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Modifying OpenEMR for use in Mental Health and other non-medical health offices

kbhbeck wrote on Saturday, August 17, 2013:

I’m looking at using OpenEMR in a private mental health counseling clinic, but I have noticed some problems that make it a challenge for non-physicians to use.

For example, the superbill has a signature line that specifies “Physician.” However, the superbills I need to print will not be signed by a physician but by a mental health provider (e.g. counselor, marriage and family therapist, clinical social worker, psychologist, nurse practitioner, etc.). Thus, the signature line cannot include the word “Physician” since signing such a line would potentially indicate that the provider is claiming to be a physician (which is illegal). To remedy this, I manually changed the superbill document to use the word “Provider” rather than “Physician.” However, finding the document was very time consuming, and I know many mental health clinicians who have no knowledge of how to find that document let alone change it. Thus, it would be beneficial for non-tech savvy users if this change was made in upcoming versions of the program.

Modifying the program for use with mental health and other non-medical health offices may require simple changes such as this or the inclusion of additional modules (e.g. DSM templates, genograms, ecomaps, etc.).

I have been searching for information on the application of OpenEMR in mental health clinics and have found very little. I was wondering if there were any plans on making OpenEMR more mental-health-friendly. Is there?

The mental health field is an ideal target demographic for the program since many providers have extremely limited budgets but still need an EMR/EHR program that satisfies legal and insurance needs while also providing practice management.

Thanks!

deschel wrote on Saturday, August 17, 2013:

Hi Kristen,

You need to contact and collaborate with Art Eaton (http://www.linkedin.com/pub/art-eaton/17/513/41a).

He has done a huge amount of work with adapting OpenEMR for Mental Health, and has an ultra-customized version of OpenEMR to support it. He has implemented OpenEMR for a group of social workers (non-physicians), so I’m sure he has already addressed the issues that you may have.

Also, Art is the type of guy who is enthusiastic about sharing and helping, so he would be an incredible resource for you.

He is also working on projects to make OpenEMR more “mental health friendly”.

David Eschelbacher MD

kbhbeck wrote on Sunday, August 18, 2013:

Awesome! Thank you. I’ll look into contacting him.

mdsupport wrote on Sunday, August 18, 2013:

One of the least appreciated features of this package is its support for languages. Every word (well, most of the words) goes through a translation mechanism before display - defaulting to English words if no translation is found. That includes ‘English’ to ‘English’ translations. So for your use, if physicians are commonly referred as ‘Provider’, try this easy change in the demo system -

  1. from Admin -> Other -> Languages menu enter constant ‘Physician’ and press search
  • Response will show all combinations currently in use.
  • Enter your choice
  • Test the complete process and all documents that you plan to use to make sure your change does not have unintended effect.
  • This approach works for most cases and does not need patching with every upgrade/change.

You are correct that MH would be a good target audience for this project. Towards that end, you could even contribute ‘Mental Health’ as a new language with practice/specialty specific translations. Your work can potentially get included in standard release so other MH practices can benefit and revise.

blankev wrote on Sunday, August 18, 2013:

Tnx MD Support. I didn’t know it would stay after every upgrade. So you translate in English to English in your local version.

It is even better since the provider get all access permissions as top user like the doctors. Also many other doctor specific issues can be changed to fit your workspot for healthcare settings without doctors.

Tnx for the advise.

bradymiller wrote on Sunday, August 18, 2013:

Hi Pimm,

Note there is even a mechanism to hold onto the translations even when updating your translation set to the most current official translation set(see the bolded paragraph at the end of instructions here for details): http://www.open-emr.org/wiki/index.php/Install_Translations#Installation_instructions

-brady
OpenEMR

bradymiller wrote on Sunday, August 18, 2013:

Regarding Mental Health,

I am guessing due to the economics of mental health care, there has been a lot of interest by mental health clinics in OpenEMR. As with Art I think some other vendors do help to support Mental Health care clinics with customized versions OpenEMR. It would be very nice to have this supported out of the box; for example, a setting in Administration->Globals->Features->Specific Application. Hopefully, somebody will contribute this to OpenEMR.

-brady
OpenEMR

blankev wrote on Sunday, August 18, 2013:

Brady,

what about the suggestion of making a special English Language for mental health clinics without doctors? (Google translations sheet.)

There are Forms that need to be changed still, but in majority most problems are solved by changing translations, or is that thought a bit too easy>

bradymiller wrote on Tuesday, August 20, 2013:

Hi Pimm,

Ok to do this type of thing in a customized instance of OpenEMR, but would advise against it in the official codebase; ie. creating a bunch of language sets for simple word substitutions. Probably better to fix this in the codebase and make it an option if want to support this out of the box. This way, the feature can also be carried over to other instances that are not using English. (of course, nothing stops users from creating lang_custom tables in order to propogate these type of customizations to others via the Administration->Language->Manage Translations feature).

-brady
OpenEMR

kbhbeck wrote on Thursday, August 22, 2013:

Brady,

I agree with you that an out of the box mod would be a good idea, and it would be nice to just be able to select it in the global settings. It’s more than just the language that needs to be considered. For example, rather than taking vitals, like blood pressure, a therapist may track mood (scale of 1-10), hours of sleep, and number of panic attacks since the last visit, etc. There are some template features that would be nice to have. DSM-IV-TR uses a 5 axis diagnosis, which would be nice to have in a template in the Assessment section of the SOAP notes (or at least the ability to insert the template into this section if needed). This is changing in DSM-5, but DSM-5 is awhile from being implemented broadly in the industry. Additionally, it would be nice to have a mental status exam template in the Objective section of SOAP notes, so it does not need to be re-entered each time. Just a few ideas off the top of my head.

I’m new to OpenEMR, so from a development standpoint, I don’t really know my way around yet, but I’d be happy to provide any input I can offer.

Economics are certainly a big part of the need for OpenEMR in the mental health community. Most of the persons I interact with who are in the greatest need of mental health services lack insurance, don’t make enough to pay for services out of pocket, and earn too much to get on programs designed for the lowest socioeconomic levels, and many of the low-fee clinics have long waiting lists, so most of the private practice therapists I know are taking on lots of pro bono clients or offering very discounted fees. When I announced that decided to become a mental health counselor, the first thing I heard from every person in the profession was, “You don’t do this job for the money.” Many of them are still using old-fashioned pen and paper or have upgraded to using Microsoft Outlook, Excel, and Word, which is great but certainly not ideal for a wide variety of reasons, all because they can’t afford high priced EHR and practice management software or online services. That’s why I’m so happy that you all have worked so hard on this project. Bravo!

–Kristen

joncallahan1 wrote on Thursday, August 29, 2013:

Hello all,

I am currently trying to implement this EMR in the Mental Health field, we have 3 clinics, a low census but slowly growing inpatient hospital and and are about to staff several community locations for in need patients that don’t have ready access to transportation. While I would also enjoy an out the box solution with a setting in Globals, I have found OpenEMR pretty easy to tailor through the codebase and believe that this EMR will be a great solution for our needs. As stated before in this thread, economics both for a practice trying to move to EMR and the socioeconomics levels of the mental health field patient base, make it difficult for a mental health practice to make the jump from tracking everything with MS Office and paper charts to a ‘ready to go’ EMR. Open source, program it yourself the best you can, is the only economically viable option. Even then, some of them out there can be incredibly tedious to even get functioning, let alone tailored to your specific needs, which is why I was happy to find OpenEMR as it is so well supported and collaborated on for many different uses.

The biggest issue I am having, and maybe I can find some help here, is with the clinical reminders. We have several forms that we have made a standard for our practice that need to be completed for each individual patient on an annual or semi-annual basis. I have been manually creating/entering these forms through the LBVF’s, along with our standard med somatic, psych eval forms, and case manager/social worker progress notes. While it’s a bit tedious, it is working for us. I am able to create Clinical Reminders for patients stating that these forms need completed but I am having difficulty tying these forms to the reminders so that when they are completed and saved, the due/past due notification will fall off. Also, I may be wrong here, but it looks as though these reminders may not track individual dates, as individuals will have different completion/due dates, but instead are just a standard, across the board, type of reminder. Any help would be greatly appreciated and I will continue to browse these forums for a solution.

Thank you all!

fsgl wrote on Thursday, August 29, 2013:

Hi Jon,

If your goal is to fashion a memory aid for clinical staff members to follow a schedule of exams/interviews, the Clinical Reminders section of the Patient Summary was constructed for the purpose of fulfilling Clinical Quality Measures of Stage I Meaningful Use and that is why the module is not “behaving” as you would expect.

You may need to set up a sticky notes application or something similar, external to OpenEMR.

mdsupport wrote on Thursday, August 29, 2013:

Jon, you are on right track with one question - lbfs are tied to encounters but your description states this to be time bound. In any case, you need to replicate one of the built-in rules that have time bound target(s) such as flu shot with target as existence of a specific record in database table lbf-data.

When you are done, you should post screen shots for your kin.

bradymiller wrote on Friday, August 30, 2013:

Hi Jon,

This brings up two features that have been proposed to improve the CDR engine (which encompasses the clinical reminders:

  1. http://www.open-emr.org/wiki/index.php/Active_Projects#Add_mechanism_to_track_items_in_LBF_forms
  2. http://www.open-emr.org/wiki/index.php/Active_Projects#Add_mechanism_to_allow_patient_specific_rules_and_plans
    (In your case, I don’t think number 2 is needed unless you intend to make patient specific rules, though.)

-brady
OpenEMR

blankev wrote on Wednesday, September 18, 2013:

Why is the Language Polish not included in the Demo-Sites? It is in the Google spreadsheet for translations…

Examples not including Polish language:

https://omp.openmedpractice.com/testdrive/interface/main/main_screen.php?auth=login&site=default

http://demo.open-emr.org:2102/openemr/interface/main/main_screen.php?auth=login&site=default

http://demo.open-emr.org:2099/openemr/interface/main/main_screen.php?auth=login&site=default

Or has this anything to do with the amount of translated lines in Google spreadsheet…

I hope I will find some time to explore the link on translations WIKI pages to see if there is a clue.

Tnx again, Pimm (Could be the wrong forum, but I got a response on my question from Brady through this forum)

blankev wrote on Wednesday, September 18, 2013:

I just found a version where it is included…

http://demo.open-emr.org:2089/openemr/interface/main/main_screen.php?auth=login&site=default

Greets, Pimm

Hello,
Did you ever get any traction on creating Intake Forms, SOAP notes, Progress Notes, Treatment plans, etc. for mental health?
Best,
Mark