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Medical problems section

Riley
2012-03-23
2013-04-06
  • Riley
    Riley
    2012-03-23

    Couple of questions related to the "Medical Problems" section for a patient:

    1) I see that the selectable list comes from the "clickoptions.txt" file.  Is there a screen for changing items on this list or must the file be edited directly?

    2) I got the impression that since the problem can be linked to an encounter, the associated fee sheet would have the problem's diagnosis code automatically entered.  Is that assumption correct, and if so, how is it accomplished?

    I'm working with a mental health provider and she will have multiple encounters for the same diagnosis so it's preferable to minimize data entry.

     
  • VOIPBound
    VOIPBound
    2012-03-28

    Yea, I don't see how that works either.  I see that to the right of the med problems are a bunch of 0's.  Once clicked on that, it will open a another menu that one can associate the problems to specific encounters.  However, I do not see how this will benefit the encounter when it comes to billing.  I wish that the Problem list can be accessible in billing so that billing and diagnosis can be done faster.

     
  • Brady Miller
    Brady Miller
    2012-04-11

    Hi,

    My suggestion would be to have a pull-down on the Fee Sheet which simply populates all previous codes that have been entered in on the patient (collect from all problem list entries and previous billing entries).

    -brady
    OpenEMR

     
  • DrKay
    DrKay
    2012-11-01

    In my understanding of office workflow with OpenEMR, after a physician documents a visit on a clinical form, they go to the patient encounter screen and document the 'Issues (Injuries/Medical/Allergies)' by name and diagnosis code. They then link the pertinent issues/diagnoses to that encounter by highlighting one or more of the issues in the list (or adding more as needed), then click 'Save'.

    In the above step, the provider is already designating the diagnoses and codes that need to be billed for for that encounter. Why pay someone to copy this information from one part of OpenEMR (this part) to another part (the fee sheet)? It's redundant work.

    I don't want to lay-off my biller, but I would like her to make better use of her time than this. :-)

    I would suggest having those Issues that are linked to the encounter pre-populate on the fee sheet for that encounter. Otherwise, it's just busywork.

    Could that be done?

    James L. Kay, D.O., FAAP

     
  • Brady Miller
    Brady Miller
    2012-11-04

    Yes,

    That could be done with minimal coding. Options to do this are to do it yourself, convince a volunteer or hire a pro. This would be a valuable addition to the official codebase, so whatever route you go, please contribute it to the official codebase.

    -brady
    OpenEMR

     
  • DrKay
    DrKay
    2012-11-05

    I've asked Tony McCormick's crew to look into doing this as something I'd sponsor. Yes, I will ask that it be contributed back to the codebase so that everyone can benefit. I'm sure Tony will make sure there is community input to help determine if my proposal is the best way to go about this, or if there is a better way.

    This would greatly decrease workloads in a lot of offices and reduce billing errors, thereby preventing loss of income to the practice, so it could be a great "selling point" for OpenEMR if we could do this.

     
  • SSalas
    SSalas
    2012-11-20

    I have paid a programmer to make these changes already.  How do I go about presenting the code?

     
  • Tony McCormick
    Tony McCormick
    2012-11-20

    I also have this done now (by Ensoftek) and will get posted for review sometime tonight.  I'm testing it today.

    As for 'samsalas'  your developer needs to have a github account and post the code for review to be considered for inclusion in the project.  See the developers guidelines pages on open-emr.org wiki.

    Tony
    www.mi-squared.com / @tonymi2
    oemr.org / @OEMR_org

     
  • Hi Brady,

    Please review the code for Populate Fee sheet using diagnosis codes from selected ISSUES in encounter.

    1. Global option placed under Features tab. By default the option is disabled.
    i.e, Administration >> Globals >> Features >> "Populate Fee sheet using diagnosis codes from selected ISSUES in encounter"

    2. Populated the selected encounter issues (that have ICD9 codes) as entries in the Fee Sheet based on global option enability.

    Please find my code in the below url.
    https://github.com/anilnakkani/openemr

    Kindly give your valuable suggestions.

    Thanks
    Ensoftek

     
  • Tony McCormick
    Tony McCormick
    2012-11-21

    Brad, etc.

       This push to gihub is very incorrect.  Don't waste any time on it yet.  I'll work with them tonight to get it corrected.

    -Tony
    www.mi-squared.com

     
  • Kevin Yeh
    Kevin Yeh
    2012-11-21

    I've been working on a more interactive approach to the same problem.
    Here is a 2 minute demo video.
    http://youtu.be/pw3dtSYOD-k
    In addition to the problems/issues, I have two additional ways to add codes: review of old fee sheets and the most common codes in the billing table. (You can see how they work in the video).

    If folks are willing to provide financial support, I will make this available and maintain it in the future. My work can also serve as a framework for future improvements.

    My implementation is modular, and won't conflict with the work Ensoftek has done.  Tony mentions that their code isn't ready for review, but at first glance I see at least one thing that is routinely done poorly in OpenEMR. That is executing a simple queries with one result multiple times within a loop rather trying to get all the data at once .  That's not the way databases were meant to be used.  It's not going to be a big deal here, but when that approach gets extended into more deeply nested loops performance becomes an issue.

        foreach($icdEncArr as $icdKey => $icdVal){
    $newtype = "ICD9";
    $code = $icdVal;
    //Skipp condition checking for saving billing codes
    if( !in_array($code,$skipIcdCodes) ){
    $icdCodeRow = sqlQuery("select * from codes where code = '".$code."' order by id DESC limit 1");
    $modifier = $icdCodeRow['modifier'];
    $units = $icdCodeRow['units'];
    $fee = $icdCodeRow['fee'];
    $provider_id = $icdProvArr[$icdKey];
    $code_text = $icdCodeRow['code_text'];
    echoLine(++$bill_lino, $newtype, $code, trim($modifier), $ndc_info,1,0,$units,$fee,NULL,FALSE,$code_text,NULL,$provider_id);
    }
    }
    

    My criticism is obviously biased. So I'm going to leave any further code review to the other integration developers unless I see something glaringly wrong.

    I hope that people are interested in funding my approach.
    -Kevin Yeh
    kevin.y@integralemr.com

     
  • Brady Miller
    Brady Miller
    2012-11-21

    Hi Kevin,

    Your solution looks pretty awesome. For the Prior Encounters, may be helpful to have an 'All' selection where all codes are shown (with most recent encounter items checked). What funding level are you asking for to complete/release this?

    -brady
    OpenEMR

     
  • Tony McCormick
    Tony McCormick
    2012-11-21

    I like it, overall it's a much more comprehensive approach.   Do you have a project in indiegogo for this one? 

    Tony
    www.mi-squared.com / @tonymi2
    oemr.org / @OEMR_org

     
  • DrKay
    DrKay
    2012-11-21

    Kevin-

    That's nice!

    Would it be possible to add an optional setting that would cause your module to put issues that are selected/associated with the encounter in the 'Patient Encounter Form' screen onto the fee sheet, bypassing the need to review them again? Since the provider already associated the diagnoses with the encounter, I'm hoping to eliminate having to perform that step again for the fee sheet. (I realize that the provider still needs to add CPT E&M codes, etc.)

    I know it doesn't seem like much work to review the checked diagnoses in the 'Issues' tab that you made, but when a provider is seeing 30 patients a day, having the option of eliminating this extra step multiplied by 30 patients may mean that the provider can make it home to eat dinner with their family instead of working late on billing.

    James L. Kay, D.O., FAAP

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-04

    I haven't created an Indigogo project for this yet, because I want a better idea of what kind of support from the community I can expect. I also want to understand how best to reach potential sponsors of the project.

    The fact that less than 20 people have viewed the YouTube video is a little disappointing. It seems that I'm not going to be able to attract enough small dollar contributions through Sourceforge to make it worth my time to fully implement and test this feature. 

    Dr. Kay,
    Your suggestion is certainly possible, as are many other things that could further reduce click count.  For example: allowing addition of CPT E&M codes and justifications directly from the Encounter form without every needing to go to current fee sheet form.  However, without reasonable funding, I cannot afford to spend time on such features.

     
  • Tony McCormick
    Tony McCormick
    2012-12-04

    Kevin,

      I would venture to guess that 20 people is virtually ALL of the active posters of OpenEMR SF developers forum.    My personal experience so far is that you can get funding for projects in the $500 - $4000 category from individual practices and much more than that for "special custom ports" of OpenEMR.   Almost all of these groups will let you share code back.   All we need to do is find one of those … I have some in the works…..  ie: contact me I may be able to help. :-)

    Tony
    www.mi-squared.com / @tonymi2
    oemr.org / @OEMR_org