DIY IMPLEMENTATION OF OPENEMR
Practice Type
The Do-It-Yourself approach to the deployment of OpenEMR is appropriate for the small or solo practice with a modest patient population. Practices which are in their Vernal or Autumnal phase are well suited to this approach because the new physician or the mature practitioner will have time to devote to successful implementation. Do-it-yourselves physicians must be persistent in this transition from paper to electronic medical records. OpenEMR, being open source, is great for practices with small budgets allocated to EHR conversion. Our startup cost was $5.99 for a backup SD card.
Required Equipment
You will need a computer devoted exclusively for the use of OpenEMR. Your medical records are a very important part of your practice, therefore this computer should not be used for your online shopping or any other extraneous activities to decrease the likelihood of compromising these records. You will need media for daily backup.
OpenEMR School
Physicians must thoroughly comprehend all of the resource materials and ensure that their staffs are familiar with the sections applicable to their job descriptions.
User Manual
Understand each topic under the Main as well as the Supplementary sections of this page. The video tutorials are extremely helpful. ZH Healthcare's YouTube tutorials are great resources as well.
Wiki
The Wiki is not yet encyclopedic, but it is expanding and you do well to avail yourself of it.
Forum Discussions
The Help Forum is geared for neophytes. Since the migration to the new Forum format, the search engine has been vastly improved. Other enhancements are a beloved Edit link, attachments and greater formatting capabilities of the posts. Remember to use the search engine before posting a question because it's quite likely someone else has had the same problem before you.
Partial or Total Conversion
For established practices with limited means and decades of paper records, it may not make sense to scan all those records into OpenEMR. For us old-timers, it is still more efficient to speed read a paper chart than it is to skim through all those electronic encounter notes. For colleagues who are tidy, consistent individuals and who will be uncomfortable not to have everything and the kitchen sink in the EHR; by all means, knock your staff out and scan everything.
Download
The current version is 4.1.1 and the easiest download to install is Option 1, the package as service, for a Windows device.
Selection of Active Patients
There is no reason to include all the patients that you have seen for the past 32 years because a number of them are deceased, transferred or for reasons unknown, will not be returning to your practice.
Enter the patient information, such as Demographics and Insurance information of patients seen in the past 10 years, before going live. The size of this population and the number of staff who will enter the data will determine the time you must allow for this task. In our office it took 2 months to manually transfer this data from the old practice management software to OpenEMR for 1500 patients.
Go->Administration->Lists, then Ethnicity, Language or Race to set the defaults for the majority of your patients. This will save your staff from having to click these items for each patient entered into OpenEMR.
Accounts Receivables
Reports
A Day Sheet with charges and receipts is not available. The Encounters report (under Visits) can substitute for the charges report while the Payment Method report (under Financial) can replace the receipts report.
An Open Item Listing type report can be run from Fees->Billing->EOB's and then a search for Due Ins for all insurance companies or for a particular time interval. You will want to know about outstanding charges out to insurance that have not been paid in 2 months.
Charges out to patients and patient statements can be obtained from the same screen.
There no equivalent of a Practice Management Report. In general you will know if your practice is in the black. You certainly don't need a report to tell you that you are in the red.
Absent professional support, you are dealing with the stripped down version. You must not feel deprived because the "bare bones" edition, nonetheless, has an embarrassment of riches in regards to functions and modules.
Posting
A bit of time is required to become accustomed to these modules. There is no obvious way to have an unapplied payment or to record a refund. You will need to put on your re-engineering hat. When posting Medicare payments, it is better to use Batch Payment because approved amounts, deductibles and adjustment codes can be entered in one screen. This is important to supply Medicare EOB data for secondary claims. The EOB module for posting requires more clicking and maneuvering to post Medicare payments. The EOB module must be used, however, for entering sequester amounts if your clearinghouse requires the breakdown of Medicare adjustments into the regular adjustments and the sequester adjustments for the submission of secondary claims.
Patient Statements
You will have to get your hands dirty if you wish to modify the format of these statements. If your practice does not accept credit card payment; this is a relatively easy modification. Be fully awake, when attempting modification, to avoid inadvertently deleting lines of codes. There is no easy way to insert dunning messages without getting deep into the weeds.
X12 Submissions
Before generating the X12 file for uploading to the clearinghouse; be certain that the patient's name matches that on the insurance card, that the insurance ID number is correct and the address of the subscriber has been populated. Run the error log and correct mistakes before uploading the file.
Clearinghouse
Setup
Office Ally staff is very helpful and professional. There is no charge for commercial claims but if your governmental claims (Medicare and Medicaid) exceed 50%, there will be a monthly surcharge. The staff will walk you through setup. Read the FAQ section. As part of the setup there will be insurance companies that require enrollment. See Payer Enrollment Forms and click the link for your state to determine which carriers require enrollment.
Upload and Download
When you have an username and password, you will be able to upload a X12 file by going to the left sidebar-> Claims->Upload Claims->Upload HCFA. Copy the file number for future reference, should you need help from Support. From Download->Download File Summary, you will be able to obtain Office Ally and insurance companies reports of accepted claims or rejected claims with error messages.
Rejected Claims
Dealing with rejected claims can be a bit quirky. Call Customer Service at (866) 575-4120 and choose Option 1 to get help. 11 a.m. to 2 p.m. Pacific Standard Time is the busiest for them.
Use the name of the subsidiary rather than the parent company when you set up your insurance companies. Use AARP and not Unitedhealthcare to avoid routing problems.
For re-submission of a previously denied claim, you must enter 7 in line 22 and also give the claim number of the denied claim to avoid having the claim sent back to you as a duplicate claim.
From Claims->Claims Fix->Repairable Claims, you will be able to correct a claim. Click a calendar date in pink. You will be taken to a list of claims that are fixable. Clicking the box next to Correct will bring up a CMS form with all the data generated from the X12 file. After correction has been completed, click Update on the bottom of the form to save the changes.
Security
If you are your own IT department, consider using OpenEMR as a desktop application by turning off the Internet connection.
Because XAMPP is open source and thus the codes are known to everyone, you must take precautions outlined in Securing OpenEMR.
Avoid the use of Patient Portals, if you don't have professional support. Even if you do have technical help, Sony and the Pentagon have been hacked into. Your budget for IT support is probably smaller than theirs.
Backup
Unlike paper records, EHR's can vanish into the ethers before your very eyes and it usually happens at the most inopportune times. The importance of backup and restore can never be overemphasized. Read the Forums discussions on this crucial topic and select the best method for your practice from this webpage.
Meaningful Use Attestation
Allow 6 months of OpenEMR use before attempting attestation. Meaningful Use requirements impose an additional burden on your practice. Don't bite off more than you can chew. Read the Meaningful Use section under FAQ before embarkation.
Updates and Patches
Check the homepage periodically to see if a new patch or version is available. Follow the instructions to the letter to prevent baldness from tearing your hair out.
Encouragement
To quote our fearless leader, OpenEMR is not "a point and click application". If you want to be spoon-fed, you will have to go the proprietary route. If your mettle measures up, you've come to the right place. Take deep breaths. Persevere and be patient. Think of work-arounds if you can. If all else fails, post your problem to the Forums. Everyone has a day job, so the reply will not be instantaneous. Eventually another Forum member will lend a helping hand. After overcoming all the hurdles, you will find this stuff is actually fun. If you have great ideas, post them to the Wiki or the Forums. Welcome aboard. We're glad you've joined us.
