Hello, newbie here, is openemr for me?

Management and Administration
1

technoid wrote on Wednesday, April 09, 2014:

Hi there, hope you can help me. I work for a solo practictioner physician, we’re a small office with only 4 employees (doctor included). I’m basically the computer guy, and a frugal one at that (actually we’re all that type of a bunch hah), and that’s one reason I’m looking at this free OpenEMR. As far as billing practice management software (PMS), we aren’t the kind to change this software many times over the years, being that we’re a small office. So we’ve been using the same PMS since 1996 (and only one other previous different software before that). But now with all these new radical changes in the medical field coming (or already here), e.g. HCFA 02/12, ICD-10, our current “old” program is not able to keep up anymore. Heck I had to do some recoding workaround when I had to start electronic claims (for Blue Cross atm) last summer (we’re using OfficeAlly).

Anyway, all we really need is a new PMS. There is no real need yet for EMR/EHR. Will Open-EMR work for us, or should we go the commercial route and spend hundreds/thousands of dollars again? Also, again, as frugality is concerned, we’ve stayed with the old PC’s since the late 1990’s. They have and still do the job. So one big question is, will Open-EMR work with Windows 98SE (and perhaps Win 95B if possible)? I assume O-EMR is a server/client configuration. Our current PMS simply uses peer-to-peer. If you must know, we’re using Lytec Medical 6.50 (yep, 1996). Anyway, a decision is imminent. Your advice is appreciated.

2

sunsetsystems wrote on Wednesday, April 09, 2014:

Wow those are old computers!

Yes OpenEMR should work for you. You’ll need a web server. I suggest finding a machine with at least 2 GB of memory and installing something like Linux Mint on it.

The workstations can be pretty much anything that will run a web browser, but I really think you’ll want to upgrade them

Rod
http://www.sunsetsystems.com/

3

technoid wrote on Thursday, April 10, 2014:

Hi. Unfortunately I know nothing about Linux. I’ve only had MS Windows/DOS experience, since the early/mid 80’s. Can the webserver be in 98SE, with the OEMR Win/XAMPP install package?

I have run the OEMR demo here on 98SE with older browsers and it seemed fine. I do have an extra PC doing nothing right now, so I could try installation on that.

Should’ve done all this a couple years ago when I discovered OEMR. If nothing else, I may have to shop for a commercial PMS. Would rather have it “traditionally” installed on the local hard drive rather than cloud-based, but we’ll have to see once I cross that bridge. Our biggest hurdle right now is transitioning to HCFA 02/12 format. For example, our old PMS won’t be able to handle HCFA box 24E changing to letters from numbers. The old PMS does have limited programmability (for report/printout customization), and I’ve used that a lot over the years, but not anything like a database language that I could reprogram, to which I could’ve coded lookup tables or If/Then statements to change the numbers to letters, etc. Oh well.

4

yehster wrote on Thursday, April 10, 2014:

A few hundred dollars for a modern laptop on which to run the OpenEMR server piece may also be an option. I doubt that XAMPP will run under 98SE. You may be pleasantly surprised, but it seems highly unlikely to me.

If HCFA 02/12 is the primary thing you need from a PMS standpoint, then I think you are in luck with OpenEMR.

5

fsgl wrote on Thursday, April 10, 2014:

Are you fellas so frugal that you squeak? (I do).

Our IBM 300 GL, purchased in 1995, had a small explosion, (motherboard short-circuited) and died last year. Fortunately we transitioned to OpenEMR 10 months before.

We use it as a desktop application by turning off the Internet connection. Our startup cost was $5.99 for a SD card.

Frugality should tell you to spend the money on hardware not software. The adage about pounds and pennies should also offer guidance.

Of course, you do know what happens right after after you posted how well and faithfully the dear old computers have run all these years… Since you’ve tempted Fate, it’s clear what needs to be done.

6

anonymous wrote on Thursday, April 10, 2014:

Hi Rob,

While free of cost may be the initial attraction to OpenEMR, you will find that free as in freedom is the more important aspect of using open source software. You are free to do whatever you wish to your OpenEMR installation without the burden of making requests to a proprietor. The community here is a great bunch of people who are more than willing to help where they can.

If a problem can’t be solved through the forums or if you wish to make customizations to your installation, there are a number of well-qualified developers who can help carry out your visions.

Our small practice also has four employees and OpenEMR has been a true game changer. We are nearly 100% paperless and our workflow is more efficient than ever. If you have any specific questions, don’t hesitate to ask.

7

technoid wrote on Friday, April 11, 2014:

Kevin Yeh wrote:

A few hundred dollars for a modern laptop on which to run the OpenEMR server piece may also be an option. I doubt that XAMPP will run under 98SE. You may be pleasantly surprised, but it seems highly unlikely to me.

If HCFA 02/12 is the primary thing you need from a PMS standpoint, then I think you are in luck with OpenEMR.

Well I’m hoping oemr 4.1.x-xampp will work with 98SE. Actually I don’t even know what xampp is. Can someone elablorate what it is and if I need that or the non-xampp win version?

Speaking of O/S versions, I can’t even find what are minimum requirements to run Oemr here. Is there one at all? I looked under Features, Wiki, Installation, etc. All I can find is that Oemr will work with Windows, Linux, MacOSX, PHP5, MySQL, etc. That is what brought me here in the first place, in that since I couldn’t find what minimum version of Windows is needed, it could possibly work with 98SE. Seeing that I might be the only one here with 98SE, I’d be more than happy to report if it will work. Otherwise there needs to be more specific requirements written down so that you don’t get too many hopes up, lol.

Yes, HCFA 02/12, but also ICD-10 and electronic claims. I’m happy though that ICD-10 has been pushed out to mid-2015! Right now I am working on a band-aid solution to getting HCFA 02/12 to work on my current PMS. Box 24E is my biggest concern, with the new qualifiers all over the claim as the next concern.

fsgl wrote:

Frugality should tell you to spend the money on hardware not software. The adage about pounds and pennies should also offer guidance.

Of course, you do know what happens right after after you posted how well and faithfully the dear old computers have run all these years… Since you’ve tempted Fate, it’s clear what needs to be done.

Yeah I know, I hope I haven’t jinxed anything. :slight_smile: I did open up one of my PC’s and the electrolytic capacitors are bulging, so I will need to recap them.

As far as alternatives, I do have some other PC’s I can put to use. There’s an old dual-CPU 1.0 GHz Pentium III (i.e. SMP, symmetric multi processor) with up to 2GB memory that I have, however that one needs to be recapped too. Or I can take a trip to the local Walmart and buy their $200-$300 Win 8.1 PC for the webserver.

Investment in hardware/software, in addition to time and money, right now is a big concern. We are at a crossroads/empass because the doctor is near retirement. He doesn’t know when, but he could decide anytime in the next few months or years. That’s why we’re not sure how much we need to get involved in high dollars, long setups, and deep learning curves. He has learned our current PMS over the years. Unsure how he will take into learning new software.

Frankie Brooks wrote:

While free of cost may be the initial attraction to OpenEMR, you will find that free as in freedom is the more important aspect of using open source software. You are free to do whatever you wish to your OpenEMR installation without the burden of making requests to a proprietor. The community here is a great bunch of people who are more than willing to help where they can.

If a problem can’t be solved through the forums or if you wish to make customizations to your installation, there are a number of well-qualified developers who can help carry out your visions.

Our small practice also has four employees and OpenEMR has been a true game changer. We are nearly 100% paperless and our workflow is more efficient than ever. If you have any specific questions, don’t hesitate to ask.

Hi Frankie. Thanks for the info. Also happy to see that there are still many small offices around. Too many have become gigantic multi/group practices out there.

I assume Oemr can have modules disabled. At the moment, we don’t need the EMR, appointment scheduling, prescripting, etc. aspects of it. Just core PMS, with paper claims, e-claims and patient billing statements. We are also looking into speech recognition for the charting. We already bought Dragon NaturallySpeaking but still early in the learning process. Unlike you though, we still bury ourselves in paper, lmao.

8

cverk wrote on Friday, April 11, 2014:

Did anybody mention that windows 98 and as of recently windows xp, are no longer HIPAA compliant for any patient information including billing. In case it wasn’t noticed, because the fed apparently hasn’t, Medicare patient ID numbers for billing are the patients social security number.

9

tmccormi wrote on Friday, April 11, 2014:

legally Medicare id numbers are not SS. They are HICN ids. as in Health
Insurance Claim Number. sometimes they are actually different than the
SS… but rarely.

Tony McCormick

–
Please be aware that e-mail communication can be intercepted in
transmission or misdirected. Please consider communicating any sensitive
information by telephone. The information contained in this message may be
privileged and confidential. If you are NOT the intended recipient, please
notify the sender immediately with a copy to hipaa-security@mrsb-ltd.com and
destroy this message.

10

fsgl wrote on Friday, April 11, 2014:

XAMPP in a nutshell.

Because OpenEMR is a browser based application, Apache and PHP are needed. A database is necessary to store practice, patient and accounts receivable data. Perl makes everything else work.

Don’t be concerned about hardware minimum requirements. The download is free. Either OpenEMR works with the old computers or it doesn’t. If not, go bargain hunting for a Windows 8.1 device at Walmart or online.

Let’s talk dollars and sense.

Lytec 2014 will cost about $3K for 1 license. This seems to be the low end of proprietary software.

E-claims generated in OpenEMR and processed through Office Ally will be a maximum of $20 per month if the govenmental claims exceed that of commercial claims. The monthly cost of labor, stamps and CMS-1500 forms should be well in excess of $20. Another advantage of e-claims is that you can avoid fooling about with all those new qualifiers and boxes.

If the physician is not interested in electronic clinical notes, staff can just use the Billing Module of OpenEMR. There is really no reason why the physician must learn to use OpenEMR as long as the 3 remaining employees have done so.

If you know how to recap electrolytic capacitors (tutorial for the rest of us), the learning curve should be relatively flat. Since staff is not retiring soon, new skills acquired learning OpenEMR should serve you well for the balance of your careers.

If the physician does not have many hobbies, he may opt to continue working. My colleagues often return to their practices out of sheer boredom. If that turns out to be the case, a new server plus OpenEMR will provide a comfortable work environment.

11

technoid wrote on Tuesday, April 15, 2014:

I see, so Xampp is basically an all-in-one (multiple) programs installer.

It’s understandable how Lytec has also grown with more expensive software. The Lytec 6.5 we are still using was purchased $1k for a 5-user license in '96.

Yes we still use paper claims mostly because “management” understands that more than e-claims. It is hard for them to get away from it as they were born in the 1940’s. Heck we still use typewriters too, though we stopped using them in the late '80’s to fully type up a HCFA claim. Nowadays we use them to type up little stuff, like checks or adding notes to whatever. Looking back though, it looks awful, tedious and slow typing up a claim form compared to what has been done faster and convenient with computers. I still have old ICD/CPT printed lists we had to look up when typing them in. Things finally changed when we bought MD Versaform by AST (Applied Software Technology), our first PMS, in ~1988. I think AST is still around and have (or had?) their own EMR. For now we use e-claims for our Blue Cross/Shield claims. I think we have to start doing that now with Medicare.

We are interested in electronic charting/notes someday soon, but for now we’re focused on the billing aspect and I hope Oemr can do that out-of-the-box per se.

Yup, I do know how to solder/desolder. Been doing that for about 3 decades now since as a kid. Taking soldering classes for motherboard factory work back when I was at Intel Corp also helped.

Will just have to wait and see if and when our doctor does make the final decision to retire. He has also thought about locums, but that could be farther down the road. He’s about 71 now.

I just finally was able to format to HCFA 02/12 in Lytec 6.5 over the weekend. The worst part was conversion from numeric to alpha in box 24E for the dx pointers. If you count all the possible different realworld combinations you can use for 4 ICD codes, there are about 14 of them. However I could only codehack about 3. It’s basically a programming space limitation in 6.5. So all I can get in for now are the DX pointer combinations of “1”, “12” and “123”. Converted to HCFA 02/12, this corresponds to “A”, “AB” and “ABC”, which are our top 3 high hitters (and probably for most other small/medium sized GP/FP clinics, idk). I could not hack in “ABCD”, which can also be a big one. Talking to the doctor, those top 3 should suffice. You have to wonder why they need 12 different DX’s in this new format, which is why they changed to alpha. Just me, but I would think that 9 or 10 codes would’ve sufficed, hence stay with numerals 1-9… or maybe 0-9 (or 1 thru 0 if you know what I mean). I’m thinking my next programming hurdle may be ICD-10. I believe the rudimentary requirement for that format is a field able to take in 9 characters, i.e. xxx.xxxxx, but luckily Lytec 6.5 already has that built-in.

Anyway, this 02/12 thing is a big programming win for me as this lengthens our tenure with Lytec 6.5 even more. The last big win was last year when I was able to get some workarounds to get electronic claims going (it had an outdated hardfixed e-claim system, so instead I just used ascii print image to send to Office Ally). Anyway, hopefully these stopgaps will give me more time to peruse other software including OEMR.

Better stop here, already long post, lol. :slight_smile:

12

cmswest wrote on Tuesday, April 15, 2014:

way to hack! i think the 12 dx codes just fit nicely but of course with icd 10 ( or maybe we’ll just go straight to 11?) there will be more codes required for each line item

so for e-claims you’re using a free 5010 package where you have to type in the claim each time, or did you hack lytec 6.5’s 4010?

13

technoid wrote on Wednesday, April 16, 2014:

In MS-Windows, there is a printer format called “generic”, where the output can go straight to a file instead of straight to a printer. The file output is in ascii/tty text. You can open it with a word processor and you see exactly what the text would look like on a paper claim form, and you see exactly where all the text are located on paper. This is what you call a “print image”. This is what you can send to a clearinghouse, and fortunately Office Ally accepts print images. They do have to initially scan your first submission to see where your fields are located. From then on you have to stay with that format. If you change anything in there, like adding an additional carriage return or move a text a few spaces to the left/right, then the clearinghouse scanning system will scream and not accept it.

Lytec Medical 6.5 (or Lytec 96 as I call it, because Lytec started titling their versions by year after 6.5, i.e. Lytec 98, 2005, 2012, etc.) does have built-in electronic claims, but it is hardcoded to specific clearinghouses (of the day), communication settings etc. that I believe are useless now. So what I did was just change/reroute the printout to save to file. This print image file is then what I upload to Office Ally. And in 6.5 you can make any type of report/claim format you want. Being that it’s from 1996, LM 6.5 did come out of the box pre-loaded with HCFA 12/90 formats, but you can customize and save those to new formats yourself. That’s how we’ve stayed with this program over the years. All I did was add or rearrange where fit and then save it to a format acceptable for the 08/05 version, and also now for the 02/12 format. That was the easy part. The hard part again was box 24E. So as I said before, due to the programming and formatting limits, I had to make a compromise and just use the top 3 dx pointer references used on most of our claims. If there is any other pointer combination other than the top 3, like “B” or “ABCD”, it will output blank. If it does that, we will just have to manually hand print or type those on the paper claim. It may sound a little kludgy but it is better than nothing and helps automate the process a little further. I am hoping that you can easily customize claims, reports and billing statements, etc with OEMR, right?

Yes, we could go all electronic claims, but there is some work flow issue involved here, so for now we are just using e-claims for BCBS. Hmm, how long will clearinghouses accept 08/05? I assume they accept 08/05 and 02/12?

So in summary, to answer your question, I “hacked” the 4010, though technically it’s not a hack, as Lytec already gives you freedom to customize paper formats. Even converting box 24E to alpha was technically not a hack, just more of a programming workaround. Hmm, ok I guess “hack” is defined as a “programming workaround”, hehe.

I still don’t understand why up to 12 DX’s are needed. I assume this is a “one size fits all” scenario, for smallest to largest medical institutions. I know we as a small office are not going to use more than 4 ICD’s per sheet. If more than 4, then the procedure lines flows over to a new sheet, so what, that’s fine. If that’s not the case, then I don’t get it and someone will have to elaborate, or I need to do some more “googling”. Even if and when we all finally have to use ICD-10, I’m thinking for simplicity we’re just going to just use the codes equivalent to what they were in ICD 9, i.e. GEM, general equivalency mapping, unless the diagnoses really does need something new that wasn’t in ICD 9. :slight_smile:

14

cmswest wrote on Wednesday, April 16, 2014:

as you can see from other threads, there’s no limit to how much you can customize the software, on the billing side it’s led to a discussion, https://sourceforge.net/p/openemr/discussion/202504/thread/ea6efc26/ , of an overhaul of the basic accounting functions.

medical billing must adapt to a changing landscape of payer(or) requirements, hipaa mandates, and other workflow considerations. your ability to keep that old classic on the road is what a small to medium practice needs to retain the profit margin, instead of paying $1000s for commercial solutions. kudos!

lytec 96 must have that mcds format for electronic claims that clearinghouses used in the 90s, i think they will continue to accept your claim images as long as the 02/12 hcfa is valid

your eclaims software is supplied by bcbs? is that the kind where you have to type in each claim?

15

fsgl wrote on Wednesday, April 16, 2014:

ICD-10 implementation has been pushed to Oct. 1, 2015.

Your office may find this little converter useful. I have about 10 codes for conversion when the time draws near.

More nuanced coding nor a boatload of ICD’s will not generate an extra penny for professional billing. The action is in the number of CPT’s and especially for the newfangled stuff.

There is a real need for small solo practices to continue to serve patients. Because most of us, senior physicians, don’t have to earn our daily bread; we can concentrate on the best interests of our patients as we were taught in medical school.

Another reason for the physician not to retire.

He probably started or will soon have to do Required Minimum Distributions. (It really annoyed me, when I first learned of RMD’s, that one cannot just leave the moola in the financial institution, accumulating interest ad infinitum.) The only way to offset RMD’s is to continue working and contributing to the Keogh or Keogh equivalent and to the Roth IRA (God bless William V. Roth, Jr.).

16

technoid wrote on Saturday, February 07, 2015:

Stephen Waite wrote: your eclaims software is supplied by bcbs? is that the kind where you have to type in each claim?

Woah, totally forgot about this thread, it’s been almost a year! Hello to everyone again. But to answer your question: No, BCBS does not supply our eclaims, but they refer all us providers to what eclaim service companies they prefer, thus one of them is Office Ally, the one we currently use. As I said above in my posts from last year, our Lytec 6.5 generates the claim file that I then upload to Officeally.com. Hope that helps.