OpenEMR process/documentation notes

tmccormi wrote on Friday, May 08, 2009:

As promised here are my tech writers comments.  This is a long list and I think, perhaps responses to various parts should be posted in a new thread perhaps by sub-head below.
–Tony

Docs To Add:
– Lists **IN PROGRESS**
– Address book
– Superbill? (billing code fees!)
– User types (descriptions & permissions)

Navigation:
– Left side navigation menus – Work flow is disrupted on occasion because associated pages are no
longer linked to load together like in the tradition navigation scheme. Can this be done?
– Somehow make it clear that choosing top or bottom screen is only relevant to personal preference
and process flow…?
– Radio Button Scheme – The order of links in the navigation menu is unclear. How is that order
determined? Recommend either alphabetical, or order of work flow, depending on the function.
Consider dividing into clear sections such as Administration, Patient/encounter process, Reporting.
– Back buttons are either inconsistent or non-existent in many places. In some cases the available
back buttons go to the wrong page! Recommend having a consistent series of back button
throughout the program. However, this may pose a problem in the top/bottom window scheme.
– Have not yet used Tree View, not familiar with functionality yet,
Consistency of button labels – 'Update” vs. “Add” vs. “Save”?
Should examine appropriateness in each situation. Consider a state-change for creating an instance
(save/add) vs. editing and existing one (update)?
Also ‘edit’ links vs. clicking an item name to edit it
Clinic Setup:
– Include address book in future documentation
– What does “accepts Assignment” mean in context of facility as a billing location?
– Insurance companies – need some way to separate individual plans within a single insurance
company (already on the to do list!) : )
Page naming also inconsistent.
Abbreviations ok in links, Full names in page headings. Also, distinction between page functions a
problem: Eg. Encounter, Encounters, New Encounter. Titles in some cases may be out-right
inappropriate: Eg. Superbill (and Superbill Report?)
Background color!!!
Consistency and readability… Consider color based on functionality? (blue for navigation, gray for
data display/entry?)

Adding a patient
– Like the new expandable demographics input forms! : )
– consider masking date field for easier manual input
– The (more)/(back) title links – see notes on Navigation above
Patient search
– should be in a more obvious location (top left?)
– can search be context sensitive? IE. Alpha characters always search name when using ‘enter’ key

Calendar/Appointments
– Consider having the calendar display all time slots by default (before schedules are set up)?
– Clicking on the calendar time brings up the add event dialog. Clicking the time on an existing
appointment brings up the ad event dialog with the appt. info. Having two times is redundant. Can
the calendar time be made to bring up a blank dialog, or a filled one, depending on whether that
time slot is filled? Or is there some reason you would want to make multiple appts for the same
time slot? (which is apparently possible…)
– And/Or change the appt time to some more useful bit of information…
– Status symbol could be made more obvious somehow? Bold? Spaces around it?

Encounters
Fee Sheet – common billing code drop-downs do not display the CPT code next to the item name in
the list. And when selected, the name doesn’t show up next to the code in the list. This means you
cannot cross check that you selected the correct code! Suggest both code AND name be listed in
one or both paces by default.
– Medications vs Prescriptions – should all prescriptions be issues by default? Do they need to be
listed twice on the summary page?
– Billing receipt – why is the close window function mapped to the patient’s name???
– Might have more questions if I worked in a clinic! : )
– Mostly layout & format consistency issues here…
Refresh! - many pages within the billing and encounter sections do not update automatically after an
action has taken place. Using the browser refresh button resets the user’s display to default (calendar +
notes/authorizations). Due to the multi-frame layout, in order to refresh an individual screen you must
go to another page and come back, or right-click and select ‘this frame → refresh’. This is very
cumbersome, Suggest more pages auto-refresh, or have a refresh button somewhere on the page.
Search Functions – VERY inconsistent… where possible, the various search function throughout the
program should all follow the same format & structure. IE. popup vs. in-line, results listed on new
page vs. in a drop-down, etc, etc. Visually as well.
Issues
– Can ICD9 codes from the fee sheet be added as ‘Issues’ automatically?
– And/or can you select an encounter to associate the issue with (in the “Add New Issue’ dialog)
during issue creation?
– And/or in the ‘Issues & Encounters’ dialog can you expand an associated encounter to display a list
of that encounter’s ICD9 codes to associate with that issue as well?
– What’s and issue’s “destination”??
– Back button fails here: takes you to the Demographics page rather than Patient Summary.

Transactions
– The description “records events that have already occurred.” seems incorrect. Eg. Referral forms
would be printed BEFORE the patient sees the referred physician, correct?
– Referral form – ‘refer to’ list shows the organization listed in the address book rather than the
physician’s name! Multiple physicians working at the same org. are not distinguishable.

Billing & AR
How does the system deal with billing for patients who have no insurance?? And print patient invoices
without having to input insurance payments first?
Reports
– Superbill report – the definition of “Superbill” needs to be made clearer… How does this report
relate to the Superbill page allowing you to add billing codes to the system?
– Appointments & Encounters report – can the encounter number or error notice be made to link
directly to the encounter or whatever page is appropriate to correct those errors? Eg. “Needs
Justify” links to the fee sheet for that encounter, allowing you to correct the missing justifications
– Can the billing report be linked from the main reports page?
– Could link the patient report as well, and include a patient search/selection dialog in the patient
report form.
– How do you create custom reports? Should this be included in the user docs?

ideaman911 wrote on Sunday, May 10, 2009:

Tony;

Just a few ideas we have used to address some of the ICD/CPT/Encounter/Issues/FeeSheet:

We are primarily a Psyche care provider, so there are a limited number of CPT’s we use.  The number of ICD codes is obviously much larger.  An added factor is that we provide services at different locations, and the billing for each is different.

To work with that we create a separate "folder" type similar to the distributed "New" and "Existing" patients.  Like those we also add specific codes we use for the individual locations, and we use the "Code - Description" model for the label so it lists both.

There is a problem here that you cannot have, for example, two CPT which are identical code but have different descriptions.  So we are fortunate that we can put a letter code following the actual code to signify the location used.  That will be a problem, though, if the billing is done from those codes directly, since they will not be recognized that way.

Entry of each of those codes is done in the Superbill section to create them, edit, etc.  And I have some codes which are not official for things like NC/NS, Admin, Late, etc which we want to track, and because one facility pays a smaller amount than they typically get paid for a specific service, but we have no wait for insurance billing etc, which is all done  by them from our summary bill and "timesheet".

The Issues are created as a list by using the database export to Excel, then a concatenate of those codes with the appropriate labels as used in …/custom/clickoptions.txt  as those can then be directly selected from the drop-down in the encounter to add to the issues list.  Again, we use the paired code and description, although we try to use a "cascading" by subject area for ease of searching (the list is pretty long), so it often does not exactly match the ICD description as published, and of course requires the adding of all 3, 4, and 5 character permutations individually.

We also use a "000" ICD for "Not Required" because we have installed a code "barrier" to prevent billing any encounter before it has been justified.  So the NC/NS must still be shown in the listing, and the Admin is a per-diem billable for the specific location.  Those are where the "000" is selected as the Justify, so the rest of the billing works correctly.

Your list is huge.  I think it best to create a thread for each subject in the tracker?  Nice job so far, though.  Please note that the Radio  Button view is NOT the distribution default from 3.0.1, although it most certainly should be in my opinion, for a host of reasons not least of which is user familiarity and documentation.

Joe Holzer    Idea Man
http://www.holzerent.com

tmccormi wrote on Sunday, May 10, 2009:

Apparently the Radio Button *is* the default from Linux but *not* the default for some of the windows installs.  I figure that’s an error or some sort …

Thanks for the feed back.
–Tony