Global Institution Flag

I’m working on adding a global institution mode flag in Globals and modifying the following:

  1. Codes by adding a new field for recording and maintaining revenue codes. Purpose is to keep revenue code with procedure code so that depending on institutions purpose they may setup procedures relating to their discipline. Better, I think, than a lookup for coder to code at billing.
  2. An encounter class field in encounters for out/inpatient and discharge. Not sure if patient location info belongs here but I could go ahead and add location to demographics if some of the clinicians can give guidance.
    We are just missing too many data points for effective institutional billing, and I can’t stress enough how much I hate anything accounting, so for decent billing validation really need to collect data where it should originate and not in billing.
    Looking for suggestions.

@sjpadgett with regards to point 2. For the encounters part, i fill for inpatient module to work effectively we have to consider the following:
a. Nursing - here in the nursing module the location of a nurse (nurse station) in the facility will be known, the ward or number of patient that the nurse will be allocated to should be made possible. The nurse would be able to get the treatment plan of the patient assigned to her by the doctor in-charge or a matron(head nurse). here when the nurse administers a drug or a particular treatment to an inpatient, the time that the nurse administered that drug should automatically be captured and not editable for reference sake. also the nurse would select that he or she has administered the medication to the patient and the system will inturn deduct from the remaining medication administration to be done. also in the patient portal the patient should be able to see his or her treatment plan.especially in the case where the patient has to come to the hospital e.g every morning by 9am for 5 days for a tetanus injection.
b. Doctor - the doctor in this inpatient module should be able to admit the patient into the hospital for medical care and he will have to choose the ward available (room available and bed number allocation) here he would in due course be able to create a treatment plan for the hospitalized patient and also be able to discharge the patient.

For the billing part, I feel we can just make it possible that we should have a standard accounting system. we can take a look at odoo’s accounting module and add to it.

i have attached a sample folder we can all access and review. i extracted this module am attaching from Care2x which development has stopped for about 3 years now. i believe we can be able to re-use the code available for it.

@Elijah_Wisdom Agreed on a decent facility mapping is needed but I leave that to others. Concerning accounting; I have written medical accounting packages in the past and swore after last one I would not do again. Besides, I think OpenEMR should only concern itself with billing with ability to export to accounting. There is already a plan to bring in new billing I believe, so for now I’m only concerned with keeping UB04 as loosely integrated as I can with eye on any new billing module.
For the portal it’s as I’ve said that it should be relegated to a communication gateway as FHIR should be focus for the rest.
Medications are being handled in this thread.
For me it seems if OpenEMR is going to do institution support we should put in the core features needed and not just nip around the edges. This means FHIR should be primary otherwise,OpenEMR is going to be left behind.

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Hi @sjpadgett ,

Regarding location, agree that storing this in patient demographics makes the most sense. Maybe a section in layouts entitled Location with the following for now that both select from a list (Unit with Ward, ICU, Surgery which facilities will customize upon; Room with 1, 2, 3 which facilities will customize upon):
Inpatient: (just a toggle should suffice)

For billing purposes, could then store this in the encounter_form if need to have a static entry (for example, if the location in patient demographics gets changed or removed altogether on discharge).

(btw, I’ll migrate this discussion back to pertinent thread when I figure out how to do this)


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Actually, to make this really clear, instead of using Location in new demographics section, would just call it ‘Inpatient’ instead. This will prevent any confusion with the location feature used on the tracker board for outpatient use.

Okay, sorry hijack tread but thought inpatient was topic. Doesn’t matter.

It’s ok @sjpadgett - but just a heads up I’ll probably move this convo into a separate thread just to keep this topic focused on MAR

I’m adding revenue code field to fee and charge sheets along with codes table. Should I also include Dept and Cost Center?

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@sjpadgett @robert.down @brady.miller @Matthew_Vita for this billing issues i want to suggest if it could be possible to integrate simpleinvoices, SimpleInvoices is an open source tool that can be harness in order to deal with OpenEMR’s redundant billing service. Kindly check it out here and tell me what you think about it.


Actually the business logic for our current invoice is very mature and robust.What really needs to be done is an update to the UI and invoice layout. I started an invoice app using angular a while back with allowing the invoice to be edited and persist in history but time is not my friend.
By the time you figure out and write all the hooks for Simple Invoice one could just modernize the existing. Also, appears SI is somewhat stagnate but my look was cursory. Doesn’t mean you can’t take a whack at it @Elijah_Wisdom but my opinion is to update the existing could happen faster.


Okay then lets do that.@sjpadgett. Also i haven’t received a mail from you in a while.

I’m sorry @Elijah_Wisdom but I’m really trying hard to keep my head down and get UB04/X12 done while at same time incorporating some of the logic for institutional to support claims a little more than just allowing claim to be edited. This means fee and charge sheet changes and I really want to get a start on facility location mapping. But time is running out for me to get done so UB04 can make it in version 5.0.1.
Unfortunately, my curious nature takes me off on tangents every so often :slight_smile: Like, as I’m an electrical engineer, looking at telemedicine hardware solutions.
It’s a curse Elijah.

@sjpadgett am an Electrical/Electronics Engineer too. i understand your plight. more grease to your elbow. email me when you are done with the UB04/X12 . A big Thunmbs up to u.

I think we may be seeing a new billing UI in the near future.

Also, I’m currently basing out an idea for better document generation. Essentially you can upload a word file (or ODF file) with fields defined and then well populate that XML file with the pertinent info.

@sjpadgett ,
Regarding Dept and Cost Center, if needed, would bring them in. And we can always move them around, if needed, later.

@robert.down Have you looked at the document template I did in Portal Dashboard? It is well on it’s way and just needs the ODF/DOC type done. It is based on Rods stuff.

@brady.miller Regarding all the billing support lists needed for UB04 such as revenue codes, value codes, occurrence/span codes and patient status codes, I’m thinking, instead of tightly integrating in options list and import to codes for rev codes, that I create a static table to house. Easier for future billing module upgrade. Some of these list are lengthy.

Hi @sjpadgett ,
To make things simpler, could also just use hard-coded lists for now as you build out the feature. Then can figure out what to do with them later (whether put them in own static table or list_options). For example,