ideaman911 wrote on Monday, March 16, 2009:
Anoj;
It would seem that you would need to create an appointment each day for a patient, then select the "@" to indicate they are "at the hospital". But that seems like tedious extra. What would seem a concern in any case will be two possible errors; creating an appointment for which the patient is not actually in the facility, and overlooking a patient who is receiving care.
Since I presume many patients will not receive acute care on a given day, even though they are in hospital, my suggestion would be to keep an independent listing of patient and bed designation, and have clerical staff enter an encounter each date the patient is in the hospital. That encounter should be expanded to include any codes appropriate for the care (FYI, we take the listing of ICD codes as we produce them in the Superbill area, and download them to Excel, where we marry them to “medical_problem::” along with a hyphen and their descriptor as a concatenate, and output the results to a csv text file. (I work in Windows, but I’m sure the Linux approach is similar). That list is then put into …/openemr/custom/clickoptions.txt so it will post as choices in the “Issues”, thereby showing the ICD as well as its description.
With my single provider doing mostly psyche, I am sure our list ius substantially smaller than yours. But the process would seem likely to be the same. Then, once you have created an encounter, you select “Fee Sheet” from the “categories” drop-down, and then select the various CPT and ICD for the care provided. I made a “fix” for the billing, described elsewhere in the forums, which prevents the actual billing of that CPT unless it has been “Justified” by associating the proper ICD with it. That allows the clinicians the ability to delay that association until their documentation is set, so as to minimize the possibility of undocumented billing in the event of an audit. The other fix I made which matters there is to prompt in the Encounters view when those CPT’s have not been Justified yet, without having to actually look in other areas.
Not sure if any of that helped, but it might help save you a lot of added steps.
Jason; given the number of possible hospitals and overnight clinics as possible users of OEMR, might it not be useful to think about using a "check-in" and "check-out" which would automatically create one encounter each day that a patient was checked in, and would trigger at 12:01 AM and any time a patient "checked-in"? Just a thought. The encounter would still have to have all the proper codes assigned, but an encounter would exist "like a sore thumb" demanding that so as to prevent the overlook while removing the tedium.
Joe Holzer