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112 <hr><br /><br /><br />
114 Getting Started<br>
116 In your browser's address bar you will need to enter the location of your OpenEMR installation. For most users <br>this address will consist of the name of your server followed by a forward leaning slash, "openemr" and another <br>forward leaning slash. This should look like this:<br>
117 http://MyServerName/openemr/ <br>
118 Be sure to check with your Administrator, as the location of your OpenEMR installation may be different. As <br>an example the OpenEMR live demo is located at:<a href="http://www.oemr.org/demo/openemr/"> http://www.oemr.org/demo/openemr/</a><br>
119 Once you have entered the correct address, you should be presented with the login screen:<br>
121 The login screen contains two input boxes: 'Username' and 'Password'. The first time you log in to a fresh <br>installation of OpenEMR you will need to log in as "admin" with a password of "pass". Your administrator may <br>provide with a your own username and password. ( Note that the OpenEMR login is case-sensitive.) <br>
122 You will also be presented with a drop-down list of possible languages in which you can view OpenEMR. The <br>default language (English) should already be selected. <br>
123 Once you have entered the correct username and password, simply click the 'Login' button or press 'Enter'.<br>
125 If this is your first time logging in to OpenEMR it is recommended that you change your password to something <br>more secure. To do this select 'Miscellaneous - Password' from the navigation list on the left, or simply <br>'Password' in the Radio Button navigation scheme.<br>
127 <hr>
129 This will bring up the "Password Change" screen. Enter your new password into the two input boxes, make <br>sure you type the same thing into each box. And remember that OpenEMR's username and passwords are case <br>sensitive.<br>
130 Once you've done this, click the 'Save Changes' button. You will then be required to login again with your new <br>password.<br>
131 ( Note: If you are using the OpenEMR demo instance, please do NOT change the admin password! )<br>
133 <hr>
136 A successful login will bring you to the main screen of OpenEMR. The user is presented with two windows, <br>the Calendar, and below that, the Messages page.<br>
138 OpenEMR can be configured with your choice of three navigation schemes. Traditional, Tree View, or Radio <br>Buttons. You can specify which scheme you would like to use by editing the file openemr/interface/globals.php <br>( Detailed instructions can be<a href="http://www.openmedsoftware.org/wiki/OpenEMR_Layout_Selection"> found here. )</a><br>
140 The Traditional navigation scheme uses context-sensitive menus located at the top of the screen, which change <br>depending on what page is being viewed. The patient search function is also located at the top left corner of the <br>screen. <br>
141 In the Traditional navigation scheme related pages are linked. Pages load simultaneously to facilitate the data <br>entry process.<br>
143 <hr>
147 The Tree View is the default navigation scheme for OpenEMR 3.2. This navigation scheme presents a <br>hierarchical list of page links on the left side of the screen which can be directed to load in either the top or <br>bottom widow of the main screen.<br>
148 The patient search function is located below the navigation list on the left hand side of the screen. Along with a <br>link to OpenEMR's support page on Sourceforge.net.<br>
150 <hr>
153 The Radio Button navigation scheme functions similar to the Tree View except that the links are presented as an <br>unordered list, with a series of radio buttons to the right and left of each item. <br>
154 Selecting the left radio button will load the desired page in the top window, while selecting the right hand button <br>will load the page in the bottom window. You can also disable the top or bottom window by clicking on the <br>appropriate checkbox at the top of the navigation menu.<br>
155 For the purpose of this Users Guide, we will assume you are using the default navigation scheme (Tree View). <br>A complete cross reference of menu items for both the Radio Button and the Tree View navigation schemes can <br>be<a href="http://www.openmedsoftware.org/wiki/Cross_Reference_Views"> found here.</a><br>
157 <hr>
159 Setting Up Your Clinic<br>
160 To begin using OpenEMR, navigate to your server's installation directory and log in using your assigned <br>username and password.<br>
161 A successful login brings you to the appointment calendar. Before you begin scheduling appointments you'll <br>want to configure some basic information for your users. To start setting up your clinic, select 'Administration' <br>from the navigation list on the left of the screen. This will bring up a list of available administration pages. <br>Click 'Facilities' to bring up the Facility Administration page.<br>
162 This is one of several pages within the Administration section of OpenEMR. Administration also includes <br>sections for managing your facility's Forms, Practice information, Calendar categories, Lists, Database <br>administration, and more. Links to these sections can be found in the left hand navigation list under <br>'Administration' (or at the top of the page if you're using one of the other navigation schemes).<br>
164 We'll start by setting up your facility for your users. There is a default clinic already built in. It will need to be <br>updated with the correct information for your clinic. To do this, simply click on the name of the clinic, in this <br>case "Your Clinic Name Here", to edit it's details.<br>
165 This pops up a lightbox containing a form for editing your clinic's information.<br>
167 <hr>
169 Enter the correct name, address & contact information for your clinic. This information will be used for billing, <br>so make sure to include who to direct billing information to, and enter your facility's NPI and CLIA number. <br>Indicate whether your facility is a billing and/or service location by clicking the checkbox next to the <br>appropriate option. If your clinic is a billing location, you may also want to check the "Accepts Assignment" <br>box.<br>
170 When you are finished entering your clinic's information click the 'Save' button to update your clinic and return <br>to the Facility Administration page.<br>
171 Your clinic may have additional facilities in which care is given, such as a hospital. To create a new facility, <br>click 'Add' and enter the relevant data as you did for the other clinic. Click 'Save' when finished.<br>
173 Clicking 'Administration - Users' in the navigation list will bring you to the User / Group Administration page. <br>This page contains a list of your clinic's users. If you have not yet added any users, then only "admin" will be <br>shown. <br>
175 <hr>
178 You can add a new user by clicking the 'Add User' button, or you can modify an existing user by clicking on <br>their username. <br>
179 Both methods will pop up a lightbox containing the user profile page. Here you can edit a user's password, <br>facility information and access controls, as well as their authorization status. Authorized users are practitioners, <br>and will appear in the appointment calendar. They can also be associated with encounters for billing purposes, <br>and are able to authorize encounter information entered by non-authorized users so that the encounter will be <br>billable.<br>
180 To authorize your practitioners be sure to click the 'Provider' check box. Other facility staff do not need to be <br>authorized. Practitioners will also need their UPIN and Federal Tax ID entered for correct billing, as well as <br>their Federal Drug ID for prescription writing.<br>
181 Once your user's information has been updated successfully click 'Save' to return to the User / Group <br>Administration page.<br>
183 <hr>
187 Next you'll need to enter the relevant practice information for your clinic. This includes pharmacy and <br>insurance company information, as well as the types of documents your clinic accepts.<br>
188 Clicking the 'Practice' link in the navigation menu will bring you to the Practice Administration page where you <br>will be presented with a list of links for editing your facilities' information.<br>
189 The Practice Administration page initially presents you with the list of your clinics pharmacies. Click the 'Add <br>a Pharmacy' button to enter the contact information for your clinic's pharmacy. A drop down menu lets you <br>select the preferred method for transferring prescription information. Once you've entered the correct <br>information, click 'Save' to add your new pharmacy.<br>
190 Before setting up any insurance companies, you'll want to enter your X12 Partner information. These are the <br>clearinghouses or large payers to whom you will send electronic billing. Most practices will probably just use a <br>single clearinghouse. <br>
192 <hr>
195 To add one of these clearinghouses, click on 'X12 Partners' and then click the 'Add New Partner' button.<br>
196 The ID numbers that you enter here will need to be provided to you by the clearinghouse/partner. The Version <br>number refers to the version of the X12 837p protocol specification used and should probably not be changed. <br>Click 'Save' to save the information you've entered.<br>
197 Selecting 'Insurance Companies' from the links at the top of the page brings up a list of Companies that have <br>been added to your clinic. If this is a new installation of OpenEMR, this list will be empty. You can add a new <br>insurance company by clicking 'Add a Company'. Or, you can edit an existing company by clicking on it's <br>name in the list.<br>
198 Once you have entered the correct information, click 'Save' to save any changes, or add the new company to the <br>list. <br>
200 <hr>
203 In practice, many insurance companies have multiple insurance plans with a separate billing address for each <br>plan. At this time, you will need to add each plan as a separate insurance company. <br>
204 Many insurance companies also assign their own doctor-specific ID numbers, and these numbers must appear in <br>your claims. Click on 'Insurance Numbers' to see a list of your clinic's providers and their default ID numbers.<br>
205 Click on a provider's name to bring up a list of insurance companies and the corresponding ID numbers that <br>have been entered for that provider. <br>
207 <hr>
210 Selecting 'Add New...' presents a form for adding this provider's numbers for another insurance company. Fill in <br>this information and click the 'Save' button to add the new number. You can also edit an existing set of numbers <br>by clicking on the company name in the list. <br>
211 Note that one of the selections in the drop down list of insurance companies is "Default"; you can use this to fill <br>in default numbers for insurance companies not otherwise entered.<br>
212 Next click on 'Documents' to see a list of patient documents that have been uploaded. Clicking the 'Edit <br>Categories' button displays a hierarchy of the different types of documents that you can attach to a patient. The <br>default set is shown. To add more categories click on the desired parent folder's name, fill in the name of the <br>new document type, and click 'Add Category'.<br>
214 <hr>
218 Select 'Lists' from the menu at left. This brings you to OpenEMR's List Management system. This is where <br>many of the selection lists within OpenEMR are stored and edited. Before you begin using OpenEMR you will <br>need to populate these lists with data appropriate to your clinic.<br>
219 Select 'State' from the drop-down list. OpenEMR comes configured with only one state by default. If your <br>clinic sees patients from only one state you can simply replace the default state by clicking in the 'ID' and 'Title' <br>fields and replacing them with the appropriate information.<br>
220 Alternatively, you can add multiple states by filling in the empty fields that are provided for you. You can also <br>specify which state you would like to use as the default by selecting the checkbox next to that state.<br>
221 When you are finished modifying the list, click 'Save'. This will update the list and generates a new set of <br>empty fields should you need to add additional states to the list.<br>
223 <hr>
226 The drop-down contains lists for Race/Ethnicity, common billing codes that appear in the Fee Sheet, Price <br>Levels, common Exams/Tests, etc. All of these lists may be modified in this same manner.<br>
228 OpenEMR also contains a built-in address book for storing useful contact information for your staff as well as <br>other doctors, clinics, etc. that your office may contact on a regular basis. <br>
229 Select 'Addr Bk' (under 'Miscellaneous') from the navigation menu to bring up your clinic's Address Book.<br>
230 This will present you with a list of all of the contacts currently contained in your Address Book. Click on a <br>person's name to edit their contact information, or click 'Add New' to enter a new contact into your address <br>book.<br>
231 In the 'Add New Person' dialog box, select a title, and enter their name and address. If you are adding a <br>
233 <hr>
236 physician to your address book, be sure to include their UPIN and other ID numbers for billing and referrals. <br>Entering a 'Specialty' will allow you to narrow your search parameters when writing letters to a particular <br>physician, etc.<br>
237 When you are finished entering the new contact information, click 'Save'.<br>
238 Note that the new contact has been added to the list.<br>
239 You can search for a particular contact in the address book by entering their name and/or specialty at the top of <br>the page and clicking 'Search'. This brings up a list of any contacts matching your search parameters.<br>
241 <hr>
244 <hr>
246 Adding A New Patient<br>
247 Once you have entered all the necessary clinic information you can begin entering patient data.<br>
248 Select 'Patient/Client – New/Search' in the navigation menu on the left of the screen to begin entering a new <br>patient into the system. <br>
250 In the Search or Add Patient page enter the patient's name & birth date. If you have an existing chart for this <br>patient, you may enter the chart number under 'External ID'. If you do not enter a number the system will <br>automatically assign one that is equal to its internal patient ID. When you are finished click 'Create New <br>Patient'. <br>
251 <i>NOTE:</i> Clicking the calendar button next to the "DOB" field will pop up an easy to use date selection tool <br>found throughout the OpenEMR program. Simply click the arrows to the right or left of "Today" to advance the <br>date forward or back a single month or year, or hold an arrow down to select the month or year manually. <br>Selecting the day of the month will then fill the selected date into it's respective field in the proper format <br>(YYYY-MM-DD)<br>
252 You should now be presented with the Patient Summary Page, which contains a summary of the patient's <br>identifying information, including employment, insurance and provider information in sections that may be <br>expanded or collapsed at will by clicking the link to the right of the desired section. The page also includes <br>links to the patient's medical history, documents, etc. at the top of the screen, as well as a list of "issues" <br>associated with that patient, and any appointments they may have scheduled. <br>
253 Notice that additional patient related pages are now accessible via the navigation menu to the left.<br>
255 <hr>
258 To continue entering patient information click 'Edit' next to the desired section.<br>
259 This will bring up a series of tabs containing inputs for the various types of patient data. Click on the tab for the <br>section you would like to work with and fill in the desired fields. Note that fields labeled in red are required in <br>order for billing to work properly.<br>
260 To enter a patient's insurance information for the first time click 'edit' next to the Demographics section. The <br>Insurance information section can be found below the Demographics tabs.<br>
262 <hr>
266 Select the patient's insurance company from the drop-down list, or you can search for it by clicking <br>'Search/Add'. Doing so brings up a dialog box containing several fields which are searchable (labeled in green). <br>Entering a partial value into one or more fields and clicking the 'Search' button pops up a second dialog <br>containing a list of all insurance companies matching those parameters. <br>
267 Selecting the desired name from the list will automatically make it the selection for that patient.<br>
269 <hr>
271 If the desired insurance company is not yet entered, you can also add it here by completing all the fields and <br>clicking 'Save as New'. This also selects the newly added insurance company for this patient. <br>
272 If the patient is the also the insured party, then selecting "self" from the drop-down list will automatically <br>populate the "subscriber" section with the relevant data for you.<br>
273 When you are finished, click 'Save' at the top of the page to save and return to the Demographics summary. You <br>can see that Insurance now has it's own section, and all of the new patient data is now visible on the summary <br>page.<br>
275 Next select 'History' at the top of the Patient Summary page This brings up a page containing information about <br>the patient's medical history.<br>
276 Clicking 'Edit' will bring up a data entry page with tabbed sections, similar to that of the Demographics page.<br>
277 Access the desired sections by clicking on the appropriate tab and enter in the patient's data as necessary, then <br>click 'Save'.<br>
279 <hr>
283 Select 'Documents' at the top of the patient Summary page. Here you may upload files that you have scanned <br>and/or saved, such as a patient's ID or insurance card. <br>First, click the appropriate Document Category for the file you wish to upload, then click 'Browse'. This will <br>present you with the standard dialog for locating the file on your computer. Once the desired file has been <br>selected, click 'Upload' to save the file in OpenEMR. <br>
284 Once the file is uploaded, you will be presented with a report, confirming the file has been uploaded <br>successfully. To see the new file, click on the plus sign next to the appropriate document category which <br>displays a list of all the files in that category. Click on the name of the new file to view it. <br>
286 <hr>
289 Here you can also attach a note to the document, associate it with a particular issue, or move it to a different <br>category or patient. <br>
291 <hr>
293 Using The Calendar<br>
294 In this section we'll discuss setting up a provider's schedule in the calendar and adding patient appointments.<br>
296 Login to OpenEMR using your assigned username and password. <br>
297 For users who are not practitioners, such as someone who works at the front desk, the Calendar will show the <br>schedules of all the practitioners at the clinic by default. When you first start using OpenEMR you will need to <br>set up schedules for all of your practitioners.<br>
298 To do this, select from the 'Providers' list on the right the person who's schedule you wish to set up. Next click <br>the time at which that provider is scheduled to enter the office.<br>
300 <hr>
303 This will present you with the 'Add New Event' dialog box. <br>
304 The clinic and provider name should be automatically filled in for you, as well as the time that you selected. <br>Choose "In Office" from the 'Category' drop-down list. <br>
305 You can also choose to make this a repeating event, which allows you to set up an event only once for a given <br>period of time. Do this by selecting the 'Repeats' checkbox, and setting the appropriate frequency & duration.<br>
306 When you are finished click 'Save' to update the calendar. Now you will see a block of available time slots for <br>that provider's schedule. Scroll down and click on the time that the provider is scheduled to leave the office for <br>the day.<br>
309 <hr>
312 You can also add a lunch break in your practitioners' schedules. This is done the same way, with the exception <br>of the duration, which in this case is non-zero.<br>
313 Now you can see your practitioner's full schedule laid out on the Calendar page. Continue setting up the <br>Calendar in this fashion until all your practitioners' schedules have been entered.<br>
315 <hr>
319 Now that the clinic and all it's practitioners are set up, you can begin scheduling appointments for your patients.<br>
320 To locate a patient in the system, enter all or part of their name into the search field in the bottom left corner of <br>the screen (below the navigation list) and click 'Name'. This will bring up a list of all the patients in your <br>system matching that name. If you need to narrow the list, you can enter a longer search term, such as their full <br>name (Eg. "rourk, rod").<br>
321 Click on the desired name to bring up the Demographics summary for that patient. If you have the patient on <br>the phone, now would be a good time to confirm that their contact and insurance information is up to date. If <br>the patient is not already in the system, you can select 'New/Search' from the menu to begin entering their <br>information.<br>
323 <hr>
326 The right-hand side of the Patient Summary shows a list of all current and future appointments for that patient. <br>Click 'expand' next to the Appointments section if the list is not already visible. Click 'Add' to schedule an <br>office visit. <br>
327 This will present you with the same 'Add New Event' dialog used earlier. This time "Established Patient" is <br>selected as the Category. You can change the category to "New Patient" if this is their first visit. If a primary <br>provider has been entered for that patient, they will be selected automatically.<br>
328 Click 'Find Available' to see a list of appointment times available for that provider for the next 7 days. You can <br>change the start date or the number of days shown and click 'Search' to display a new list using those <br>parameters. <br>
330 <hr>
333 Once a date and time have been agreed upon, selecting that time from the list will close the window, and the <br>selected time will appear in the 'Add Event' dialog. <br>
334 Make sure to enter the correct duration for the appointment and click 'Save'.<br>
335 Return to the calendar using the navigation menu on the left. Advancing to the appropriate date, using the <br>arrows at the top of the screen, shows the new appointment listed in the provider's schedule. Mousing over the <br>patient's name displays a toot-tip with information about that patient, such as date of birth.<br>
337 <hr>
341 OpenEMR's calendar system includes a status indicator, allowing doctors and staff to see at a glance what is <br>going on with all appointments and the corresponding encounters for the day. <br>
342 To change the status of a given appointment, double-click on the appointment block. This brings up the 'Edit <br>Event' window. Choose the correct appointment status from the drop-down list. Notice each status has a unique <br>symbol associated with it.<br>
343 You can also type a note into the 'Comments' line if more information is needed. Click 'Save' to update the <br>status of the appointment.<br>
345 <hr>
347 You can see that the symbol next to the appointment time has changed to indicate it's new status. Any <br>comments are now also visible when mousing over the patient's name on the appointment calendar.<br>
349 <hr>
353 Patient encounters are handled primarily by a clinic's providers. <br>
354 Logging in as a provider presents you with the Calendar page showing only that provider's schedule by default. <br>To view another provider's schedule, select the desired user from the list to the left of the calendar. <br>
355 The bottom window also shows any notes left for that provider about their patients. <br>
356 The Calendar shows the appointments scheduled for that day. Providers can see the status of any given <br>appointment, indicated by the symbol shown between the appointment time and the patient's name. The "@" <br>symbol, for example, indicates that the patient has arrived at the clinic and is ready to begin their appointment.<br>
358 <hr>
362 To begin the encounter, click on the patients name in the Appointment Calendar. This brings you to the patient's <br>Summary page, as well as the Past Encounters & Documents page which lists any previous encounters or files <br>that were uploaded for that patient.<br>
363 Select ' History' at the top of the page to view a summary of the patients Medical History and Lifestyle <br>information. Click 'Edit' to enter any information that may be incomplete. <br>
364 The Patient Encounters & Documents page at the bottom of the screen displays a list of all encounters that have <br>been entered for this patient. For new patients, there may be no encounters listed. <br>
366 <hr>
369 By default, OpenEMR is set to generate an empty Encounter when a patient's status has been set to "Arrived <br>(@)". To open this encounter and begin entering data, click on the new entry in the Encounters list, then click <br>'Edit' next to the provider's name.<br>
370 If your clinic's version of OpenEMR is configured differently, you can begin a New Encounter manually by <br>selecting 'Create Visit' from the navigation list on the left. Both methods will bring you to the New Encounter <br>Form.<br>
371 Here you can enter a brief description of the encounter and the date of service. Encounters for new patients will <br>not have any Issues or Diagnoses associated with them at this time, so click 'Save' to continue with the <br>encounter.<br>
373 <hr>
377 This will bring you back to the summary page for This Encounter. Displayed is a list of all the forms associated <br>with this encounter. You may click 'Edit' next to any of these forms to edit its contents. <br>
378 To the right is a drop-down list of forms that can be added to the encounter. OpenEMR comes configured with <br>several common encounter forms by default, but your clinic may have their own customized encounter forms as <br>well.<br>
379 Select 'SOAP' from the drop-down list to add it to the encounter. <br>
380 The SOAP form will contain a subjective & objective record of the patient’s vital information, as well as any <br>notes on the assessment of the patient's health and suggested treatment plans.<br>
381 Enter the appropriate information and click 'Save Form' to return to the Encounter summary page. <br>
383 <hr>
386 You'll see that the SOAP form has been added to the list of forms for this encounter. Also shown is a summary <br>of its contents. <br>
388 Next select the 'Fee Sheet' from the drop-down list. The Fee Sheet is different from most other forms in that it <br>enters and modifies billing information that is stored elsewhere in the system; it is not really an encounter form, <br>and when used it will not appear in the encounter's list of forms. <br>
389 The Fee Sheet includes several drop-down lists of the most commonly used billing codes. It can and should be <br>customized so that it's most suitably adapted to your practice; <br>
390 Included is a search feature, where you can search for and select from the thousands of billing codes in the <br>database. And below that is a list of all the billing codes, along with their charges and other related information, <br>that have been selected for this encounter. <br>
392 <hr>
395 For example, selecting 'Detailed' from the "New Patient" drop-down adds the associated CPT code to the list. <br>
396 Look for an appropriate billing code by entering a search term in the box to the left of the 'Search' button. Make <br>sure the correct code type is selected and click 'Search'.<br>
397 A drop-down list will then be populated with any billing codes that match your search parameters. Selecting the <br>desired code from the list will add it to the list of codes for this encounter.<br>
398 The Fee Sheet also allows you to justify the selected codes for billing purposes. Justification is the association <br>of ICD9 codes with procedure codes. Insurance companies require this for billing, in order to "justify" paying <br>for procedures.<br>
399 To do this, click the drop-down menu under 'Justify' for the desired CPT code. Select the appropriate ICD9 <br>code from the list and click 'Save'.<br>
401 <hr>
404 To see the Feet Sheet has been associated with this encounter, click 'Visit History' in the navigation menu to go <br>to the list of encounters for this patient. You can see that the CPT & ICD9 codes are listed next to the new <br>encounter, as well as the SOAP form that was added earlier.<br>
406 To prescribe medication for this patient click 'Edit' next to the Prescriptions section in the Patient Summary <br>window, and click 'Add'.<br>
408 <hr>
411 This presents you with a form for entering prescription data, including dosage, refills, and whether or not <br>generic over-the-counter substitutions are allowed for this patient. <br>
412 The Prescription form includes a search function for looking up a particular type of medication. Selecting <br>'(click here to search)' next to the Drug field will bring up a new field into which a search term may be entered. <br>
413 Clicking 'Search' displays a drop-down list of possible medications generated by connecting to the web site <br>www.rxlist.com.<br>
414 Selecting the desired medication will fill in the Drug field for you. Also, clicking 'Yes' next to "Add to <br>Medication List" will allow the prescription to be included in the Issues list as a Medication. <br>
416 <hr>
419 Enter the correct data to complete the form and click 'Save'. You are then presented with a form for generating a <br>PDF of the prescription information. It may be printed or sent by email or fax. "Auto Send" will use whichever <br>default method was selected when you set up the pharmacy. <br>
420 Clicking 'Print (PDF)' will generate the following PDF document to be saved or printed as necessary. The <br>default template for this form may also be customized to your clinic's own specifications.<br>
422 <hr>
425 <hr>
430 An "issue" is a medical problem, allergy, medication, surgery or dental issue. These issues are related in that <br>they can all be associated with multiple encounters. <br>
431 This is especially useful with medical problems, where the user may want to quickly determine which <br>encounters treated a particular problem, or which problems were treated by a particular encounter. <br>
432 The Issues list can be found on the right-hand side of the Patient Summary page. <br>
433 You can see that the prescription added earlier has been listed in the Medications section. Clicking 'Edit' next to <br>one of these sections will present you with a complete list of all issues for this patient. Click 'Add Issue' to add <br>a new medical issue you want to kept track of for this patient.<br>
435 <hr>
438 This pops up the 'Add Issue' dialog box. <br>
439 The default issue type is set to 'Problem'. For each issue type there is a list of commonly selected titles which <br>are customizable for your clinic's specific needs. If the desired title is not included, it can be typed into the text <br>box below the list. <br>
440 Enter the appropriate beginning and end dates, and select the 'Occurrence' from the drop-down list provided.<br>Clicking in the 'Diagnosis' field will present a search dialog for locating the correct ICD9 code for this issue. <br>Enter the appropriate search term and click 'Search' to bring up a list of possible ICD9 codes. Selecting the <br>desired code will close the search window and enter the selected code in the text field.<br>
442 <hr>
445 Complete the remainder of the form as necessary and click 'Save'. <br>
446 Additional issues are entered in the same manner; clicking 'Add Issue' and selecting the appropriate type, such <br>as 'Allergy'. Notice that the 'Add New Issue' dialog also uses the OpenEMR date selection tool described <br>earlier. <br>
448 <hr>
451 Once the new issues have been added successfully you should see an updated list of all the issues that have been <br>entered for this patient. You may click on an issue in the list at any time to edit it.<br>
453 The far right column in the Issues list represents the number of encounters associated with a given issue. Click <br>on the '0' next to a newly added issue to bring up the 'Issues & Encounters' dialog.<br>
455 <hr>
458 This dialog contains a list of all the issues and encounters associated with this patient. It is used to set (and <br>view) the relationships between issues and encounters. Note that the issue that was just clicked on has been <br>highlighted. <br>
459 Select the appropriate encounter from the list on the right to highlight it. Clicking 'Save' now links the selected <br>issue to the selected encounter.<br>
460 Continue associating issues with encounters as necessary. Refreshing the Issues list shows the current <br>information for all issues.<br>
462 <hr>
466 Click 'Back' to return to the Patient Summary page. Now click 'Edit' next to the Immunizations section. This <br>page contains a form for entering information on the any immunizations the patient has received.<br>
467 Select the type of immunization from the drop-down list provided, and enter any data you may have, including <br>the date of the shot, and the name of the provider who administered it. <br>
468 Click 'Save Immunization'. The newly added immunization now appears in the list at the bottom of the screen.<br>
470 <hr>
473 Return to the Summary page via the navigation menu on the left. Notice that the lower left portion of the <br>patient summary now shows an updated list of all active issues, immunizations and prescriptions. <br>
475 <hr>
479 Patient notes store patient information that is unrelated to the patient's medical condition. Such information may <br>include outstanding balances, changing insurance information or patient requests for actions by the clinic.<br>
480 Transactions are somewhat similar, but record events that have already occurred. These may be referrals, <br>requests from either the patient or the doctor, or legal transactions.<br>
482 To begin, log in to OpenEMR, and use the search function in the lower left-hand corner to locate the patient for <br>which you would like to add a note. <br>
483 Click on the desired patient to bring up the Patient Summary page.<br>
485 <hr>
488 If the user is not Authorized they will be unable to see the patient's medical details such as issues, <br>immunizations and prescriptions.<br>
489 Click 'Edit' next to the Notes section to bring up the Patient Notes page, then click 'Add'.<br>
490 This will pop up a lightbox with a text field for entering the note, as well as drop-down lists for selecting the <br>type of note, and the person to whom the note is addressed.<br>
491 Type your note in the text box and click 'Save as new note'.<br>
492 The new note now appears in the list on the Patient Notes page. The checkbox is used to control whether the <br>note is "active". Above are options to view only the active or inactive notes. <br>
493 Click 'View Patient' to return to the patient summary.<br>
494 The new note is now listed on the Summary page.<br>
496 <hr>
500 Select 'Transactions' at the top of the Patient Summary to go to the Transactions page.<br>
501 The Transactions page contains two basic form types. A simple form for internal transactions such as patient <br>requests or billing transactions, and a Referral form.<br>
503 Click 'Add' and select 'Referral' from the drop-down list to begin a new Referral transaction.<br>
504 Another drop-down contains a list of physicians and clinics from the Address Book to which you can refer your <br>patient. Select the referring physician, risk level, etc., and enter a reason for the referral.<br>
506 <hr>
509 Click 'Save'.<br>
510 The referral is now in the Patient Transactions list. <br>
511 Click 'Print' next to the transaction to generate a printable version of the Referral form.<br>
512 Depending on your system's configuration, you may be asked to save the file, or it may be printed <br>automatically.<br>
514 <hr>
517 When you are finished return to the Transaction list and click 'Add'.<br>
519 Other transaction types use the simple transaction form. Select the desired type from the list and enter the <br>transaction details in the text box provided. Click 'Save' when finished.<br>
520 The new transaction has now been added to the list along with the referral. Click 'Edit' next to a transaction to <br>edit its contents.<br>
522 <hr>
525 Basic Billing<br>
526 Only the Administrator, authorized users, and those with Access Control designated as 'Accounting' in their user <br>profile can access OpenEMR's Billing system.<br>
527 To begin, log in with your designated username and password.<br>
528 Select 'Fees - Billing' from the navigation menu on the left. This brings you to the main Billing screen. This <br>
530 <hr>
532 will present you with options to generate a variety of printable and electronic claims and reports.<br>
534 The Billing Report page will automatically display any billable encounters that were generated today. To view <br>billables from a different time period enter the 'From' and 'To' dates using the date selection tool, and click <br>'Update List' in the top right corner of the screen.<br>
535 The list should now display all billables from the selected date range.<br>
537 <hr>
541 Clicking the checkbox to the right of the desired encounter will enable a set of buttons for generating claims. <br>Your system should be configured with the appropriate set of forms for the insurance companies and <br>clearinghouses used by your clinic.<br>
542 Click 'Generate X12' to create a claim file that is suitable for sending to the clearinghouse.<br>
544 <hr>
548 OpenEMR will present you with a confirmation popup, reminding you to check the log file after you have <br>finished generating your claims.<br>
549 Click 'OK' to proceed.<br>
550 The standard Save File dialog should appear, allowing you to save the generated batch file to your computer. <br>
551 Once the file has been saved, click 'View Log' to check whether the claims were generated successfully.<br>
553 <hr>
556 If there were any errors in the claim generation process, they will be displayed here. Otherwise you will see a <br>note indicating that the file was generated successfully.<br>
557 The downloaded claim file should contain the necessary encounter information, formatted for billing. This is <br>what will be sent to the clearinghouse, by whatever method has been specified. <br>
558 Uncheck 'Show Unbilled Only' and click 'Update List' to refresh the billing list and see the updated status of the <br>encounter.<br>
560 <hr>
563 Click 'Mark as Cleared' to indicate that billing has been completed for this encounter.<br>
564 You will then be presented with a screen indicating that the claim has been "marked as billed only."<br>
565 Click 'Back' to return to the Billing Report page.<br>
567 <hr>
570 In OpenEMR multiple forms may be generated for each claim. <br>
571 For example, re-enter the desired date range, uncheck 'Show Unbilled Only' and click 'Update List' again to <br>show the current status of the claim. You can see that the claim has been "Marked as cleared."<br>
573 OpenEMR will now generate a PDF of the HCFA claim, based on the standard HCFA form template. The new <br>form can be viewed using a PDF viewer, or printed automatically on a pre-printed HCFA 1500 form, depending <br>on your system's configuration. <br>
575 <hr>
577 Returning to the Billing Report and clicking 'Update List', you can see that the status of the billable encounter <br>has been updated.<br>
579 <hr>
582 <hr>
585 Users classified as Accounting or Administrator are also authorized to enter receivables for the clinic. Checks <br>received from insurance companies can be entered here and distributed to cover the appropriate encounters. <br>Patients can also be billed, and their payments recorded.<br>
587 To begin, select 'Fees - Billing' from the navigation menu and click 'EOBs' to bring up the Explanation of <br>Benefits Search window. This is where you can upload an ERA file (click 'Help' in the upper right-hand corner <br>for more information) or begin inputting payments manually.<br>
588 At the top you may enter a source ( Eg. check number ), pay date and check amount. The amount field will be <br>automatically decremented as payments are entered into the associated invoices. When all invoices have been <br>completed this value should be zero.<br>
590 <hr>
593 The search fields, with the blue background, are for locating a specific invoice (or invoices). Enter the <br>appropriate parameters, such as the date of service, and click 'Search' to bring up a list of all invoices (claims) <br>matching the requested parameters.<br>
594 The list shows the patient and invoice number, as well as the current balance to be paid. The number with a '-' <br>in the 'Prv' column indicates the number of insurance companies for which this invoice is awaiting payment.<br>
596 Clicking the invoice number you wish to work with opens the EOB Invoice window. Notice that the source and <br>pay date from the previous window have been copied over; this saves time in the common case where a single <br>check from the insurance company pays for multiple claims. <br>
598 <hr>
601 The EOB Invoice page contains a detailed list of payments made on this invoice so far. Enter the payment <br>amount next to the remaining balance, and check 'Needs secondary billing'. This will allow the claim to be re-<br>billed to the secondary insurance. Select 'Done with Ins1' above to indicate that the primary insurance EOB has <br>been posted. When you are finished, click 'Save'.<br>
602 Once payment has been billed and received from secondary insurance, it can be entered in the same way. Enter <br>the source and pay date, etc. and locate the appropriate invoice(s) using the search function. <br>
603 Payment amounts are now shown along with the remaining balance. The number in the 'Prv' column has also <br>decreased. Select the invoice number to bring up the EOB Invoice window again.<br>
605 <hr>
608 Enter the payment amount and select 'Ins2' to indicate that the secondary insurance EOB has been posted.<br>
609 Invoice adjustments may also be made here. Enter the adjustment amount (or click 'W' to waive the entire <br>remaining balance), and select a reason for the adjustment from the drop-down list provided. Click 'Save' when <br>finished.<br>
611 Once payments from the insurance companies have been received and entered, you can use OpenEMR's EOB <br>page to generate invoices for billing patients the remaining amounts.<br>
612 Select 'Due Pt' from the drop-down list and click 'Search' to display a list of all invoices that are awaiting <br>payment from patients. Invoices still awaiting payments from insurance companies will not be shown.<br>
614 <hr>
618 Check the box next to the desired invoice and click 'Print Selected Statements' to generate an invoice for that <br>patient using a customizable template. Depending on your clinic's OpenEMR configuration, the invoice may be <br>printed automatically.<br>
619 A '1' in the 'Prv' column now indicates that the patient has been billed once for this claim. This number will <br>increment every time a new invoice is printed for this encounter. This is useful when printing so that second <br>and later notices may be worded differently from the initial statement. <br>
620 You can also click on the patient's name in the invoice list to create a billing note for that patient. Enter your <br>note into the text field and click 'Save'.<br>
621 Once payment has been received, it can be entered into the invoice in the same manner as the insurance <br>payments. In the 'Now posting for' list be sure to select 'Patient'. Enter the payment amount as before and click <br>'Save'. <br>
623 <hr>
626 <hr>
628 Reporting<br>
629 Within OpenEMR there are a wide array of reports you can generate which may be useful for your practice. <br>These include general reports such as appointment and encounter reports, billing reports, and patient specific <br>reporting.<br>
631 Most general reporting tools can be found by selecting 'Reports' from the navigation menu at left. In the Tree <br>View scheme, the list of available reports is divided into a hierarchical list within the navigation menu.<br>
633 Clicking 'Reports – Visits – Superbill' brings up the Superbill Report page. This presents you with a dialog for <br>selecting a date range. <br>
635 <hr>
638 Clicking 'Submit' produces a report for each encounter in the date range, and shows patient demographics and <br>insurance information <br>
639 As well as the billing codes and amounts. <br>
641 <hr>
644 The Appointments Report ('Reports – Visits – Appointments') gives you a list of appointments for a given <br>provider, or for all providers, in a specified date range. It can be sorted by clicking on any of the four column <br>headings. <br>
645 The Appointments and Encounters Report ( 'Reports – Visits – Appt-Enc' )gives you a useful cross-reference of <br>appointments with their corresponding encounters. This allows you to easily spot many types of errors, such as <br>appointments with missing encounters, encounters with missing appointments, missing charges, and <br>authorizations or justifications that are required but not done. <br>
647 <hr>
650 The Insurance Distribution report (listed under 'Reports – Insurance) shows you how many patients seen over a <br>given time period use each kind of insurance. <br>
651 The Indigent Patients report lists all encounters for patients that were seen without insurance. (None shown <br>here.)<br>
653 <hr>
657 From the main Billing page click 'Reports', or select 'Reports – Financial – Cash Rec' from the navigation menu.<br>
658 This is the Cash Receipts report. It breaks down gross income by provider for a given time period. <br>
660 <hr>
663 The user can also elect to see a detailed breakdown of cash receipts, itemizing each procedure for which a <br>charge was made. <br>
665 When a patient is active within the system, the user has the option of generating a report for that specific <br>patient. To do so, click on 'Report' at the top of the Patient Summary page.<br>
666 The user can choose to include or omit a wide variety of patient information. When satisfied with your <br>selections, click 'Generate Report'.<br>
668 <hr>
671 This produces a report including all the specified patient information.<br>
673 <hr>
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