ideaman911 wrote on Wednesday, September 02, 2009:
Folks;
My wife (and client) is a Psyche NP with the unique niche of providing house calls. It allows her much faster and more accurate insights to the interactions of family members, especially in her child & adolescent caseload. The House Calls is what got me involved with OpenEMR, as I needed it to be capable of stand-alone (ie no continuous web interface) but be able to maintain and do billing, which occur when she is at a "hot spot". We use Hamachi for the VPN functions, which works very well. We copy the prior day data to a server on our LAN to allow the biller to refer to data full-time, while she often must wait for VPN connectivity to actually do data entry, as it must occur on the "master", which Lynne has in her tablet notebook.
Some lessons learned, as she provides services at multiple locations with different fee structure at each:
a) The ‘Superbill’ allows only a single definition ICD or CPT for a given code, so we embellish with suffix codes where an actual HCFA compatible bill (X12 or CMS 1500) will not be prepared, and create a separate section in the ‘Fee Sheet’ to list those, all loaded manually. We use “000” codes to reflect “NoCall/NoShow” etc. for internal tracking and associated billing. The biller, though, uses the X12 and CMS 1500 printouts directly.
b) We also use a similar separate section (we currently use 3.0.1 in Windows and Radio Buttons, with a number of proprietary enhancements offered for CVS but not yet included there) in Fee Sheet for the G codes required for the Medicare eRx incentive. She uses Allscripts free portal, and of course has a large percentage which require NYS specific script papers, so she does not currently use the OpenEMR prescription functions (saving duplicate entry). I am currently working on enhancing the OpenEMR system to separate eRx from Controlled Substance (CS) and others which require paper scripts, so they can be batch processed when she gets to a printer and/or internet portal. I want to use the same entries to OpenEMR as data, formatted to the script papers or as a keyboard emulation macro in the Allscripts which could be adapted readily to any users’ choices and forms. My problem is I first have to learn the programming needed to achieve same ;-) I believe Rod Roark is working some parallel for another client of his.
c) Her use of a tablet style computer vs a conventional notebook seems to be far more comfortable for most psyche patients. Accordingly, we would love to hear of others who have developed forms which could be used for psyche, as again my programming limits have hurt our forms generation. She provides both therapy and prescriptive services, generally under the 908xx CPT range.
d) Because of the repeat visit nature of Psyche care, she gets value from OpenEMR which would be denied for something like a surgical visit, as the data entry costs are distributed over multiple visits, and need be entered only once. The cost of that entry is a "push-back" by many small providers for any EMR system. Our experience suggests that prescription preparation and conveyance is a substantial time cost, especially in psyche care. So its automation is a critical goal.
I can happily add more info for those interested. Please contact me directly via below, though I will share as applicable with the forum community. I have been away due to other demands for almost two months, for which I apologize, but will try to be better. If you look at forums earlier than that, you will see many of my inputs. Thanks.Folks;
My wife (and client) is a Psyche NP with the unique niche of providing house calls. It allows her much faster and more accurate insights to the interactions of family members, especially in her child & adolescent caseload. The House Calls is what got me involved with OpenEMR, as I needed it to be capable of stand-alone (ie no continuous web interface) but be able to maintain and do billing, which occur when she is at a "hot spot". We use Hamachi for the VPN functions, which works very well. We copy the prior day data to a server on our LAN to allow the biller to refer to data full-time, while she actually must wait for VPN connectivity to actually do data entry, as it must occur on the "master", which Lynne has in her tablet notebook.
Some lessons learned, as she provides services at multiple locations with different fee structure at each:
a) The ‘Superbill’ allows only a single definition ICD or CPT for a given code, so we embellish with suffix codes where an actual HCFA compatible bill (X12 or CMS 1500) will not be prepared, and create a separate section in the ‘Fee Sheet’ to list those, all loaded manually.
b) We use a similar separate section (we currently use 3.0.1 in Windows and Radio Buttons, with a number of proprietary enhancements offered for CVS but not yet included) in Fee Sheet for the G codes required for the Medicare eRx incentive. She uses Allscripts free portal, and of course has a large percentage which require NYS specific script papers, so she does not currently use the OpenEMR prescription functions (saving duplicate entry). I am currently working on enhancing the OpenEMR system to separate eRx from Controlled Substance (CS) and others which require paper scripts, so they can be batch processed when she gets to a printer and internet portal. I want to use the same entries to OpenEMR as data, formatted to the script papers or as a macro in the Allscripts which could be adapted readily to any users’ choices and forms. My problem is I first have to learn the programming needed to achieve same ;-) I believe Rod Roark is working some parallel for another client of his.
c) Her use of a tablet style computer vs a conventional notebook seems to be far more comfortable for most psyche patients. Accordingly, we would love to hear of others who have developed forms which could be used for psyche, as again my programming limits have hurt our forms generation. She provides both therapy and prescriptive services, generally under the 908xx CPT range.
I can happily add more info for those interested. Please contact me directly via below, though I will share as applicable with the forum community. I have been away due to other demands for almost two months, for which I apologize, but will try to be better. If you look at forums earlier than that, you will see many of my inputs. Thanks.
Joe Holzer Idea Man
http://www.holzerent.com
