The key features of EMSOW include the following:

• Scheduling and logistics
• Work time tracking for technologists
• Patient data entry
• Document management
• DICOM images viewing and automated interpretation
• PACS-based image storage and transfer
• Medical records management
• Electronic fax for sending reports
• Billing and collections
• Financial analysis and forecasting
• Inventory management

If the module is not available, please ask your system administrator to give you the appropriate permissions. You can also view and edit billing information from the Processing module by clicking the Billing Edit button or double-clicking the required service.

The pending requests represent HL7 messages that EMSOW were not able to process automatically, e.g. if a message references an unknown referring facility or study description. If you see a pending request in the module, try processing it manually (see “How to process an HL7 request” below).

User interface

The HL7 Requests module consists of two panes: Options (left) and Results (right).

The Options pane is a search filter that allows you to find specific requests. To perform a search, you have the following fields at your disposal:

	Status: the current request status. The statuses are explained below. Created date: the date range of when a request was received. Processed date: the date range of when a request was processed (automatically or manually). Provider: the EMR where a request came from.
	A/N: the accession number of the study created based on a processed request.

After you have specified a search query, click Search to perform the search. A click on Clear will reset the search fields to their default values.

The found requests will be displayed on the Results pane. If you didn’t perform a search, the Results pane will show all requests.

The Results pane displays the received requests in a grid with the following columns:

1. ID: the unique identifier of a request in EMSOW.
2. Provider: the EMR where a request came from.
3. Created: the date when a request was received.
4. Processed at: the date when a request was processed.
5. Processed by: the user who processed a request.
6. Action: what should be done as the result of request processing. The Action can be one of three types:
   • Add: a request for a new study.
   • Modify: a request of this type modifies a specific request that was received previously.
   • Cancel: a request of this type cancels a specific request that was received previously.
7. Status: the current state of a request:
   • Pending: the request is waiting to be processed.
   • Processed: the request has been successfully processed.
   • Failure: the request processing ended with failure.
   • Cancelled: the request has been cancelled by a follow-up request.
8. Referring facility: the referring facility name, as specified in an HL7 message. Note that requests are not processed automatically if this name does not match your records in the Referring facilities module. However, you can copy this name and create an alias in the corresponding referring facility record to enable automatic processing.
9. Referring doctor: the referring doctor name, as specified in an HL7 message. Note that referring doctor records are created automatically when EMSOW processes incoming requests.
10. Patient: a patient name.
11. Studies: the name and CPT codes of the study that was ordered. Note that this name or codes must match your records in the Studies module. You can use aliases to enable automatic processing.
12. Service ID: a link that opens the service in EMSOW that was created as the result of request processing. Click it to open the service in the Processing module.
13. Actions: this column contains several buttons which you can use to work with a request:
    • remove the request
    • : process the request
    • : mark the request as pending
    • : view the HL7 message
    • : open the created study in the Dispatch module

Just above the requests, there is a toolbar:

• Process: process the selected request. After clicking the button, EMSOW will open a service creation wizard to import the data from the request. The request processing is covered later in this instruction (see “How to process an HL7 request”).
• Mark as pending: change the status of a processed request back to pending. To do this, you need to remove the service created from the request first.
• Parse: after clicking this button, EMSOW will analyze and break down the HL7 message into meaningful parts to be populated in the columns. This happens automatically upon receiving an HL7 request. Note: you cannot parse requests with already created services.
• View: display the contents of an HL7 request in a pop-up window with two tabs: Text and Tree. Text tab allows you to see a raw HL7 message:
  

  The Tree tab offers you a structured view of the data in the HL7 message with short annotations for HL7 message fields:

  
• Open in Dispatch: if the selected request has been processed and a service has been created, use this button to jump to the service in the Dispatch module where you can dispatch a technologist to perform the requested exam.
• Remove selected: remove the selected request.
• Export: export the list of requests as an Excel, CSV, PDF, or HTML document.

How to process an HL7 request

In order to process a pending HL7 request, follow these steps:

1. Select the necessary request.
2. Click Process on the toolbar or in the Actions
3. In the window that opens, change the necessary patient data:
   
   Then click Next.
4. Change the required service data:
   
   Click Next.
5. Change the ordered studies and diagnoses, if necessary:
   
   If the required study is missing from the drop-down menu in the Study field, you can set up a new study by clicking or modify an existing study by clicking . If you have more than one study, it is possible to copy the already entered diagnoses to all studies without diagnoses by clicking . Click Next to proceed.
6. Edit the service note, if needed:
   
   Check Archive if you need to make the note archival. Archival notes are displayed collapsed by default. To view the note, you will need to click the plus sign (+).
7. Click OK to finish.

As a result, EMSOW will create a service based on the data imported from the HL7 request and the data provided by you on steps 3–6. A link to the service will appear in the Service ID column. By clicking this link, you will open the order with the created service in the Processing module.

Having processed the request, you can also dispatch a technologist to perform the requested exam by using the Open in Dispatch button on the toolbar or in the Actions column.

Accessing study records

1. Click Portals in the menu bar and select Patient Portal in the dropdown menu.

2. The Patient Portal will open.

Use the search filter in the Options section to the right to retrieve the needed studies. Enter the search parameters, then press Enter or click Search at the bottom of the Options section. The studies will be displayed as tiles in the Results section to the left.

3. Below is a study example:

Here, you can see exam details (accession number, diagnosis codes, the technologist, the reading facility/doctor), as well as attached diagnostic images and files.

Click on the Images icon to view the diagnostic images in EMSOW viewer.

Click on links with the Documents icon to view or download attached files, such as reports.

Click on the Chat icon to exchange messages with users who have access to the study. A chat window will open, where you can type messages and view the users’ replies in real time.

Sharing a study

The Patient Portal allows you to share studies with users who do not have EMSOW accounts, by emailing them a secure link (e.g., you can use this feature to get a second opinion from an external physician). To share a link, select the needed study by checking the box in the upper right corner of the study tile, then click Share study in the toolbar at the top of the Results section.

The Share study window will open.

Set the Link expiration date, enter Case notes, select File types to be shared, enter the recipient’s email address in the E-mail field, and type a message in the E-mail message field. If you don’t need to include the case notes in your message, uncheck the Include case notes in e-mail box. Then click Save, and EMSOW will send a message to the email address you specified, which will allow the recipient to view the shared study without logging in.

Downloading images

If you need to download images of a study, select the study and click on the Pack icon in the toolbar at the top of the Results section. This will allow you to save the images as a ZIP file on your computer or burn a CD. See details in the “How to record images to a CD/DVD or a USB flash drive” article.

If images have been sent to your domain and you cannot locate the corresponding service in the Processing module, please try following the steps below:

1. Go to the PACS → PACS Storage module by clicking PACS → PACS Storage, search for the needed images by last/first name or date of birth.
   

2. Look at their status (Attached or Detached). If they have a status of Attached, click the accession number link in the Attached to column to jump to the service to which these images have been attached.

   

3. If the images have a status of Detached, you need to click the Reprocess as new.

   

4. If you get an error message that reads “The Patients directory already contains an entity with the following attributes: patient_mrn,” you can use the following workaround to create a patient record without an MRN. This error occurs if your system already contains a patient with the same MRN but a different name.

   

5. Go to Setup → PACS → PACS Clients.

   

6. Select the default PACS Client (the one with a green checkmark in the Default column) and double-click it (or select it and click the Edit selected button).

   

7. In the Edit PACS client window, go to the Automator tab and disable the checkbox Patient No under Import options.

   

8. Repeat step 2. After a service has been successfully created and the images have been attached to this service, please go back to the PACS client settings and re-enable the checkbox Patient No.

   

Technologist portal – the place where tech will be able to view studies he submitted, process them automatically or manually with assistance from EMSOW, attach additional documents and download finalized reports. By default, each tech will see only studies submitted by him, with the option to see all DICOM studies on the domain.

Interface

Search options

General options:

‘Received on:’ search for studies that have been sent on the specific date or range of dates. ‘Uploaded by:’ with this option user that has access to all DICOM studies at the domain can search for studies that were uploaded by specific user; ‘Status:’ option to search for DICOM studies that have been ‘Attached’ to the service / DICOM studies that are ‘Detached’ and waiting to be processed / ‘ALL’ studies. EMSOW remembers position of this option, no need to switch it every time you log in; ‘Worksheet:’ option to search for DICOM studies that have the worksheet ‘Saved’ / ‘Not saved’ / ‘All’ when you do not care.

Quick search

Search with the query in this section will ignore options in all other sections.

‘Service ID:’ search for specific service id in EMSOW; ‘Accession No:’ search from accession number of the study in EMSOW; ‘Study UID:’ search for DICOM study based on the DICOM study uid.

DICOM: Patient

The section that in which you can search for the specific patient by demographics data that are inside DICOM. Note that if the last name of the patient in DICOM contains a mistake – you would not find anything if you will be searching by the last name without the mistake.

‘Last Name:’, ‘First name:’, ‘Date of birth:’ is self-explanatory; ‘Patient ID:’ search by ID of the patient that was added on the equipment; ‘Accession No:’ of the accession number that was added on the equipment;

DICOM: Study

‘Description’ search by study description that was added on the equipment; ‘Modality’ search by specific modality of the DICOM study (US for ultrasound studies, DX for digital radiography, etc); ‘Study ID’ search by study description that was added on the equipment; ‘Study date’ search by date of service that was added on the equipment.

DICOM: Other

‘Referring doctors:’ search by referring doctor name that was added on the equipment; ‘Reading doctors:’ search by reading doctor name that was added on the equipment.

Menu bar

• ‘Select all’ – select all studies on the current page;
• ‘Deselect all’ – remove selection from all studies on the current page;
• ‘Remove’ – remove selected DICOM study;
• ‘Documents’ – if study is attached to the service in EMSOW you will be able to access Documents of said study, upload additional documentation or download the finalized report;
• ‘Attach’ – options to attach DICOM studies to the already created EMSOW studies. This option is useful for the clients that use the schedule in their workflow. Consist of three options:

‘Attach/manual’ – will open window where you can search for specific service/study in EMSOW; ‘Attach/auto (for selected)’ – system will try to find and attach selected studies to the proper service/study in EMSOW; ‘Attach/auto (for all)’ – system will try to find and attach all studies on the current page studies to the proper service/study in EMSOW;

• ‘Detach’ – detach already attached DICOM studies from EMSOW study;
• ‘Pack’ – option that will open window where you can download study in zip/iso archive;
• ‘View’ – open images of the studies;
• ‘Edit worksheet’ – open worksheet for the study;
• ‘Reprocess as new’ – for the clients that did not use the schedule in EMSOW and creation of the studies should be done manually or by EMSOW based on the DICOM information.

‘Reprocess automatically’ – EMSOW will create service and study based on the information from DICOM study; ‘Reprocess step-by-step’ – will open the interface that allows user manually provide all necessary information to create a service. It will be described in detail in the section “Reprocess step-by-step (Reprocess (steps))” of the manual.

Bottom menu

The bottom menu consists of (from left to right):

• First-page button;
• Previous page button;
• Number of the current page;
• Number of all pages;
• Next page button;
• Last page button;
• Refresh current page;
• Page size – amount of studies to show on one page (10 – 100, default 50);
• Phrase that indicates index number of the studies that are currently shown;
• Option to change current sorting:

  by patient name (ascending); by date of service (ascending); by date of birth (ascending);

Study tiles

Each tile represents one DICOM study. Patient demographics on the tile retrieved from DICOM study information and would not change after the study have been attached to the EMSOW service. In the right upper corner of each tile, there is the checkbox that user should use to select study to perform actions from the menu bar.

Colours

Each DICOM study will be shown on the separate tile of three different colors:

• Red if the DICOM study is detached from the EMSOW study;
• Green if the DICOM study is attached to the EMSOW study;
• Yellow if the DICOM study is partially attached to the EMSOW study;

Menu buttons on tiles

Some of the most commonly used menu options we copied onto the buttons that will appear only when the user hovers its mouse over the tile. This buttons is totally optional and can be disabled.

• ‘Edit worksheet’ – open worksheet for the study;
• ‘Manual attach’ – will open window where you can search for specific service/study in EMSOW;
• ‘Auto attach’ – system will try to find and attach current study to the proper service/study in EMSOW;
• ‘Detach’ – detach already attached DICOM studies from EMSOW study;
• ‘Pack’ – option that will open window where you can download study in zip/iso archive;
• ‘Reprocess (auto)’ – EMSOW will create service and study based on the information from DICOM study;
• ‘Reprocess (steps)’ – will open the interface that allows user manually provide all necessary information to create a service. It will be described in detail in the section “Reprocess step-by-step (Reprocess (steps))” of the manual.

Information icons

In the right bottom corner of the tile, we place four icons that will provide some crucial information about the study. Those icons highlighted on the image above. From left to right:

‘Cache status’ – if a DICOM study is available right now to be viewed the icon will have a green tic. After 7 days from the date when the study has been received we place the DICOM study in long-term storage. In that case, the icon will have a red cross.

‘Uploaded by’ – this icon will provide information by whom the study was uploaded into the system.

‘Worksheet status’ – if there is no worksheet saved for the DICOM study – the icon will be transparent. If there is a saved worksheet for the Study – tooltip will show what template was used and was the worksheet last saved;

‘Report indicator’ – Red transparent cross if there is no report for the study. Green tic if there is a report added to the study.

Documents

Document management window consists of two sections:

1. View of all documents that are attached to the EMSOW study, including the reports. To view the document click ‘view’. Under the preview, there will be keys to download.
2. Uploader – interface where you can upload select documents that you want to attach to the study, select their type and leave a note about the document.

Reprocess step-by-step (Reprocess (steps))

Reprocess step-by-step – is a very simple and straightforward interface in EMSOW which give user ability to manually create studies in EMSOW based on patient demographics from the DICOM study. It consists of just two steps:

At first step, you verify patient demographics:

At second step you verify Service data such as DOS, Referring facility, and Referring doctor and type of study.

Below is the description of the Analysis module’s sections.

Reading turn around time analysis

In this section of the Analysis module, you can view the statistics for the reading turnaround time (the period of completing a reading cycle). To open it, click ANALYSIS on the upper navigation bar, then select READING TURN AROUND TIME ANALYSIS in the drop-down menu. The Reading Turn Around Time Analysis tab will open:

Here you can see the reading turnaround time statistics arranged in the following columns: Service ID, Reading facility, Reading doctor, Study, AVG time (average time), RMS time (root mean square time), MAX time (maximal time), MIN time (minimal time), and Count (displays how many studies were read).

Above the reading turnaround time statistics there are several fields which allow you to change the representation of the data:

Date – in these fields, you can select a date range for the reading turnaround time statistics. Select the start date in the from field and the end date in the to field:

Filter by – in these fields, you can filter the turnaround time statistics by reading facility, reading doctor, and study:

Group by – these checkboxes let you change the way how the reading turnaround time statistics is grouped: by reading facility, reading doctor, or study:

You can deselect all checkboxes to disable grouping.

Only positive reading – click this checkbox to disregard negative values of reading turnaround time:

Refresh – click this button to refresh displayed data:

Finance analysis

In this section of the Analysis module, you can view the revenue data based on actual reimbursement postings from insurance carriers. This data is updated and leveraged in real time for maximum accuracy. To open it, click ANALYSIS on the upper navigation bar, then select FINANCE ANALYSIS in the drop-down menu. The Finance Analysis tab will open:

Here you can see the left sidebar and the list of search results (finance analysis data) on the right.

The left sidebar provides a search filter with numerous search options. It allows you to specify the date of service range (specific date or date range), referring facilities, referring doctors, reading facilities, reading doctors, rendering providers, ordering facilities, technologists, billing companies, components, study groups, studies, and branches. You can also select the way how the search results are grouped: by referring facility, reading facility, rendering provider, billing company, technologist, branch, referring doctor, reading doctor, ordering facility, component, and year/month.

After you specify the necessary fields, click the Search button to display the required finance analysis data. To reset all fields, click the Clear button. The Reload button allows you to reload the search results. It can be useful after you have changed some of the search fields.

Finance analysis data is arranged in columns. The first columns represent the selected way of data grouping (Referring facility, Reading facility, and so on). To the right of them, you can see the Pending, Written off, Paid, Real Projected, Only Projected, Errors, Dates, Patients, Studies, and Orders columns. Right above the Finance analysis data there is the Export button. It allows you to export the finance analysis data to an Excel, Excel 2007, CSV, PDF, or HTML file.

The Pending column displays the amount that is pending insurance payment.

The Written off column displays the write-off amount which is the difference between a provider’s fee for healthcare services and the amount that an insurance company is willing to pay for those services that a patient is not responsible for. The write-off amount may be categorized as a “not covered” amount for billing purposes.

The Paid column displays the amount that has been paid.

The Real Projected column displays the projected amount that must be paid.

The Only Projected column also displays the projected amount to be paid, but this amount is based on the billing projected settings (to access them, follow the path: SETUP → BILLING → BILLING PROJECTED).

The Errors column displays the number of estimation errors.

The Dates column displays the number of days within the date of service range when services were rendered.

The Patients, Studies, and Orders columns display the number of patients, studies, and orders respectively.

To view more detailed information about each group, double-click the required row. The Group details window will appear:

Here you can see the detailed information about each rendered service and study. All data is arranged in the following columns: Ordering facility, Branch, Referring doctor, Reading facility, Reading doctor, Rendering provider, Billing company, Technologist, Component, Study, CPT, Units, Submission date, Closed, Order ID, DoS, Service ID, Patient, Primary insurance, Pending, Written off, Paid, Real projected, and Only projected.

The last column may contain the Add button that lets you change the real projected amount. When you click this button, the Edit billing projected record window appears:

In the Amount field, enter the new real projected amount. Then click OK to update the real projected amount or click Cancel to close the window without saving.

The Group details window has the Show estimation errors only checkbox in the upper left corner. Click this checkbox to display estimation errors only.

The Export button in the upper right corner of the window allows you to export the group details to an Excel, Excel 2007, CSV, PDF, or HTML file.

Income aging analysis

In this section of the Analysis module, you can view the income distribution over a specific period of upcoming months. To open the section, click ANALYSIS on the upper navigation bar, then select INCOME AGING ANALYSIS in the drop-down menu. The Income Aging Analysis tab will appear:

Here you can see the left sidebar and the list of search results (income aging analysis data) on the right.

The left sidebar provides a search filter with numerous search options. It allows you to specify the date of service range (specific date or date range), referring facilities, referring doctors, reading facilities, reading doctors, rendering providers, ordering facilities, technologists, billing companies, components, study groups, studies, and branches. You can also select the way how the search results are grouped: by referring facility, reading facility, rendering provider, billing company, technologist, branch, referring doctor, reading doctor, ordering facility, component, and year/month.

After you specify the necessary fields, click the Search button to display the required finance analysis data. To reset all fields, click the Clear button.

Income aging analysis data is arranged in columns. The first columns represent the selected way of data grouping (Referring facility, Reading facility, and so on). To the right of them, you can see the Errors, Paid studies, Paid, and Projected columns. The last three columns are repeated for several time intervals (0-30 days, 31-60 days, 61-90 days, 91 and over days).

Right above the finance analysis data grid there is the Export button. It allows you to export the finance analysis data to an Excel, Excel 2007, CSV, PDF, or HTML file.

Next to the Export button there is the Grid view control that has two options: Normal (selected by default) and Detail. Click the Detail option to see more columns: Studies, Projected studies, Written off studies, Overdue studies, and Overdue.

To view more detailed information about each group, double-click the required row. The Group details window will appear:

Here you can see the detailed information about each rendered service and study. All data is arranged in the following columns: Referring doctor, Reading facility, Reading doctor, Billing company, Technologist, Component, Study, CPT, Units, Order ID, DoS, Service ID, Patient, Payers, Paid, Projected, Date sent on reading, and Total turnover days.

The Export button in the upper left corner of the window allows you to export the group details to an Excel, Excel 2007, CSV, PDF, or HTML file.

Profit and loss analysis

In this section of the Analysis module, you can view revenues, costs and expenses for a given time range. To open it, click ANALYSIS on the upper navigation bar, then select PROFIT AND LOSS ANALYSIS in the drop-down menu. The Profit and Loss Analysis tab will appear:

Here you can see the left sidebar and the list of search results (profit and loss analysis data) on the right.

The left sidebar provides a search filter with search options. It allows you to specify the date of service range and select the business type, account or facility. You can also select the Debug checkbox to display referring facilities that are not included in any referring account.

After you specify the necessary fields, click the Search button to display the required profit and loss analysis data. The Reload button allows you to reload the search results. It can be useful after you have changed some of the search fields.

Click the Export button to export the profit and loss analysis data to an Excel file.

The profit and loss analysis data is arranged in the following columns: Year, Month, Name, Visits, Tests, Revenue, Collected, Rent, Rent time, Tech Time, Tech Cost, Eqp + Travel, Billing, Reading, Profit, and Margin. At the bottom, you can see the TOTAL row which summarizes the profit and loss analysis data.

Every study is linked to a referring doctor, which is the physician who has referred a patient for the examination. The referring doctor’s name is typically entered on the equipment. EMSOW groups the referring doctors by referring facility.

The main item of the processing routine is a service, which is a collection of studies performed on the patient on a certain date. The services are grouped into orders based on the referring facility. In case your company has several operating units, the orders may belong to different branches or ordering facilities, which should be set up during the system installation.

The end goal of processing the service is to assign two things to it: a reading doctor who will interpret the medical images (if there is more than one study in the service, each may have its own reading doctor), and a billing company on behalf of which the service will be billed for. The Processing module allows you to properly process all received data for the service (including the medical images and the associated documents such as tech sheets), and send it to the reading doctors and the billing companies. It must be done correctly and quickly so that your company gets the images interpreted and the services billed for in time.