database applications, such as Microsoft Excel®, and can be formatted to be compatible with existing medical applications such as Medical Manager® and Physicians Office Computer®. Alternatively, a suite of such applications, such as Microsoft Office®, may be used. Other off-the-shelf applications that can be advantageously integrated with embodiments of the present invention include an event scheduler, a desktop-emulation package (e.g., PC Anywhere®, Carbon Copy®), Internet connectivity and browser software, and utility packages such as Norton Utilities®. 
     In accordance with another embodiment of the present invention, illustrated in  FIG. 2 , office automation system  10  is electronically linked to a transcription service  30  by a communications link  32 . This embodiment thus facilitates the outsourcing of tape transcription, enabling a service provider to either reallocate staff to other tasks or reduce the size of the staff (thereby reducing overhead). For this purpose, office automation system  10  includes a communications interface (not shown) for electronically exchanging data with transcription service  30 . The communications interface can be implemented as customized software included in, for example, control module  12  of office automation system  10 . Alternatively, or in addition, the communications interface can be implemented using an off-the-shelf communications package, including but not limited to an e-mail application. In short, any application that permits files to be exchanged between two computers is suitable. Likewise, communications link  32  can be virtually any type of communications medium, including a dial-up connection over telephone lines, a satellite connection, a wireless connection, part of a dedicated computer network (e.g., in a LAN (local area network) or WAN (wide area network)). In one particular implementation, communications link  32  comprises an Internet connection. 
     Office automation system  10  can also be configured to facilitate outsourcing of medical records review in much the same way as outsourcing of tape transcription. For example, rather than managing the exchange of information with transcription service  30 , office automation system  10  can manage the exchange of information (e.g., medical records, reports) with an off-site record review service (not shown). 
     In accordance with the embodiment in  FIG. 2 , a given service provider would typically make a number of dictation tapes during the course of a day reflecting, for example, services provided and/or entries to be made in patient charts. Before the present invention, such tapes presented significant logistical, administrative, and staffing challenges. Various office personnel would be responsible for collecting the dictation tapes, transcribing them or assigning others to transcribe them, distributing the tapes back to the service provider for proofing, and then updating patients&#39; charts with the transcribed reports. With this embodiment, it is now possible to outsource much of the labor associated with tape transcription, while at the same time improving the associated tracking and processing functions. 
     To illustrate some of the advantages of the embodiment shown in  FIG. 2 , consider a medical office in which one or more service providers generate a number of dictation tapes in any given day. During the course of the day, the providers give tapes to a designated staff member for logging and outsourcing. Using facilities provided by tape management module  16 , the staff member would input to office automation system  10  information such as the provider&#39;s name, the date the tape was made, the patient(s) to whom the tape relates. This information is used to build a table entry that will eventually be stored in database  18 . In one possible implementation, the staff member would then select an off-site transcriptionist to transcribe the tape. Such selection is preferably done by choosing one of a number of possible transcriptionists presented to the staff member on a display screen. Upon selection of a transcriptionist, tape management module  16  adds to the aforementioned table entry information identifying the selected transcriptionist. Tape management module  16  can also be configured to automatically print a shipping label for each copy of each report sent to the transcriptionist. Once all identifying information is input, the table entry is stored in database  18 . 
     At the end of the day, tapes ready for transcription are shipped to transcription service  30  using, for example, an overnight courier service. Upon completion of transcription, transcription service  30  transmits a file containing the transcribed report back to office automation system  10  over communications link  32 . Tape management module  16  will update database  18  appropriately to reflect receipt of the transcription, and the transcribed report can be distributed electronically to the provider or other staff member for review. All such processing can be performed automatically in a background mode, as is known in the art, without requiring any staff interaction. 
     Embodiments of the present invention can be advantageously used to departmentalize the administrative functions of a medical office, significantly altering the approach typically taken to medical office administration. Many traditionally necessary interactions between office personnel can be reduced or eliminated entirely by relegating tasks to intelligent software to the maximum extent possible. For example, in accordance with another embodiment of the present invention, illustrated in  FIG. 3 , office automation system  10  is configured to establish a plurality of “virtual departments,” each of which is directed to managing and/or performing different administrative functions. To this end, control module  12  of office automation system  10  coordinates the operations of a collection of “tracker” modules aimed at minimizing communication and document handling requirements for the office, thereby reducing personnel needs. In this particular embodiment, control module  12  is coupled to a tape tracker  40 , a report tracker  42 , a management tracker  44 , a database tracker  46 , a provider tracker  48 , and an administrator tracker  50 . Examples of the types of functions performed by each tracker module are presented below. 
     As is well known in the art of computer programming, the various tracker modules shown in  FIG. 3  can be configured, for example, as substantially independent routines operating under the supervision of control module  12 , and capable of sharing data with one another through, for example, access to database  18  or a local data store. Alternatively, the tracker modules can be configured in a master-slave relationship under close control by control module  12 , operating only when expressly invoked by control module  12  and returning control to control module  12  upon completion of processing. Persons skilled in the art will recognize that a wide variety of implementations are possible, and the present invention is not limited to any particular control configuration. 
     Looking more closely at the individual sub-modules in the particular embodiment shown in  FIG. 3 , tape tracker  40  is configured to provide a comprehensive transcription management system. Tape tracker  40  provides facilities for tracking and/or reporting information relating to tapes (e.g., physical location, status), transcriptionists (e.g., name and address, number and identity of tapes assigned, current workload), record reviewers (e.g., records assigned, age of assigned records, review status), and documents (e.g., charts, invoices, shipping information), all with minimal user input. 
     In accordance with a particular implementation of this embodiment, tape tracker  40  includes a facility for automatically assigning tapes to transcriptionists based upon, for example, workload information maintained in database  18 . For example, database  18  may include a transcriptionist table containing records for each of a plurality of transcriptionists, whether on-site or off-site. For each such transcriptionist, database  18  would include information relating to the identity and address of the transcriptionist, as well as the number of tapes currently assigned to the transcriptionist. Thus, upon being advised of a new tape to be transcribed, tape tracker  40  can identify the transcriptionist with the lightest current workload and automatically assign the new tape to that transcriptionist. Other information, such as average turnaround time, can be used to further refine the assignment of new tapes. 
     Report tracker  42  is configured to provide comprehensive report generation and distribution facilities, aimed at reducing the extent of user input required for these tasks. For example, report tracker  42  uses information in database  18  to automatically insert patient registration data on all reports relating to a given patient, filling in headings, captions, and carbon copy entries on all reports. In accordance with a particular implementation, report tracker  42  uses customizable templates built, for example, using standard macro features provided by most popular word processing applications (e.g., Microsoft Word®), to reduce the amount of effort required to complete reports. For instance, macros can be used to establish setup forms that enable users to easily customize report headings and establish standard text entries (i.e., boilerplate) for each provider. Similarly, customized letterhead for each branch office of a multi-branch practice can be readily provided, as well as automatically-inserted signatures for each provider. 
     Report tracker  42  also provides the ability to streamline report distribution. In a typical office environment, reports must be reviewed and signed by a provider, and often must also be reviewed by an editor for quality control purposes, leading to a situation in which large numbers of physical documents are constantly being passed around the office. To alleviate the logistical and administrative problems inherent in such an approach, report tracker module  42  can be configured to distribute reports electronically whenever possible. For example, providers can choose to have final versions of reports electronically copied to a personal directory accessible through office automation system  10  for review, or can select a designated editor to receive signed reports and review them, again by copying the report to the editor&#39;s personal directory. Depending upon the nature of a particular implementation, such personal directories may reside on a server computer accessible by the provider and/or editor, or on some other computer capable of communicating with the computer running office automation system  10  (e.g., an office PC capable of accessing office automation system  10  over a LAN, a home PC capable of exchanging files with office automation system  10  using e-mail). 
     Report tracker  42  also permits reports to be routed to designated printers on demand (e.g., by copying a file containing the report to a print directory). Indeed, persons familiar with medical office administration will appreciate that report tracker  42  allows many types of reports to be processed without ever being handled by a provider. For example, office notes, follow-ups, and other simple reports can be automatically sent by report tracker  42  directly to a printer. 
     Report tracker  42  can also be configured to automatically create a wide variety of standard forms, such as those associated with workers&#39; compensation claims (e.g., notification forms, QME Summary). Such forms can be generated in batch jobs run during off-hours using information stored in database  18 , and the generated reports can then be copied to appropriate directories for access when the office reopens. In certain cases, forms can be generated without any staff interaction at all based only on the registration type of each new patient. Again, such forms can be made easily customizable through the use of word processor macros. 
     In accordance with the embodiment shown in  FIG. 3 , management tracker  44  is configured to provide statistical information relating to office management for use in identifying potential problems and further streamlining operations. For example, to address the logistical problems typically associated with tracking patient charts, management tracker  44  automatically generates a daily report showing the number of charts assigned to each department in the medical office. This report can include further detailed information, setting forth the identity of each chart and its “age” (i.e., how long the chart has been in a given department). By simply consulting this report at the beginning of each day, an office administrator can ascertain a workload status for each department without ever consulting another employee. 
     Likewise, management tracker  44  can be configured to automatically generate and print a variety of other daily reports, including listings of past, present and future appointments; charts requiring specific action (e.g., needing a pain drawing); and identification of no-show patients with contact name and phone number. Other possible reports include database maintenance listings identifying, for example, duplicate entries and other errors; and database/file archiving information (e.g., identifying tape backups generated during overnight processing). Management tracker  44  preferably maintains a table identifying all periodic reports to be generated automatically, and such table can be readily updated by the office administrator. Programming techniques and tools for implementing this type of automatic report generation are well known in the art. 
     In keeping with the approach of the tracker modules already described, database tracker  46  is configured to automatically perform a variety of database maintenance activities, most or all of which preferably occur at night when the medical office is closed to avoid competition for precious computer resources. For example, records can be automatically archived after a predetermined period of inactivity (e.g., 30 days), and such archived records can be automatically removed from any and all directories to which copies had been transferred. Database tracker  46  can also be configured to automatically send e-mail notifications of required actions (e.g., report review) to appropriate personnel based upon information in the database records (e.g., age of record, status). Database tracker  46  is also responsible for constantly tracking the flow of files into and out of the office, automatically adding new clients to database  18  and automatically finding and inserting data for future patients into appropriate records. Thus, very little data entry is required after the initial input of registration information for a new patient. In addition, database tracker  46  can be configured to maintain updatable tables of information relating to employees, providers, report types, and other data for use in populating display screens with the latest available information. 
     Provider tracker  48  is configured to give providers access to a variety of information and facilities aimed at reducing overhead requirements and improving efficiency with respect to administrative tasks. For example, provider tracker  48  can provide a report of all currently outstanding dictations. Similarly, provider tracker  48  can give the provider access to a report of all outstanding reports, and can prioritize such reports by their respective ages. The provider thus knows how much work needs to be done, as well as what should be done first, without having to contact a staff member. In this embodiment, provider tracker  48  also provides the ability to transfer files to a diskette or to a remote computer (e.g., a home PC), and automatically distributes reports received from report tracker  42  to the appropriate provider&#39;s personal directory. Provider tracker  48  can also be configured to maintain information in database  18  relating to provider workload, thus enabling the office administrator to assess current workloads when determining to whom to assign new work (e.g., new managed care patients). 
     Administrator tracker  50  is configured to provide users with access to a variety of information typically required by an office administrator to perform his or her duties. For example, administrator module  52  provides instant access to management reports for each department in the medical office; reports of on-site and/or off-site data availability; instant access to provider workload, tape status, and chart location information. By maintaining all of the underlying information for such reports in database  18 , administrator tracker  50  enables the office administrator to acquire an array of necessary information without the need for interactions with other office staff members. To further reduce unnecessary employee contacts, administrator tracker  50  can be configured to maintain an administrator mailbox for receiving e-mail copies of pertinent communications sent by other employees. 
     Referring now to  FIG. 4 , in accordance with another embodiment of the present invention, office automation system  10  is accessible by remote PCs  60  over second communications links  62 , thereby enabling providers or other office personnel to access system functions from locations other than the office (e.g., home). Second communications links  62  comprise, for example, dial-up connections, but the present invention is not limited to any particular communication means. Remote PCs  60  may be loaded with special software to support particular functions of office automation system  10 . Alternatively, remote PCs  60  need only be capable of receiving files from and transmitting files to office automation system  10 . 
     The embodiments described above can readily be implemented in a Microsoft Windows® environment, providing users with a familiar, user-friendly interface to the many capabilities offered by systems configured in accordance with the present invention. As is well known in the art, user interfaces can be constructed in menu form, and users can be given access to help screens, audio cues, tutorials, video demonstrations, and so on using standard facilities. Various other time-saving measures can also be built into the user interface. For example, timers can be incorporated into menus where some user selection is required. In the event no selection is made within a predetermined period of time, such as ten seconds, the program driving the menu can automatically choose the selection that would most commonly be correct in a given situation. In this way, even users with little or no system knowledge are able to benefit from the system. 
     In accordance with an enhancement of the foregoing embodiments, each user screen can be configured to display a bitmap image of the user associated with the logonid used to access the system. In other words, when “John Doe” logs on, his picture would appear, for example, in the upper-left hand corner of at least one open window at all times. This feature allows anyone in the area of the user to ensure that the person logged on is in fact the owner of the logonid used. Implementation of this feature is readily accomplished by storing a picture of each authorized user in respective bitmap files. When a user logs on, the logonid is used to retrieve the associated bitmap file, and the stored picture is displayed on the screen. 
       FIG. 5  illustrates an embodiment of the present invention directed to a network environment. In accordance with this embodiment, database  18  resides on a server computer  80  accessible by a plurality of client computers  82 . Each client computer  82  is loaded with an instance of office automation system  10  configured, for example, as in the embodiment of  FIG. 1 . In contrast to the embodiment in  FIG. 1 , however, database  18  does not reside on the same computer as office automation system  10 . Such an arrangement is especially useful where, for example, a practice has a number of different branches at which the same patients may be seen, since the shared use of database  18  eliminates the need to maintain duplicate data at each of the multiple locations. For performance reasons, a copy of selected records from database  18  can be cached in local memories (not shown) of client computers  82 . Updates in progress can be made to the cached record and then copied to database  18  upon completion. As is known in the art, particularly with respect to Internet applications, client computer  82  can be configured to determine whether such a locally cached record has been updated on database  18  and, if so, to automatically replace the cached version with a copy of the updated version. 
     Referring now to  FIG. 6 , in accordance with another embodiment of the present invention, an office automation system  10  such as that shown in  FIG. 1 , is provided as part of a subscription service, thereby offering a variety of off-site services to providers in remote locations. In accordance with such an arrangement, services can be paid for as they are used. Thus, a solo practitioner with only periodic need for transcription services has comparable access to the features and benefits of office automation system  10  and associated subscription services as does a large medical group that may choose to use the system for overflow dictation or to outsource large volumes of clerical work. 
     As shown in  FIG. 6 , each of a plurality of subscriber computers  92  are in communication with a subscription service center  90 . In one particular implementation of this embodiment, subscription service center  90  comprises an office location and a server computer (not shown) accessible over the Internet. Each subscriber computer  92  has loaded thereon office automation system  10  configured, for example, like the embodiment of  FIG. 1 . It should be appreciated, however, that each subscriber computer  92  could actually comprise a server maintained by a particular practice group, to which are connected a number of individual computers used by providers, administrators, and other personnel. 
     In accordance with the embodiment shown in  FIG. 6 , a number of different types of services can be offered on a subscription basis, including but not limited to tape transcription, record review, and chart preparation. In addition, all of the necessary tracking and reporting associated with these services can also be provided. 
     With respect to transcription, the level of service provided is fully customizable to the needs of any particular subscriber. For example, a provider can simply dictate a tape during an office hours session and send it to subscriber service center  90  (e.g., by overnight delivery service). Subscriber service center  90  would then arrange for transcription (either on-site or using an off-site vendor), print the report and make all copies, mail and/or e-mail the reports and copies back to the subscriber, and update the subscriber&#39;s database  18  to document progress. In a particular implementation, subscriber service center  90  periodically updates database  18  with the progress of the requested service, thereby enabling the subscriber to use office automation system  10  to access status information. Once the file containing the transcription is transmitted or otherwise loaded into database  18 , the subscriber can view, print, or edit the transcription using the above-described facilities of office automation system  10 . 
     Many variations of the foregoing transcription service are possible. For example, where a subscriber has its own transcriptionist, transcription files can be sent by diskette or electronically to subscriber service center  90 , after which subscriber service center  90  can print and mail reports and update the subscriber&#39;s database  18  as just described. If a subscriber wishes to transcribe and print tapes on-site, subscriber service center  90  can receive the transcription files, process them, and transmit files containing the desired reports to office automation system  10  for automatic printing on the subscriber&#39;s printer. Similarly, if a subscriber wishes to use a particular off-site transcriptionist, subscriber service center  90  can receive transcription files from the transcriptionist either electronically or on diskette. As before, such files can then be processed and reports either printed and shipped by subscriber service center  90 , or transmitted to the subscriber computer  92  for printing. In either case, chart copies are shipped to the subscriber. 
     Subscriber service center  90  can also provide record review services, performing quality control checks on transcribed dictations and/or on records and reports generated from transcription files. Likewise, subscriber service center  90  can prepare charts. For example, a complete set of history forms, status forms, and fee tickets for an entire office session of patients, complete with patient information imprinted, can be delivered directly to any subscriber office location. 
     Subscriber service center  90  can also provide special services to subscribers on demand, such as binding, preparation of slides, and preparation of other presentation materials for lectures, academic conferences, and so on. Facilities built into office automation system  10  for exchanging files with subscriber service center  90  can readily be used for forwarding the underlying information to subscriber service center  90  along with appropriate instructions. By providing for Internet access and/or direct modem connections, subscriber service center  90  can offer maximum flexibility to providers who are traveling. Any subscriber can then access subscriber service center  90  from a remote location to gain access to their particular practice&#39;s data, retrieve reports, or drop off work. Subscriber service center  90  can also provide data archiving services, freeing up resources on the subscriber&#39;s system that might otherwise have to be dedicated to storing outdated records. Access to archived records can then be provided on-demand by subscriber service center  90 . 
     It should be emphasized that the foregoing subscription services are described by way of example only. Persons in the medical field will recognize that many other services, both administrative and otherwise, can be provided on a subscription basis using arrangements such as that shown in  FIG. 6 . 
     Office automation systems configured in accordance with embodiments of the present invention can be distributed, for example, as a set of instructions residing on a storage medium. Such a storage medium might be a portable storage device, such as a diskette or a CD-ROM; a memory of a computer; a piece of firmware; or any other medium on which it is known to store executable instructions. 
     The foregoing is a detailed description of particular embodiments of the present invention. The invention embraces all alternatives, modifications and variations that fall within the letter and spirit of the claims, as well as all equivalents of the claimed subject matter. Persons skilled in the art will recognize from the foregoing description that many other alternatives, modifications and variations are also possible.