I’m a few days into my openemr install. It’s really really awesome.
I’m a social worker in my own private practice. I decided to ditch all the paper and go electronic. After seeing some very dumbed down online versions of EMR for social workers I decided to build my own using MS Access. And then I found Openemr and saved myself a lot of time and effort… It’s really awesome as to how customizable it is.
I’m pretty good at tech although I’m no professional. I’m good at reading stuff and following directions.
4 questions.
I don’t bill insurance, everything is private pay. My fee structure is very simple. It’s based on the length of the session. Is there any way to automate billing so that for any encounter it auto bills based on the length of the session?
Also, some clients qualify for a sliding scale. Can I add that the fee is also based on a value I would set for each individual client?
For my encounter forms I often reuse my notes from last session. If I created an exposure hierarchy for a client with OCD I would like to reuse that info next session so they can rerate the items on the hierarchy.
In addition, currently, I have a paper I call my ‘global client note area’ where I check at the beginning of every session and I mark down info that I want to see every session. So if I have a key insight, I will mark it down there. After each session I will change it around and edit some stuff.
And so I would like to to create a set of forms where some fields are prefilled in with the information that was in that field from the last encounter. This would help with both of my needs. I will be able to reuse hierarchies and I will effectively have a ‘global client note area’ (it will actually be improved as it will save each version of the area for each visit). How would I do this?
My billing tab under Fees is missing. Any idea as to how this might have occurred?
I installed the mobile plugin. It doesn’t work. After some poking around in logs a php files and mysql tables it seems that this thing was created back in the day when login was encrypted with a simply md5 hash, now it looks a heck of a lot more complex. Anyone know how to get the login on that thing working with todays version of Openemr?
Create your own CPT codes based on time expended, i.e., 00015 for a 15 minute visit with an associated fee. Rather than maintaining multiple fee schedules, reduce the fee schedule on a case-by-case basis.
4 seems to be an API that will at sometime be implemented, I didn’t see any instructions in that thread that helps me now. I don’t ‘need’ mobile right now, but it would be useful.
As for 1 and 2.
fsgl, how would I set it up so that the CPT code based on time expended automatically gets billed so that I don’t have to add it or do anything?
If I use CAMOS I’m limited to one big text area to hold my notes. It will work for my global note area, but not for other forms that I want to clone. I want to be able to clone fields in specific forms so I can have a set ‘OCD Exposure form’ that I use that I can set to auto populate with the information from last visit. Is that possible in the form builder? If not, how would I code it in?
Question 4: I would use a something somewhat bigger than smartphone, go for a tablet. Login with your Browser and everything is within typing distance. In any shop you can make a test session with the Demo’s of openEMR.
Only need a Wifi hotspot or other Internet connection, if the OpenEMR is on the Internet or a distant machine.
Whatever is your preference, even if you run it from the tablet or a USB stick, the crucial important thing to remember is: make and SAVE Back-ups.
I need mobile for my secretary. As I’m a very very tiny practice, she isn’t my dedicated employee, rather I pay her to take my phonecalls in addition to her other jobs. And so she is often on the go with her iphone as her companion. I need her to be able to do scheduling from the iphone.
As for backups, I have a script that runs every 3AM that copies the whole xampp directory to my dropbox folder. It’s also autobackedup using crashplan. So I have 2 cloud backups at all times.
OK, that is different. Mobil has been developed some versions ago and I realy don’t know how much more development is needed to get this working for what you are looking for.
May be give your secretary a tablet as a Christmas present for making appointments you don’t need a very sophisticated version. See how dedicated she becomes ;-)) with that little axtra attention.
Some dedicated improvement courses come now with a free tablet.
Regarding Questions 1 & 2: We had come across this type of situations & we did fixed those. Code customization work is needed to accomplish those tasks.
After setting up the specialized CPT codes, the Fee Sheet must be used. Coding the visit can be streamlined by populating the procedure codes in Administration/Lists/Fee Sheet. Because no insurers are involved, it is not necessary to code for diagnosis.
Not automatic, but 2-3 clicks in Fee Sheet will send the charge to EOB’s for printing of the patient statement. Patients tend to be sensitive about inaccurate billing, especially when out-of-pocket; therefore automating this process may save time but at the cost of good will.
From the above posts, it should be possible to use CAMOS to achieve the charting needs. Although Layout Based Visit forms and NationNotes can handle static texts; in this case, CAMOS will lend itself better to the organization of the notes.
For example, there may be a heading for Affective Disorders with a static text for all visits in this group. A sub-heading of Manic-Depressive can be further divided into the Manic and Depressive phases. The advantage of CAMOS is that the organizational tree is readily visible and the appropriate form can be selected without a search, although a search engine is provided as well.
If you have not done so, read the Wiki article and test it in one of the Demo’s. The nuances of a module are best understood with a Demo “test drive”.
Although there many incomplete items in the Masterpro API Review, perhaps enough has been done to enable appointment scheduling from an IPhone. The free lance secretary should have limited access anyway. The Med Master Mobility application is a free download. The codes are in Github. If it works, great; if not, no money has been lost.
There is always the option of an answering machine. Most patients are gracious about “talking to a machine” if the return call is within 24 hours. When there is no secretary sitting at the front desk, the majority of patients will understand that you cannot drop everything to take the call.
I use the Layout Based Forms function to do a lot of what you want with the notes. Check that out. It is very simple. I have one for mental status exam and another for quick treatment plans. The options are limitless.
There are some modifications I have noticed for billing that are needed on the insurance end for psychotherapy practice. One visit per CMS 1500 is a major issue. Fortunately I only have a few who are clinging to paper.
Check out the patient portal for on line scheduling and forms. That is perfect for a solo practice. You can also have them fill in the intake assessment right there when setting the appointment. And you can have on line assessments feed right in throughout treatment. You need a dedicated server for that. I am setting mine up now with a Synology NAS. If you are interested in how that is working out contact me.
I solved the billing issue! In CAMOS you can enter a billing code which will automatically enter the billing info like this
/billing::CPT4::80054::CMP:: :: ::50.00/
And so I put it in the first session and from then on whenever I clone the last visit (as I’m using the CAMOS form as my ‘global session notes’ area) the billing info is automatically entered! I never need to touch the fee sheet!
TY for the suggestion to use CAMOS.
I’m still working on getting a separate ability to set the default field in any form as ‘cloned from last visit’ so I can set specific forms like Exposure for OCD and Anxiety. If you have any idea on how to code that I would appreciate it.
Craig,
I would love to borrow from your experience. I need to clone info from the last visit. Can I do that using the Layout Based Forms?
I don’t bill insurance as of yet in my practice.
I will be checking out the patient portal. It’s next on the list…
CAMOS is niftier than I realized. CPT, ICD & fee can be entered into the billing table according to the Advance Use section. The question is whether the data will be carried over to the EOB’s module to print patient statements. Only one way to find out.
The ability to clone a note or set of notes is the reason for recommending CAMOS. Additional coding is unnecessary for what you’ve indicated as your needs.
Harley Tuck added a very lucid tutorial on the topic (Mark Leeds is the author of the module while Brady wrote the original article). It’s easier for you to read the article and try it out in the Demo than for me to explain it again.
Would be a nice feature to add a ‘P’ paste (C is already taken) here:
This is the library that deals with the layouts fields (ie. used in LBF forms). So, if that option is selected for a field, then could have it populate what was in most recent note by default (I’d suggest following the code to see how the “T = Use description as default Text” option works; but instead of placing default text, you’ll do a query to get text from most recent form). This would be a very useful feature to have in the official codebase.
The static text can be cloned with the Layout Based Value form as suggested by Brady.
CAMOS has the advantage of arranging static text forms in a “tree”. The arrangement of LBV forms is linear in the Clinical Tab, not branching.
A user can have as many CAMOS forms as he cares to create, not merely the one at the apex of the “tree”. Additionally the user can clone the apical form and any number of the forms found throughout the hierarchy for one encounter.
It is a bit more efficient to clone multiple forms within CAMOS. Multiple cloning in LBV forms requires entering and exiting from each form in the tab.
If many static text forms are contemplated, the drop down menu becomes unwieldy. Just think of the browser Bookmarks tab that extends down to the bottom of the screen. But unlike Bookmarks, a user cannot organize the mess into folders for static text LBV forms.
Because CAMOS will be used to enter charges, staying inside CAMOS for charting represents another efficiency.
I found a function in a file that did this (for some odd reason it’s only if the entry was in the last 14 days, although you can edit it). So I called the file and the function and it works! Took me 5 hours (I have never written any code in PHP before…).
Here it is.
In the folder “library” in the file options.inc.php, go to line 121 and add this
// Supports edit option P which pastes the value from the previous encounter as
// the default value.
require_once(dirname(__FILE__) . "/../sites/default/LBF/LBFgcac.plugin.php");
if (strpos($frow['edit_options'], 'P') !== FALSE) {
$currescaped = _LBFgcac_recent_default($field_id);
}
Then in any layout based form you can set the Options code to P and that field will automatically populate with the content from the last filled form.
Nice. Did not know that function exists. Problem is stuff in that directory can’s be used since it may not exist. Will be better to create a new function(essentially almost duplicates the other function) and store it in a new script called library/lbf.inc.php (and then include this). Could call the function LBF_past_value() or something like that. Will also need to ensure your above code is only processed when it’s using a LBF form (ie. place it in a if that ensures it’s an LBF and not a layout for the demographics, etc.). Happy to point you in the right direction, if your interested in getting this feature into the official codebase.