Critical Issue:

The client needed a way to lower cost and streamline growth.  There were many commercial providers of transcription software but no complete solutions for the client so they decided to create their own. They needed a medical transcription platform that they could use and could be leased to other Medical Transcription Service Organizations via a SaaS model.  The platform needed to interface with hospitals and providers to deliver custom dictation documents. Also, provide the ability for doctors to perform dictations on the phone, via a voice recorder or by mobile phone and allow medical transcriptionists to easily transcribe dictations remotely.   It also needed to allow administrators to add clients, run reports for billing and payroll and pull up past completed jobs.  The platform had to complete these tasks with a more intuitive interface, be simpler to administer, be more secure, have better reporting and improved auditing over the competition

Project Roles Provided:

Application Architect and Design, Software Development, Testing, Project Management, User Documentation, Technical Documentation, Training, Software Release, Support

Technologies Used:

C#, Visual Basic.NET (VB.Net), MS SQL Server 2000/2005, SSIS, WCF Services, Web Services, Speech Recognition, Audio Manipulation, Encryption, Secure File Transfer, Workflow

Services/Applications Provided: 

A suite of integrated custom applications that allowed doctors to leave dictations in their preferred mode and transcriptionists to complete jobs remotely in an efficient manner.  The application also allowed administrators to setup clients, run reports and review billing and payroll and query on past jobs.  The system also contained a custom report generator, custom document creator and supported dynamic data for some data entry forms and reports.

Workflow:

The heart of this platform was the custom workflow that was designed to allow a different workflow based on each facility or provider.  The workflow would move a job from between status, assign priority and assign work to users based on certain rules that were configurable by the client without programming changes.

Enterprise Application Integration (EAI):

The application was written to complete the final job and deliver the final product to the client in whatever format they chose.  In the suite, there are four external applications that integrate to the platform for allowing dictations to be loaded or retrieved.

Extract, transform and load (ETL):

We cleaned and imported medical transcription data from a previous system into SQL Server.  The ETL source was flat files that were transformed and loaded using SSIS.

Electronic data interchange (EDI):

Data was exchanged between application and hospital or provider through middleware (Mirth and SSIS).  The system also has interfaces for direct connection with EMR systems for patient data of new dictations.

Document Management: 

This entire application managed the transcription document from audio format all the way to completed .rtf format.  Along the way, we save every version of the document in a searchable format for dual history, audit and backup purposes.  Administrators have the ability to view a job’s version history and also to remove certain versions from history.  This application has the capability to allow doctors to login to the system, review a partially completed transcription and electronically sign the job to complete it.

SQL Server:

Sql Server 2005 is the database.  T-Sql, triggers and stored procedures were used comprehensively in order to achieve better performance and for improved security measures.  We also wrote custom audit logic to capture all inserts, updates and deletes in the system.

Security:

The platform manages and shares ePHI and has HIPAA secured controls in place.  The servers are physically behind 24 X 7 security with managed access.  The network can only be accessed by two other networks and password policy on the network is strong.  The application is accessible only over encrypted SSL channels.  All ePHI data is encrypted prior to storage in the database or file system. All access to the application is tracked along with changes to data.

Service-oriented architecture (SOA):

WCF Web Services were used in the application to allow for better code reuse, effortless deployment and improved information exchange between individual applications.

WCF: 

WCF Services were used extensively throughout this project.  The Transcription application used WCF to download the audio dictation file in chunks, to upload the completed transcription as well as save parts of the transcription on a certain “heartbeat” schedule.  WCF was also used in the handheld upload application to allow doctors upload the dictation without having to call the specified 1800 number.  Finally, WCF was used in order to create dictations from our PBX servers.  Doctors could call into our server via an 800-number which in turn would create the dictation after calling a WCF service.

Integration:

This application integrated with clients by using Mirth to deliver their final transcribed product.  An auto print application was written to automatically print the final document to a specified network or local printer.

SSIS:

SSIS was used in this application for integration of parts of the suite.

Integrated Mobile Application:

Using windows mobile devices, Doctors are able to dictate into the phone and enjoy the ability to stop, rewind and return the dictation when needed.  We the recording is complete, the recording is encrypted and uploaded to secure servers where it can be transcribed.

Speech Recognition:

By customizing MS Speech Server and technologies we were able to add spoken commands into the main windows application. Users could say things like stop, play, rewind, etc to improve transcription speed while operating the system.  Also, a transcription recognition engine was built that could manipulate audio files to improve accuracy and transcribe the recordings to text.

Custom IVR:

Using an open source phone system, we integrated a custom IVR into the application to allow Doctors around the country to call in and leave recordings for the system.

Results:

This system is in production for the client.  The client is steadily moving their current customers over to the new system and also is focusing on signing up organizations to use the application.  The application was released ahead of schedule and under budget and required minimal training for all involved.