WO2001095234A2

WO2001095234A2 - Method and system for medical data entry and analysis

Info

Publication number: WO2001095234A2
Application number: PCT/US2001/018086
Authority: WO
Inventors: John Joe; Philip Beckett
Original assignee: Baylor College Of Medicine; Rosettamed, Inc.
Priority date: 2000-06-07
Filing date: 2001-06-05
Publication date: 2001-12-13
Also published as: WO2001095234A3; AU2001275221A1

Abstract

A method and system of medical data receipt and analysis includes the step of receiving medical information in a first format (170). The medical information is then converted into a second format suitable for inclusion in a database (180). While in the second format, the medical information is displayed in response to a user request. The medical information is then converted into a third format suitable for inclusion in an electronic medical records system (184). The electronic medical records system receives and stores the medical information in the third format (186).

Description

METHOD AND SYSTEM FOR MEDICAL DATA ENTRY AND ANALYSIS

TECHNICAL FIELD OF THE DISCLOSURE

The present disclosure relates in general to electronic healthcare systems, and, more particularly, to a method and system for medical data entry and analysis.

BACKGROUND

Physicians and other healthcare providers provide services to their patients based on several sources of information. The patients themselves can provide information regarding current subjective impressions of their physical and mental health. Patients can also provide information about their medical history and the medical history of their family. Medical instruments and tests also provide information about patients . Physicians and their assistants make their own observations, which constitute information that another healthcare provider may find useful. A physician will often review a file containing each type of information before deciding on whether to recommend a course of treatment. The information is conventionally stored in paper form, but several electronic systems for storing medical information are now available. For example, U.S. Patent No. 5,924,074, assigned to Azron Inc., discloses an electronic medical records system, with a specific interface for creating, modifying, and viewing patient information.

Medical information can also be usefully employed when aggregated across many patients. Researchers can benefit from having information with a large number of parameters from a large number of patients available. Unfortunately, the providers of conventional electronic medical record systems each utilize a different format and different parameters to store patient information.

Gathering and entering medical information into an electronic medical records system in a conventional manner is costly in terms of the time required of a physician or other healthcare provider. However, allowing information that has not been reviewed to be entered into files can threaten the integrity of the system and undermine the accuracy of patient diagnoses and research conducted using the information. For example, a physician would know that there is a relationship between two values and that the two values provided by the patient are not consistent. The physician would focus on the issue and is, therefore, more likely to obtain accurate information from the patient. In addition, information can be less extensive, even if accurate, due to the lack of physician involvement. A patient filling out a form will not know about additional information that a physician would find useful. The physician, having seen the answers to the standard form, would know to ask additional questions .

The many providers of electronic medical records systems use incompatible data formats for the storage of medical information. For example, providing a test result from a blood analysis device in a format that one system can assimilate results in other systems not understanding the test results. A laboratory that works with several customers having different electronic medical record systems must either disappoint most customers or spend significant resources in developing specific conversion software for each system. The continued networking of medical practices increases the importance of different systems being able to communicate with each other. Also, whether the medical information comes from the patient, the physician, or an instrument, that information is most useful when it is collected and conveyed to the electronic medical record in the form of discrete data elements, as opposed to blocks of text . The data element structure allows ready searching to facilitate decision support and outcomes research.

SUMMARY OF THE INVENTION

A method and system for receiving and manipulating medical data is disclosed. None of the advantages, by itself, is critical or necessary to the disclosure.

A method of medical data receipt and analysis includes the step of receiving specific medical information in a first format. The medical information is then converted into a second format suitable for inclusion in a database. While in the second format, the medical information is displayed in response to a user request . The medical information is then converted into a third format suitable for inclusion in discrete data fields of an electronic medical records system. The electronic medical records system receives and stores the medical information in the third format. A more specific method includes storing in the medical information in discrete or different fields in the third format.

A more specific method is also provided in which the medical information is edited while in the second format . A single action by the user initiates the conversion into the third format and storage in the electronic medical records system. A system is provided for entry and storage of medical information as discrete data elements. The system includes a display coupled to a text entry device. The medical information is entered with the text entry device and shown on the display in a first format. A clinic computer is coupled to the text entry device. The clinic computer stores the medical information in a second format suitable for inclusion in a database. When the clinic computer receives a view request from a user, it displays the medical information. The system also includes an electronic medical records (EMR) system that is coupled to the clinic computer. The EMR system receives the medical information in a third format suitable for inclusion in discrete data fields in the EMR system. A specific embodiment of the system employs a keyboard as the text entry device and couples the keyboard and display to the clinic computer through the Internet .

It is a technical advantage of the disclosed methods and systems that medical information corresponding to particular patients is stored electronically.

It is also a technical advantage of the disclosed methods and systems that medical information entered by a patient can be stored electronically in discrete fields of an electronic medical records database . Another technical advantage of the system and method disclosed is that medical information can be entered by a patient independent of a physician or healthcare provider.

Another technical advantage of the system and method disclosed is that medical information received by a clinic can be provided to discrete data fields in multiple EMR systems . Another technical advantage of the system and method disclosed is that medical information can be edited or annotated by a physician or other healthcare provider before being included in an EMR system. Another technical advantage of the system and method disclosed is that patients provide medical information responsive to additional questions posed based on responses to earlier questions.

Another technical advantage of the system and method disclosed is that patients do not need to spend time at the physician's office providing basic medical information.

Other technical advantages of the present disclosure will be readily apparent to one skilled in the art from the following figures, descriptions, and claims. Various embodiments of the invention obtain only a subset of the advantages set forth. No one advantage is critical to the invention.. For example, one embodiment of the present invention may only provide the advantage of storing medical information corresponding to particular patients electronically, while other embodiments provide several of the advantages .

BRIEF DESCRIPTION OF THE DRAWINGS A more complete understanding of the present disclosure and advantages thereof may be acquired by referring to the following description taken in conjunction with the accompanying drawings, in which like reference numbers indicate like features, and wherein: FIGURE 1 is a diagram of a computer system for receiving and storing medical information in accordance with one embodiment of the present invention,- FIGURE 2 is a data flow diagram in accordance with one embodiment of the present invention;

FIGURE 3 is a method flowchart of initial configuration in accordance with one embodiment of the present invention;

FIGURE 4 is a method flowchart of patient entry of medical information in accordance with one embodiment of the present invention;

FIGURE 5 is a method flowchart of clinician review and editing in accordance with one embodiment of the present invention; and

FIGURE 6 is a data flowchart in accordance with one embodiment of the present invention.

DETAILED DESCRIPTION OF THE DISCLOSURE

FIGURE 1 is a diagram of a computer system for receiving and storing medical information in accordance with one embodiment of the present invention. A clinic computer 10 acts as a server for the system. The clinic computer 10 is coupled to a medical device workstation 12, for example a workstation for a pulmonary function device, and directly to a medical instrument 14. The workstation 12 is needed for devices that require specific software to export medical information. That software is then used to create a file of medical information received from the medical device. The file is sent to the clinic computer 10 by the workstation 12. Other medical instruments output their formatted medical information without special software. Such instruments, for example medical instrument 14, can be directly coupled to the clinic computer 10. In both cases, the clinic computer receives the medical information in the specific format dictated by the medical instrument or its specialized software.

The clinic computer is also coupled to a gateway 16 for connecting to the Internet 18. Personal computers (PCs) 20 connected to the Internet are then able to communicate with the clinic computer 10. The gateway 16 may include a firewall and other network security devices to prevent unauthorized viewing and editing of information available on the clinic computer 10. The PCs 20 can be used by patients to enter medical information, see Figure 4. PCs 20 generally have a text entry device such as a keyboard, as shown in the figure, a touch sensitive screen or a microphone with dictation software. Many other options for a text entry device that connects to a PC 20 are known to persons of ordinary skill in the art. The PC also includes a display such as a monitor, as shown in the figure, or an LCD screen. Information is received from the text entry device in a specific format as defined by the peripheral. For example, information entered into a page displayed on a browser such as Netscape Navigator or Microsoft Internet Explorer is stored in HTML format .

The Internet 18 connected PCs 20 are, in this one embodiment, also used by authorized healthcare providers to access the clinic computer 10. Adequate security measures for such access are important because of the confidentiality of patient information. For example, only statistical aggregate information may be available over the Internet rather than information about specific, identified patients. A smaller group of users may be authorized to retrieve and edit the specific patient information. The clinic computer 10 is also connected to a wireless transceiver 22 that is configured to communicate with a portable computer 24. The portable computer 24 is installed with software that is used by a patient to enter medical information. A workstation 26 is also coupled to the clinic computer 10 and supports wireless hand-held devices 28, for example a Palm V or Pocket PC, that are programmed to allow a clinician to enter new medical information. A clinician can also, in this embodiment, access, annotate, and edit patient medical information stored by the clinic computer 10. The software programs used by the portable computer 24 and hand-held devices 28 include security features to limit their use by unauthorized persons. The clinic computer 10 is also coupled to a workstation 30 located in the clinic waiting room. Patients can use the workstation 30 to enter medical information in response to questions displayed by the workstation 30, see Figure 4. As shown, the workstation 30 includes a display and a keyboard as a text entry device. In alternate embodiments, the text entry device could be a touch-sensitive screen or an optical mark scanner among other options known to those in the art.

Medical information received at the medical instruments 12,14, the Internet PCs 20, the wireless devices 24,28, and the waiting room workstation 30 is in a format unsuitable for use with a database. For example, a selection of a 'yes' option on a page displayed on a browser can be stored in HTML format. The clinic computer 10 uses database software, for example Microsoft Access or SQL, to organize and manipulate the medical information. Before the clinic computer 10 can enter the information into the database, it must be converted into the correct format. The conversion occurs for some sources, for example the directly connected medical instrument 14, after the medical information is received by the clinic computer 10. In one embodiment, the PCs 20 and the waiting room workstation 30 also send files that need to be converted at the clinic computer 10. In another embodiment, the PCs 20 and workstation 30 convert the information, for example when the patient selects a button for new questions, and send database files to the clinic computer 10. New medical information entered by patients on the portable computer 24, or by healthcare providers on the handheld devices 28 and the workstations 32 is also converted to database format in order to be manipulated by the clinic computer 10. Editing and annotation performed by the healthcare providers manipulates information already entered into the database using the database software.

The clinic computer 10 is connected to an electronic medical records (EMR) system server 34. Workstations 32 that are coupled to both the clinic computer 10 and the EMR server 34 are provided. The clinic computer 10 includes the function of converting medical information in its database format, for example Microsoft Access files, into a different format that can be assimilated into the EMR system by the EMR server 34. EMR system vendors provide information on the formatting necessary for information to be received by their systems . A workstation 38 is coupled to the EMR server 34 but not the clinic computer 10. For example, a researcher may have access to the aggregate data of the EMR system but not the patient -specific data. The EMR server 34 is coupled to a data storage device 36 that stores the medical information as records corresponding to each patient. A printer 40 is also connected to the EMR server 34 for printing patient records . Figure 2 is a dataflow diagram in accordance with one embodiment of the present invention. Medical information is provided rom three types of sources . Alternate embodiments include othe sources or a subset of the sources. Text answers and option choices 50 by patients in response to medical questions are received by the clinic computer 10. Medical instrument data 52 is provided to the clinic computer 10. Clinician input 54 is received by the clinic computer 10. The clinic computer 10 converts the medical information it receives from the three sources into a database format, if that information has not already been converted by, for example, the computers on which the data was entered. The clinic computer 10 allows the medical information to be viewed, edited, and annotated, see Figures 5 and 6. The medical information, as modified by edits and annotations, is then converted into a format that corresponds to the EMR system 56 and is transmitted to that system 56 for inclusion in its database 58.

Figure 3 is a method flowchart of initial configuration in accordance with one embodiment of the present invention. The clinician selects initial questions that are asked of every patient 100. The clinic computer 10 includes software that stores a large number of possible questions from which the clinician can choose. Each question is associated with a discrete field of the EMR database in which the answer is intended to be stored. In an alternate embodiment, a question can be associated with discrete fields of more than one EMR system. The clinician can also formulate her own questions to associate with a chosen discrete EMR field. The clinician then selects additional questions and triggers for each additional question 102. Additional questions can also be linked to specified fields of an EMR database. For example, a response to a question about pain that includes "chest pain" could trigger a series of additional questions related to heart problems. As another example, a patient might want to include multiple answers to a question asking about exercise: running and weight training. In that case, the additional question would match the initial question. Additional questions can be triggered from responses to initial questions or from responses to other additional questions. As with initial questions, the software can include additional questions and triggers that can be selected by the clinician or the clinician can create his own.

For the questions selected, the clinician then chooses answer format and allowed values 104,106. Answer formats include numerical format, text format, and others. Allowed values can be specified as specific values as a range. For example, a multiple choice question can have text format and only allow "a", "b", and "c" as answers. As another example, the allowed answers can be "yes", "no" and "unsure" . A question about age can have numerical format and only allow integer values from 18 to 120.

The clinician also specifies an export value associated with each allowed answer value. In some cases, the two values will be identical; in other cases, the values can be synonymous statements in two different languages. For example, the question and allowed answer values may be written in Spanish, but have associated export values in English. The export values in English are the values that will ultimately be incorporated in the EMR database in the field associated with the question. The clinician can also allow all answer values. A question of this type is called a free text question, which allows the patient to enter anything that he or she desires. In an alternate embodiment, the clinician limits the length of the answer, but does not otherwise restrict the answer to a set of allowed values . The clinician can then set the export value to be the text entered in response to the question.

In the next step, the clinician determines whether educational materials and reports will be offered to patients 108. For example, a patient who describes a family history of heart disease can be provided with a file that discusses how to reduce heart disease risk factors. The clinician or a technician selects the medical instruments 110 that are connected to the clinic computer 10 and selects conversion programs for those instruments.

The clinician can also determine a default EMR system 56 for which the clinic computer should convert its medical information files 112. The clinician or a technician selects the appropriate conversion program for the chosen EMR system 56.

Figure 4 is a method flowchart of patient entry of medical information in accordance with one embodiment of the present invention. The patient begins by signing in to a workstation 120. In an alternate embodiment, the patient uses her own PC and logs in via the Internet . The clinic computer 10 determines whether the patient ' s computer is within the provider's secure network 122, for example the waiting room workstation 30 is within the secure network, see Figure 1. If the workstation is not, the clinic computer 10 prompts for a public key 126,128 or a patient identification number 130. The patient identification number is provided to the patient with appropriate security precautions and is associated with the patient ' s demographic information by the clinic computer 10. Thus, information entered via computers outside the provider's secure network either is encrypted or is not associated with any publicly recognizable identifiers prior to being received by the clinic computer 10. If the patient is using a computer within the provider's secure network, she may enter her demographic information directly.

Once the patient has engaged the system, the patient is presented with an initial set of questions 132. In one embodiment, the patient uses a text entry device, such as a keyboard or touch-sensitive screen, to provide the answers. In one embodiment, the answers are entered as free text and are checked against the allowed values and a message is displayed if the proposed answer is not allowed. The patient is then prompted to answer with an allowed value. In another embodiment, the patient provides answers by selecting values from a drop-down list that contains only allowed values. In another embodiment, the patient provides answers by clicking radio buttons corresponding to allowed values. In another embodiment, the patient provides chronological answers by clicking a graphical calendar. Other embodiments can combine those approaches. In one embodiment, the patient's answers are recorded in HTML format when text is entered or an option of a drop-down list is chosen. When the patient selects a continue button, the medical information is converted from HTML format to a database format such as Microsoft Access. Conversion can occur for subsets of the initial questions. If the patient's answers have triggered any additional questions, those additional questions are presented 134. In one embodiment, answers to additional questions do not trigger different additional questions. In another embodiment, additional questions are triggered immediately and the remaining initial questions are presented thereafter. The patient's answers are compared to predetermined reference values 136. Educational materials and one or more reports are generated for the patient 140. Patient ' s answers are sent to the clinic computer 142. Figure 5 is a method flowchart of clinician review and editing in accordance with one embodiment of the present invention. The clinician sends a request to the clinic computer 10, which responds by displaying patient specific data 150. The clinician can then interview the patient to clarify or confirm her answers 152. Clinicians are able to edit and annotate the medical information for a specific patient as needed 154. The clinic computer 10 is configurable with a default setting that either always checks for alerts and reports or never does 156. A clinician can also override the default setting. If alerts and reports are desired, the medical information is compared to predetermined alert definitions 158 and generates an alert if it finds a match 160. Reports can also be automatically generated 160. If the clinician desires that the medical information be transferred to the default EMR system, a single action, for example clicking a button, will instruct the clinic computer 10 to convert the medical information into a format corresponding to the EMR system and transfer the information to the EMR system 162. In one embodiment the information is converted into a format receognized by the EMR system 162, but not the native EMR system format. In an alternate embodiment, a copy of the information is retained after transfer. In another embodiment, an option allows the clinician to send the data to a nondefault EMR system.

Figure 6 is a data flowchart in accordance with one embodiment of the present invention. Medical information enters the clinic computer 10 which hosts the database software, for example Microsoft Access. If the data are encrypted 176, for example with a public key, they are deciphered 174. If the data do not have associated demographic data 176, for example they were entered with a patient identification number as in Figure 4, the clinic computer 10 accesses a table that includes the demographic data 178, for example by matching the patient identification number. The medical information is then converted into a format that is suitable for a database 180, for example Microsoft Access. Using the database functionality, the software allows authorized users to view, annotate, and edit the medical information 182. In response to a user request, the clinic computer 10 converts the medical information into a format suitable for the default or chosen EMR system 184 and transfers the formatted information to the EMR system 186.

An example of software source code for converting medical information from HTML format to Microsoft Access database format is included as Appendix A. An example of software source code for converting medical information in Microsoft Access database format into a format suitable for inclusion in the Logician electronic medical records database is included as Appendix B.

Although the present disclosure has been described in detail, it should be understood that various changes, substitutions and alterations can be made thereto without departing from the spirit and scope of the invention as defined by the appended claims .

Code for displaying questions to patient in HTML on a web browser, collecting responses, and saving responses to a database.

<% ©Language = "VBScript" %>

<% Option Explicit response.buffer = true response.expires = - 1000%>

<!-- #include file="adovbs.inc"~>

<!-- ^include file="database.asp"~ >

<html>

<head>

</head>

<body>

<tr>

</td>

< tr> < table> <%

If Err Then

Response.Redirect "pfshwelcome.asp"

End If

Dim objCn

Dim objCmd

Dim rsA

Dim rsNE

Dim rsQ

Dim rsPA

Dim rsQA

Dim rsS

Dim rsDel

Dim strAge

Dim strAnswer im strQID im strCn im strRFV im strEncounterlD im strQGroup im strlmportName im strQAName im strQuot im strQuestion im strSex im strRepeat im strUnits im strVl im strV2 im strRowColor im intCount im i im k im m im iNA im intDel im intQ im intQA im intQT im intQS

Dim intRecords

Dim intRecordsNA

Dim varAnswerType

Dim varCounter

Dim My_Link

Dim scriptresponderl

Set objCn=Server.CreateObject("ADODB.Connection") strQuo1^Chr(39)

Sub SaveAnswer intQS = Request.Form("QAName").Count

For i = l To intQS strQAName = Request.Form("QAName")(i) strEncounterlD = session("EncounterID") intQA = Request.Form("A" & strQAName & "").Count strAnswer = ""

For m = 1 To intQA strAnswer = strAnswer & Request.Form("A" & strQAName & "")(m) & " "

Next Set rsS=server.CreateObject("ADODB.Recordset") rsS.Open "SELECT EncounterlD, OBXvalue, OBXDT, QID, QNA, Qpostpone from qryOBXWEB Where " & _ "EncounterID=" & Session("EncounterID") & _

"And QID=" & strQAName, objCn, adOpenKeyset, _ adLockOptimistic, adCmdUnknown If (rsS.BOF) Or (Err.Number >0)Then Set objCmd=Server.CreateObject("ADODB.Command") strQuot = Chr(39) obj Cmd. activeconnection=Obj Cn objCmd.CommandType = adCmdText objCmd.CommandText = "INSERT INTO qryOBXWEB VALUES (" & _ strEncounterlD & "," & _ strQuot & strAnswer & strQuot & ", " & _ strQuot & now & strQuot & ", " & _ strQAName & "," & _ strQuot & "" & strQuot & ", " & _ strQuot & "" & strQuot & ", " & _ strQuot & "" & strQuot & ")" objCmd.Execute intRecords Else

If Trim(str Answer) ="" Then Else

If Request.Form("RepeatSave") = "AddNew" Then intRecords = 0

Set objCmd=Server.CreateObject("ADODB.Command") strQuot = Chr(39) obj Cmd. acti veconnection=obj Cn objCmd.CommandType = adCmdText objCmd.CommandText = "INSERT INTO qryOBXWEB VALUES (" & _ strEncounterlD & "," & _ strQuot & strAnswer & strQuot & ", " & _ strQuot & now & strQuot & ", " & _ strQAName & "," &_ strQuot & "" & strQuot & ", " & _ strQuot & "" & strQuot & ", " & _ strQuot & "" & strQuot & ")" objCmd.Execute intRecords objCmd.activeconnection = Nothing Else rsS("OBXvalue") = strAnswer rsS(OBXDT") = now rsSC'QID") = strQAName rsS.Update End If End If rsS.Requery rsS.close End If Next

End Sub

Sub DeleteAnswer

Set rsS=server.CreateObject("ADODB. Recordset") rsS.Open "SELECT * from qryOBXWEB Where " & _

"EncounterID=" & Session("EncounterID") & _

"And QID=" & strQAName, objCn, adOpenStatic, _ adLockOptimistic, adCmdUnknown intDel = Request.Form("Delete").Count For i = 1 To intDel if (rsS.RecordCount =1 ) Then Else

Set rsDel=Server.CreateObject(" ADODB .Recordset") rsDeLOpen "SELECT * FROM qryDELOBXWEB WHERE " & _

"ObservationID- ' & Request.Form("Delete")(i), objCn, adOpenKeyset, _ adLockOptimistic, adCmdUnknown If (rsDeLBOF) Or (Err.Number >0)Then Else rsDel.Delete rsDel.Close End If End If rsS.Requery Next rsS.Close set rsS = Nothing End Sub Sub SkipGroup m=Session("EncounterID ") Set rsQ=server.CreateObject("ADODB.Recordset") rsQ.Open "SELECT * FROM qryQUESTIONNAIREWEB Where " & _

"qryQUESTIONNAIRE.RFVCode=" & strRFV & _

"AND qryQUESTIONNAIRE.Male=" & strQuot & strSex & strQuot & _

"AND qryQUESTIONNAIRE.MalegtAge<" & strAge & _

"AND qryQUESTIONNAIRE.MaleltAge>" & strAge & _

"AND QID NOT IN (SELECT QID FROM qryPTOBXWEB WHERE EncounterlD =" & m & ")" & _

"AND qryQUESTIONNAIRE.GROUP=" & strQuot & Request.Form("NA") & strQuot & _

"OR qryQUESTIONNAIRE.RFVCode=" & strRFV & _

"AND qryQUESTIONNAIRE.Female=" & strQuot & strSex & strQuot & _

"AND qryQUESTIONNAIRE.FemalegtAge<" & strAge & _

"AND qryQUESTIONNAIRE.FemaleltAge>" & strAge & _

"AND QID NOT IN (SELECT QID FROM qryPTOBXWEB WHERE EncounterlD =" & m & ")" & _ "AND qryQUESTIONNAIRE.GROUP=" & strQuot & Request.Form("NA") & strQuot, objCn, adOpenStatic, _ adLockreadOnly, adCmdUnknown If (rsQ.BOF) Or (Err.Number >0)Then Else intRecordsNA = 0

Set objCmd=Server.CreateObject("ADODB.Command") obj Cmd. acti veconnection=obj Cn objCmd.CommandType = adCmdText Do while NOT rsQ.EOF objCmd.CommandText = "INSERT INTO qryOBXWEB VALUES (" & _ m & "," & _ strQuot & "N/A" & strQuot & ", " & _ strQuot & rsQC'Units") & strQuot & ", " & _ strQuot & now & strQuot & ", " & _ rsQ("QID") & "," & _ strQuot & "True" & strQuot & ", " & _ strQuot & "" & strQuot & ", " & _ strQuot & "" & strQuot & ")" obj Cmd.Execute intRecordsNA = intRecordsNA + 1 rsQ.moveNext Loop End If rsQ.Requery rsQ.Close set rsQ = Nothing intRecordsNA = intRecordsNA - Request.Form("iNA") End Sub

Sub Answer(AnswerType) Select Case AnswerType Case "CB"

Set rsA=server.CreateObject("ADODB.Recordset") rsA.Open "SELECT * from qryANSWERSWEB Where " & _

"QID=" & strQID, objCn, adOpenForwardOnly, _ adLockreadOnly, adCmdUnknown Response. Write "<td valign- top'>" rsA.moveFirst Do while NOT rsA.EOF Response. Write "<input type='checkbox' name='A" & rsQ("QID") & "value="' & rsA("exportname") & '">" & rsA("DisplayName") & "< inpu1>" rsA.movenext loop Response.write "< td>" rsAxlose set rsA = Nothing Case "FTNR"

Response.write "<td valign='top'><input type='text' name='A" & rsQ("QID") &

^,"size=^,20' value = *Not Answered^,></input></td>"

Case "FTR"

Response.write "<td valign- top'xinput type='texf name^'A" & rsQ("QID") &

^,"size=^,20' value = Wot Answered'></input></td>"

Response.write "<td>" & rsQ("RepeatText")

Response.write "<input type- Checkbox' name- Repeat' value- " & rsQ("QID") &

'">< inρut < td>"

If Not (isNull (Request.Form("Repeat"))) Then

Set rsPA=server.CreateObject("ADODB.Recordset") rsPA.Open "SELECT * from qryPTOBXWEB Where " & _ "EncounterID=" & session("EncounterID") & _ "AND QID=" & rsQC'QID"), objCn, adOpenKeyset, _ adLockOptimistic, adCmdUnknown If (rsPA.EOF) Or (Err.Number >0) Then Else Response.write "</tr><tr><td>Previous values entered:</td> tr>"

Do while NOT rsPA.EOF Response.write "<tr><td>" & rsPA("OBXvalue") & "</td>" Response.write "<td><Input type- Checkbox' name = 'delete' value- " & rsPA("ObservationID") & '">Delete input></td>" rsPA.movenext loop End If rsPA lose set rsPA = Nothing End If Case "FTCNR"

Set rsA=server.CreateObject("ADODB.Recordset") rsAOpen "SELECT * from qryANSWERSWEB Where " &_ "QID=" & strQID, objCn, adOpenForwardOnly, _ adLockreadOnly, adCmdUnknown Response.write "</tr>" rsA.moveFirst Do while NOT rsA.EOF Response.write "<tr><td valign='top'>" & rsA("DisplayName") & " td>" Response.write "<td valign-top'xinput name='A" & rsQC'QID") & '"x/iηputXtd>" rsA.movenext Response.write "</tr>" loop rsA.close Set rsA = Nothing Case "FTCR"

Set rsA=server.CreateObject("ADODB.Recordset") rsAOpen "SELECT * from qryANSWERSWEB Where " & _ "QID=" & strQID, objCn, adOpenForwardOnly, _ adLockreadOnly, adCmdUnknown Response.write "</tr>" rsA.moveFirst Do while NOT rsA.EOF Response.write "<tr><td valign='top'>" & rsA("DisplayName") & "</td>" Response.write "<td valign='top'xinput name = Α" & rsQC'QID") & '"x/input></td>" rsA.movenext Response.write "</tr>" loop rsA.close Set rsA = Nothing Response.write "<tr><td>" & rsQ("ReρeatText") & "<input type='Checkbox' name-Repeat' value="" & rsQC'QID") & "'x/inputx/td>" IfNot(isEmpty(Request.Form("Repeat"))) Then Set rsPA=server.CreateObject("ADODB.Recordset") rsPA.Open "SELECT * from qryPTOBXWEB Where " & _ "EncounterlD— ' & session("EncounterID") & _ "AND QID=" & rsQC'QID"), objCn, adOpenKeyset, _ adLockOptimistic, adCmdUnknown If (rsPA.EOF) Or (Err.Number >0) Then Else Response.write "< tr><tr><td>Previous values entered:</tdX tr>"

Do while NOT rsPA.EOF Response.write "<tr><td>" & rsPA("OBXvalue") & "</td>" Response.write "<td><input type='Checkbox' name = 'delete' value ='" & rsPAC'ObservationlD") & '">Delete input> td>" rsPA.movenext loop End If rsPA lose set rsPA = Nothing End If Case "LB"

Set rsA=server.CreateObject("ADODB.Recordset") rsAOpen "SELECT * from qryANSWERSWEB Where " & _ "QID=" & strQID, objCn, adOpenForwardOnly, _ adLockreadOnly, adCmdUnknown Response.write "</tr><tr><td valign="toρ"><select name- A" & rsQC'QID") & "size='10' multiple>" rsA.moveFirst Do while NOT rsA.EOF Response.write "<option value='" & rsA("exρortname") & '">" & rsA("DisplayName") & "</option>" rsA.movenext loop rsAxlose set rsA = Nothing Response.write "</selectX/tdx/tr>"

Response.write "<tr><td><font>Hold down the shift key to select multiple options< font></td></tr>" Case "DDM"

Set rsA=server.CreateObject("ADODB.Recordset") rsAOpen "SELECT * from qryANSWERSWEB Where " & _ "QID=" & strQID, objCn, adOpenForwardOnly, _ adLockreadOnly, adCmdUnknown Response.write "<td valign-top'xselect name- A" & rsQC'QID") & '" size=T onchange='setMonthField(A" & rsQC'QID") & ")'>" rsA.moveFirst

Do while NOT rsA.EOF Response.write "<option value- " & rsA("exportname") & '">" & rsA("DisplayName") & "</option>" rsA.movenext loop rsAxlose set rs A = Nothing Response.write "</select> td>" Case "RB"

Set rsA=server.CreateObject("ADODB.Recordset") rsAOpen "SELECT * from qryANSWERSWEB Where " & _ "QID=" & strQID, objCn, adOpenForwardOnly, _ adLockreadOnly, adCmdUnknown Response.write "<td valign- top'>" rsA.moveFirst

Do while NOT rsA.EOF Response.write "<input type='radio' name- A" & rsQC'QID") & '" value- " & rsAC'exportname") & '">" & rsA("DisplayName") & "< input>" rsA.movenext loop Response.write "< td>" rsAxlose set rsA = Nothing End Select End Sub strVl = session("strVl") strV2 = session("strV2") strRFV = sessionC'strRFV") strAge = sessionC'strAge") strSex = session("strSex") objCnxpen strCn

If request.form("questionnaire") = "true" Then If isEmpty (Request.Form("NA")) Then call SaveAnswer

Else call SkipGroup

End If

Else

Session("strSex") = request.Form("SEX") sessionC'strRFV") = Request.Form("RFV") strRFV = sessionC'strRFV") strSex = session("strSex")

Set rsNE=server.CreateObject("ADODB.Recordset") rsNE.Open "SELECT * from qryENCOUNTERWEB Where " & _

"V2=" & strQuot & strV2 & strQuot, objCn, adOpenKeyset, _ adLockOptimistic, adCmdUnknown

If (rsNE.BOF) Or (Err.Number >0)Then ' ifbof rsNE.addnew rsNE("Vl") = strVl rsNE("V2") = strV2 rsNE("Sex")= strSex rsNE("StartEncounter")= now rsNE.update rsNE.movelast session("EncounterID") = rsNE("EncounterID")

Else rsNE.movefirst

SessionC'EncounterlD") = rsNE("EncounterID")

End If rsNE.close set rsNE = Nothing

End If

If isEmpty (Request.Form("Delete")) Then

Else

Call DeleteAnswer

End If m=Session("EncounterID")

If isEmpty (Request.Form("Repeat")) Then

SetrsQ=server.CreateObject("ADODB.Recordset") rsQ.Open "SELECT * FROM qryQUESTIONNAIREWEB Where " & _

"qryQUESTIONNAIREWEB.RFVCode=" & strRFV & _

"AND qryQUESTIONNAIREWEB.Male=" & strQuot & strSex & strQuot & _

"AND qryQUESTIONNAE EWEB.MalegtAge<" & strAge &_

"AND qryQUESTIONNAIREWEB.MaleltAge>" & strAge & _

"AND QID NOT IN (SELECT QID FROM qryPTOBXWEB WHERE

EncounterlD =" & m & ")" & _

"OR qryQUESTIONNAIREWEB.RFVCode=" & strRFV & _

"AND qryQUESTIONNAIREWEB.Female=" & strQuot & strSex & strQuot & _

"AND qryQUESTIONNAIREWEB.FemalegtAge<" & strAge & _ "AND qryQUESTIONNAIREWEB.FemaleltAge>" & strAge & _ "AND QID NOT IN (SELECT QID FROM qryPTOBXWEB WHERE EncounterlD =" & m & ")" , objCn, adOpenStatic, _ adLockreadOnly, adCmdUnknown If (rsQ.BOF) Or (Err.Number >0)Then If request.form("questionnaire") = "true" Then response.write "Thank you, you have answered all the questions " rsQ.Close set rsQ = Nothing objCnxlose Set objCn = nothing scriptrespόnderl- 'pfshwelcome.asp" my_link=scriptresponder 1

Response.write "<a href- " & my_link & '">Return to home page</a>" Else

Response.write "Either there are no relevant questions for you under the selections you made or you have completed all the questions previously." & _ "You may use the back button of your browser to go to the previous page and select a different reason for your visit or to edit your previous answers" rsQ.Close set rsQ = Nothing objCnxlose Set objCn = nothing End if Else

If request.form("questionnaire") = "true" Then Else intCount = rsQ.RecordCount Session("intCount") = intCount End If rsQ.movefirst i = 0 iNA = 0 i=i + Request.Form("i") + intRecordsNA Response.write "<table cellpadding^'2' cellspacing='2'>" Response.write "<tr><td colspan- 8'>" & rsQ("GroupText") & "<ytdX/tr>" Response.write "<tr><td colspan- 8'xinput type-Checkbox¹ name='NA' value- " & rsQC'GID") * '">" & rsQC'NAText") & "</inpu1X/tdx/tr>"

Response.write "<tr bgcolor='#8080FF'xtdxbxfont face='Arial Narrow, helvetica, sansserif size='-l'># of&nbsp" & Session("intCount") & "&nbsp totaKbXtd>< font>" Response.write "<td align- center'xbxfont face- Arial Narrow, helvetica, sansserif size--r>Questions<ybx/tdx/font>"

Response.write "<td align-center'xbxfont face- Arial Narrow, helvetica, sansserif size='- 1 *>Ans wer Options</b></td></font></tr>" intQ = 1 k = 0 strQGroup = rsQ("GID") intQT = rsQC'QperPage") strRowColor="#C4C4FF"

Do While k<intQT i = i + l iNA = iNA + 1 if strRowColor = "#C4C4FF" Then strRowColor = "#FFFFA4"

Else strRowColor = "#C4C4FF"

End If Response.write "<tr bgcolor='" & strRowColor & '" align='left'xtd width- 70' valign- top' style- text-decoration: overiine;'>Q." & i & "&nbsp</td>" Response.write "<td valign='toρ' width- 400'>" & rsQ("DisρlayName") Response.write "<input type='hidden' size='2' name='Q" & rsQC'QID") & '" value='" & rsQC'exportname") & '"></input>"

Response.write "<input type='hidden' size='2' name='QD" & rsQC'QID") & '" value='" & rsQC'displayname") & '"></input>"

Response.write "<inρut

size='2' name='U" & rsQC'QID") & "' value='" & rsQC'units") & x/mput>"

Response.write "<input type='hidden' size- 2' name- QAName' value- " & rsQC'QID") & "'X/inputx/td>" strQID = rsQC'QID") varAnswerType = rsQC'TypeAbbrev") call Answer(varAnswerType) Response.write "<input type- hidden' value- " & rsQC'exportname") & "' name=OBXExρortName'x/input></tr>" rsQ.movenext If rsQ.EOF Then k = 999 Else If rsQ.fieldsC'GID") = strQGroup And rsQ.fields("QperPage") = intQT Then k = k+l intQ = inιQ+1 Else k = 999 End If End If Loop rsQ.Close set rsQ = Nothing objCnxlose Set objCn = nothing

Response.write "<input type- hidden' size- 2' name='i' value- " & i & '"x/input>" Response.write "<input type- hidden' size- 2' name- iNA¹ value- " & iNA & '"x/input>" Response.write "<input type-hidden' name- Qnumber' value- " & intQ & '">< input>" Response.write "<tr><td>&nbsp</td><td>&nbsp</tdxtd><input type-submit' name='Cl' value=TSText Page'x/td>< tr>" end if

Else strQID = Request.Fonn("Reρeat")

Set rsQ=server.CreateObject("ADODB.Recordset") rsQ.Open "SELECT * FROM qryQUESTIONNAIREWEB Where " & _

"qryQUESTIONNAIREWEB.QID=" & strQID, objCn, adOpenStatic, _ adLockreadOnly, adCmdUnknown rsQ.movefirst i = 0 i=i + Request.Form("i") Response.write "<table cellpadding='2' cellspacing='2'xtr bgcoloι='#8080FF'>" Response.write "<td><b><font face- Arial Narrow, helvetica, sansserif size- -l'># of&nbsp" & SessionC'intCount") & ">&nbsp total</b> td>< font>" Response.write "<td align- center'xbxfont face- Arial Narrow, helvetica, sansserif size--r>Questions< bX/td></font>"

Response.write "<td align- center'xbxfont face- Arial Narrow, helvetica, sansserif size--r>Answer Options</b></tdx/font></tr>" intQ = 1 k= 0 strQGroup = rsQC'GroupText") intQT = rsQC'QperPage") strRowColor="#C4C4FF" Response.write "<tr bgcolor='" & strRowColor & *" align- lef '>" Response.write "<td width='70' valign- top' style- text-decoration: overline;'>Q. " & i & "&nbsp td>"

Response.write "<td valign='top' width='400'>" & rsQ("DisρlayName") Response.write "<input type='hidden* size='2' name='Q" & rsQC'QID") & "' value="' & rsQC'exportname") & '"></input>"

Response.write "<input type='hidden' size='2' name='QD" & rsQC'QID") & '" value="' & rsQC'displayname") & '"></input>"

Response.write "<input type='hidden' size='2' name='U" & rsQC'QID") & '" value='" & rsQ("units") & '"></inρut>"

Response.write "<input type-hidden' size- 2' name- QAName' value- " & rsQC'QID") & "'Xinput> td>" strQID = rsQC'QID") varAnswerType = rsQC'TypeAbbrev") call Answer(varAnswerType) Response.write "<input type- hidden' value- " & rsQC'exportname") & '" name='OBXExportName'>< input>< tr>" rsQ.Close set rsQ = Nothing Response.write "<input type- hidden' size- 2' name- i' value='" & i & '"></input>" , Response.write "<input type-hidden' name- Qnumber' value- " & intQ & '"></input>" Response.write "<tr><td>&nbsp tdxtd>&nbsp</td><td>" Response.write "<input type- submit' name- Cl' value^=,Next Page'x/td></tr>"

End If Response.write "</table>" If isEmpty (Request.Form("Repeat")) Then strRepeat = "Update" Else strRepeat = "AddNew" End If

Response.write "<input type- hidden¹ size- 2' name- RepeatSave' value- " & strRepeat & '"></inρut>"

Response.write "<input type- hidden' size- 2' name- Questionnaire' value='true'x/input>" %>

</form> </body> </html>

APPENDIX B Code to display data and send to EMR

Display:

Private mOBXdata As OBXData Private mPtEncData As PtEncData Private mExportData As ExportData Private mReadData As ReadData Private mlmportData As ImportData Private Sub cmdExport_Click()

Set mExportData = New ExportData mExρortData.ExρortORU App.Path & "\textfile.hr"

MsgBox "FileSaved.", vblnformation End Sub

Private Sub cmdImport_Click()

Set mlmportData = New ImportData

Set DataGrid3.DataSource = mlmportData

End Sub

Private Sub form_load()

Set mPtEncData = New PtEncData

Set DataGιid2.DataSource = mPtEncData

DataGrid2.DataMember = "PtEnc"

DataGrid2.Columns(0).Caption = "Medical Record #" DataGrid2.Columns(l).Caption = "Last Name" DataGrid2.Columns(2).Caρtion = "First Name" DataGrid2.Columns(3).Caption = "Date of Birth" DataGrid2.Columns(4).Caption = "Sex" DataGrid2.Columns(5).Caption = "Encounter Date" DataGrid2.Columns(6).Caption = "Encounter Time" DataGrid2.Columns(7).Caption = "Provider"

DataGrid2.Columns(0). Width = 1500 DataGrid2.Columns(4).Width = 500

DataGrid2.Columns(8)Nisible = False

End Sub

Private Sub bttnReadFile_ClickO Set mReadData = New ReadData mReadData-ReadORU Aρp.Path & "\textfile.hr"

Textl .Text = mReadData.txtRead

End Sub

Private Sub DataGrid2_RowColChange(LastRow As Variant, ByVal LastCol As Integer)

Set mOBXdata = New OBXData

Set DataGridl .DataSource = mOBXdata

DataGridl. DataMember = "OBX"

DataGridl .Columns(0).Caption = "Observation" DataGridl .Columns(l).Caption = "Value" DataGridl. Columns(2).Caption = "Units"

DataGridl .Columns(3).Visible = False

End Sub

Public Property Let txtEnc(ByVal strNew As String)

DataGrid2.Columns('ΕncounterID").CellValue(DataGrid2.Bookmark) = strNew End Property Public Property Get txtEncO As String txtEnc = DataGrid2.Columns("EncounterID").CellValue(DataGrid2.Bookmark) End Property Public Property Let MSH3(ByVal strNew As String) txtMSH3.Text = strNew End Property Public Property Get MSH30 As String

MSH3 = txtMSH3.Text End Property Public Property Let MSH4(ByVal strNew As String) txtMSH4.Text = strNew End Property Public Property Get MSH40 As String

MSH4 = txtMSH4.Text End Property

Private Sub Class_GetDataMember(DataMember As String, Data As Object) Select Case DataMember Case ""

Set Data = Nothing Case "PtEnc"

Set Data = mrsPtEnc Case Else ' Error End Select

End Sub

Private. Sub Class_Initialize()

Set mrsPtEnc = New ADODB .Recordset mrsPtEnc.Source = "select * from qryPtEncounter" mrsPtEnc.CursorType = adOpenKeyset mrsPtEnc.LockType = adLockOptimistic mrsPtEncActiveConnection = "DSN=Qdb;" mrsPtEnc.Open

DataMembersAdd "PtEnc"

End Sub

Set Data = Nothing Case "OBX"

Set Data = mrsOBX Case Else

' Error End Select

End Sub

Private Sub Class_Initialize()

Dim strEnc As String

Set mrsOBX = New ADODB. Recordset strEnc = OBXform.txtEnc mrsOBX.Source = "select * from qryOBX " & _

"where EncounterlD = " & strEnc mrsOBX.CursorType = adOpenKeyset mrsOBX.LockType = adLockOptimistic mrsOBX-ActiveConnection = "DSN=Qdb;" mrsOBX.Open

DataMembersAdd "OBX"

End Sub

Public Property Let strEnc(ByVal strNew As String) mstrEnc = strNew End Property

Public Property Get strEncQ As String strEnc = mstrEnc End Property

Export- Private mrsEXP As ADODB.Recordset Private mtxtRead As String Private mstrEnc As String

Private Sub Class_Initialize()

Dim strEnc As String

Set mrsEXP = New ADODB.Recordset strEnc = OBXform.txtEnc mrsEXP.Source = "select * from qryExport " &

"where EncounterlD = " & strEnc mrsEXP.CursorType = adOpenKeyset mrsEXP .LockType = adLockOptimistic mrsEXP.ActiveConnection = "DSN=Qdb;" mrsEXP.Open

End Sub

Public Property Get ORUTextO As String

Dim str As String

If mrsEXP.EOF = False Then mrsEXP .MoveFirst

'MSH str = str & "MSH|^Λ~\&|" & OBXform.MSH3 & "|" 'MSHl-3 str = str & OBXform.MSH4 & "|" & "|" & "|" 'MSH4-6 str = str & Format(Now, "yyyyrrrmddhhhhmm") & "|" & "|ORU|" 'MSH7-9 str = str & "1 j" & "P|" & "2.2|" 'MSH10-12 str = str & "I" & "I" & "NE|" 'MSH13-15 str = str & "j" & vbCrLf 'MSH16-19

'PID str = str & "PID|1|" & "|" & mrsEXP.Fields("LID") & "|" & mrsEXP.Fields("MRN") &

"|" 'PID1-5 str = str & mrsEXP .Fields("PLN") & "^Λ" & mrsEXP.Fields("PFN") & "^Λ|" 'PID6 str = str & "I" & Format(mrsEXP.Fields("DOB"), "yyyymmdd") & "|" 'PID7-8 str = str & mrsEXP.FieldsC'Sex") & "|" & "|" & mrsEXP.Fields("Race") & "|" 'PID9-

11 str = str & "AΛΛΛΛ|" _& ..j.. _& "i" -PID12-14 str = str & "I" & "I" & "|" 'PID15-17 str ^ sir & "j" & mrsEXP.Fields("SSN") & vbCrLf 'PID18-19

'PV1 str = str & "PV1|1|" & "R|" & "E IM|" 'PVl,l-4 str = str & "|" & "I" & "|" 'PV1, 5-7 str = str & mrsEXP.FieldsC'ProviderName") & vbCrLf 'PV1,8

'OBR str = str & "OBR|l|" & "RSQA^Λ1|" & "|" & "HLTI|" OBR1-4 str = sir & "I" & Format(Now, "yyvymmdcM hrnm'') & "|" & Format(Now, "yyyymmddlilihhmm") & ^«T* OBR5-7 str = str & "I" & "I" & "|" & "|" & "|" & "|" 'OBR8-13 str = str & "I" & "I" & mrsEXP.FieldsC'ProviderName") & "|" & "|" & "|" & "|" & "|" OBR14-20 str = str & "I" & Format(Now, "yyyymmddrώhhmm") & "|" & "|" & "|" & "F" & vbCrLf'OBR21-25

OBX

Loop

ORUText = str End If

End Property

Public Sub ExportORU(strFileName As String)

Dim fs As Scripting.FileSysternObject Dim txt As Scripting.TextStream

Set fs = New Scripting.FileSysternObject

Set txt = fs.OpenTextFile(strFileName, ForWriting, True) txt. Write ORUText Set fs = Nothing End Sub

Public Property Let txtRead(ByVal strNew As String) mtxtRead = strNew End Property

Public Property Get txtReadO As String ixtRead = mtxtRead End Property Public Property Let strEnc(ByVal strNew As String) mstrEnc = strNew End Property

Public Property Get strEncO As String strEnc = mstrEnc End Property

Claims

WHAT IS CLAIMED IS:

1. A computer system for entry and storage of medical information, comprising: a display coupled to a text entry device, the medical information entered and shown on the display in a first format; a clinic computer, coupled to the text entry device, that stores the medical information in a second format suitable for inclusion in a database, the computer responding to view requests from a user by displaying the medical information; and an electronic medical records system, coupled to the clinic computer, that receives the medical information in a third format suitable for inclusion in the electronic medical records system.

2. The computer system of claim 1 wherein the medical information in the third format is suitable for inclusion in discrete data fields in the electronic medical records system.

3. The computer system of claim 1, further comprising a personal computer and wherein the text entry device is a keyboard coupled to the personal computer, the display is a monitor coupled to the personal computer, and the personal computer is coupled to the clinic computer through a computer network.

4. The computer system of claim 1, wherein the clinic computer is coupled to the text entry device through the Internet.

5. The computer system of claim 1, wherein the clinic computer in response to a user input edits the medical information in the second format.

6. The computer system of claim 1, wherein the clinic computer in response to a user input annotates the medical information in the second format.

7. The computer system of claim 1, wherein the text entry device is a touch detection device attached to the display that converts user touch actions into alphanumeric characters .

8. The computer system of claim 1, wherein the clinic computer is wirelessly coupled to the text entry device .

9. The computer system of claim 1, wherein the display is a monitor and is connected to a first memory that stores predetermined initial questions and predetermined additional questions, the monitor displays the initial questions and, in response to textual answers to the initial questions, displays corresponding additional questions.

10. The computer system of claim 9, wherein the first memory stores predetermined allowed values corresponding to the initial and additional questions.

11. The computer system of claim 1, wherein the clinic computer includes a first memory that contains predefined alert definitions, compares the medical information to the definitions, and generates an alert when it finds a match.

12. A method of medical data receipt and analysis, comprising: receiving medical information in a first format; converting the medical information into a second format suitable for inclusion in a database; converting the medical information into a third format suitable for inclusion in an electronic medical records system; and storing the medical information in an electronic medical records system.

13. The method of claim 12, further comprising the step of displaying the medical information while in the second format in response to a user request.

14. The method of claim 12, wherein the first format corresponds to the output format of a medical device.

15. The method of claim 12, further comprising the step of editing the medical information while it is in the second format .

16. The method of claim 12 , wherein the step of receiving data comprises entering textual data in a wireless hand-held computer.

17. The method of claim 12, wherein the step of converting into the third format and the step of storing occur automatically in response to the user taking a single action.

18. The method of claim 12, wherein the step of receiving data comprises entering data on a computer attached to the Internet, encrypting the data, and decrypting the data before the data is converted to the second format .

19. The method of claim 12, further comprising the steps of generating educational materials based on the data received in the first format and displaying the educational materials near the point where data was entered.

20. The method of claim 12, further comprising the steps of generating a report based on the data received in the first format and displaying the report near the point where data was entered.

21. The method of claim 12 wherein the step of convertig the medical information into a third format suitable for inclusion in an electronic medical records system comprises the step of organizing the medical information into different data fields.

22. A computer system for receipt and storage of medical information, comprising: a medical instrument operating to provide medical information about a patient in a first format; a clinic computer, coupled to the medical instrument, that stores the medical information in a second format suitable for inclusion in a database, the computer responding to view requests from a user by displaying the medical information; and a first electronic medical records system, coupled to the clinic computer, that receives the medical information in a third format suitable for inclusion in the first electronic medical records system.

23. The computer system of claim 22, wherein the clinic computer includes a first memory that contains predefined alert definitions, compares the medical information to the definitions, and generates an alert when it finds a match.

24. The computer system of claim 22, wherein the clinic computer in response to a user input edits the medical information in the second format.

25. The computer system of claim 22, wherein the clinic computer is operable to convert the medical information from the second format into the third format, is operable to convert the medical information from the second format into a fourth format suitable for inclusion in a second electronic medical records system, and converts the medical information in response to user input indicating either the third format or the fourth format.