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INSTALLING PIMSY EMR SYSTEM Updated 04-19-15

Installing the System

To install the EMR in your computer, you will need the following items: Link to install PIMSY: https://www.smispimsy.com/PIMSY/Clients/BBBH/publish.htm MAKE SURE YOU ALLOW YOUR FIREWALL IN YOUR COMPUTER TO INSTALL THE PROGRAM. (Every computer is different so I am not sure what specific message you will receive, but always allow)

User ID and Password: This information is being sent to your Big Bear email soon. If you haven’t gotten it, PLEASE EMAIL KARLA to get it. She’ll create one for you.

Web Service URL (copy this exactly): https://www.smispimsy.com/PIMSY/Clients/BBBH/WebService/Main.asmx

Security key (copy this exactly):

B4A43B98-FAE6-450A-A515-3CDD110EE071

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LOGGING INTO THE EMR

1. After you install the program, this is the icon that you will find on your desktop: Click on it.

2. This log-in box will appear:

3. Type in your Login ID and Password These were provided to you via e-mail. If you lost the email, please ask Karla to re-send.

If you are asked to changer your password, please do so, and don’t forget your password!

MOVING AROUND THE EMR This is your homepage: The top-left side of the screen looks something like this:

In order to get familiar with the system, please play around with CLIENT ALICE. The main section that you’ll be working with is the CLIENTS drop-down menu option. To quit, you will need to press: LOG OUT

NEVER EVER USE THE Windows “X” on the top-right corners: Always press SAVE. And then EXIT to close anything that you are working on.

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After pressing CLIENTS, YOUR CASELOAD LIST is displayed in the left-hand side. The FILTER button allows you to filter for information that you are looking for. For example, if you want to look at all your notes that you did for Client-A, you can do that with a FILTER. This is a very useful tool of the EMR.

You can also expand the left hand side so that you can see the list better. Click on the green REFRESH button if something is missing:

If you click on EXPORT, you can save a copy of your caseload list in Excel format.

If you want to check your authorizations for your cases, follow these steps: In the homepage, go to clients, then to Authorizations: It will give you a long list of all your clients, and all the bill-codes that your client was authorized for.

Here it shows how many units are allowed for; how many are remaining; and the auth exp date.

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CREATING/UPDATING A DIAGNOSIS

When you are doing a treatment review, and need to update/change the diagnosis, you simply select your client and select the diagnosis tab.

When you are doing an intake, you add the diagnosis in the Assessment Note. There is a tab in the bottom part which is called diagnosis.

Select New Diagnosis (to create one) or View Diagnosis (to view) A new window opens up (explanation for each item on next page):

1 – Select ICD-9 2 – Here you can filter for a code (let’s say you want only codes with 314… or you want to filter for only those codes that are “bipolar”… any filter/search you want. 3 – Here is where you SELECT THE CODE. If you have used a filter in “2”, then only those codes will appear. 4 – Select ACTIVE or RESOLVED (not active). 5 – Select the diagnosis date. If you are doing a treatment plan review, make sure this date is the date of your treatment plan review.

If you are saying that the client’s diagnosis is no longer valid, check and date the Resolved Date and Inactive Date. 6 – Make sure one (1) of your diagnoses is checked-off as PRIMARY 7 – SAVE!!! If you are updating/changing the diagnosis, ALWAYS REMEMBER TO SAVE!!!

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UPLOADING DOCUMENTS

WHAT TO UPLOAD You cannot fax or cannot email docs to us anymore. You must upload them to the EMR yourself. You must have access to be able to scan these pages. INTAKES The person who reviews your intakes will be looking out for these scanned consents. If the 5 required signed papers are not there, they will not release your intake for payment. REVIEWS Treatment Plan Review Signature Page - Signed by client AND parent, AND Therapist OTHER You can also upload Release of information Forms, Drawings, or any other document.

HOW TO UPLOAD Go to the Documents Tab >> A new window opens up.

In the 1st column (Thread); type something…. (SEE PAGE 7 FOR 5-REQUIRED THREADS)

Intake - type INTAKE Note - type SESSION DOCS Review - type TPR SIGNATURE

Select the DOCUMENT TYPE from the 3rd Column SELECT THE APPROPRIATE CATEGORY FROM THE DROP-DOWN MENU.

SAVE

NOW……Go to the bottom half of the page. Press New Document

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1. A window opens where you can upload a document

Type something in the “Document Description” section

If you are uploading 5 different forms at a time, type each form’s name (e.g. “Consents”).

But if you are uploading all 5 required forms in 1 file, type “Intake Forms”

Press BROWSE to look for your document in your computer.

Press SAVE and EXIT.

2. Now, in the bottom half of the page… your document(s) will appear:

3. Press SAVE You can press VIEW Document on each line, and a window will open up with the document.

TO GET YOUR CASELOAD READY… Please make sure that your DOCUMENTS TAB looks like this:

Type the Thread Names (above), and select the corresponding Document Type (like here)

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NOTES The entire EMR system is based on “Notes”. Everything is a Note. Every billable service has a note. If you do not do a note, you don’t get paid or get credit for doing your work. You will create a “Note” for a CFARS, for a Treatment Plan Review, for a Treatment Plan, etc… GETTING TO THE NOTES You can: (1) access the NOTES tab from your caseload, or (2) access the NOTES button on the home. CREATE A NOTE There are 2 types of “Notes”. A Progress Note, and an Assessment Note.

RULES EVERYTIME YOU DO A NOTE, you must enter these 2 critical things: a bill-code and a note-type Not doing this correctly will affect your payroll & billing. Please make sure you always select the correct bill-code and correct note-type.

Select the note-type that you want. After you enter the Note-Type, the note will Therapy? PSR? Group? Non-Billable? now auto-populate for you to complete.

1. For a BIO or In-Depth Note use “Assessment Note”| ANYTHING ELSE use “Progress Note”

2. Always remember to release for review, otherwise, the Supervisor does not get them, and you won’t be paid on time. Always press SAVE and EXIT <<---- do not forget!

3. Only “Release-for-Review” when you’re done with the note. After that, if you save it, you cannot edit it, only your RCD can.

4. For therapy Notes (IT and TBOS): All you need to do is to complete the main section and the MSE Tab in the bottom. Stick to 15 minute increments! (not 50min; not 38min; not 13min etc)

5. CFARS/MTP/TPR/DC/WWS/BIO/INDEPTH > Always stick to 5 minutes Duration!! 6. For Master Treatment Plan and Treatment Plan Reviews… LOCATION CODE ALWAYS (select 11-OFFICE) 7. For Treatment Plan Reviews… remember to change the DX if needed; and upload the TPR Signature Page

8. For CFARS/FARS Notes… If you are discharging the client, remember to do a Discharge Note as well.

9. Pay attention to the AUTHS tab and the IT/TBOS/PSR Expiration Dates!!! Your notes must be started BEFORE the Auth it expires. For example… If the Auth for IT expires 06/30/15, you must create any note that you need to do before that date, before 06/30/15, because after that date, the AUTH is gone from your list. The week before your auth expires, start your note, save it, and then you can come back to finish it.

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CHEAT SHEET | BILL-CODES & NOTE TYPES TO SELECT TOGETHER Note Service Bill-Code Note-Type Comments Assessment Note Bio-Psychosocial H0031-HN Intake Select BIO tab if CT is 6+ Assessment Note In-Depth Ass’t H0031-HO Intake Select IN-D tab if CT is 0-5 Note CFARS H0031 CFARS/FARS Complete DC note also, if necessary Note Treatment Plan H0032 TX Plan New Complete then go to Treatment Plan Tab Note TX Plan Review H0032-TS TX Plan Review Note Individual Tx H2019-HR Therapy * Note TBOS H2019-HO Therapy * Note PSR H2017 PSR Note Group Therapy H2019-HQ Group Note In-Depth EST CT H0031-TS In-Depth ESTCT Note Non-Billable WWS N-B WWS Week without Service WWS Note Discharge DC Discharge Note

HOW DO I KNOW IF I HAVE NOTES or ITEMS TO BE FIXED? Go to Clients… then Notes. Then look at the grid of notes.

Make sure all your notes are RELEASED FOR REVIEW.

If they are not, your supervisor will not approve them, and you won’t get paid!

If you previously checked “Release for Review” but they’re now un-checked, that means that your

Supervisor is asking you to fix something about that note (see section below). Go to each note, see if

you have to fix the note, and check again “Release for Review” box and save each. Refresh the list.

Knowing what to fix: Click on the note. Press View Note The note will open in a new window. In the bottom, look for MISC Q&A TAB. It will tell you exactly what you need to fix.

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The supervisor has included notes on what needs to be fixed. Simply fix the errors, and MODIFY each remark, adding “DONE” in the Remarks section.

After you address all the issues that need fixing, you will see that you have put “Done” by every deficiency

Release for Review, SAVE, EXIT. Remember to always check the EMR to see if you have notes to be fixed or that are either not “released for review” or “released”.

INTAKES For Medicaid cases, which are 98% of our cases, when doing intakes, you will need to do:

- An Assessment Note (Bio/InDepth) - A CFARS/FARS Note - A Master Treatment Plan Note

There are 3 tabs that you’ll be using:

The Notes Tab The Treatment Plan tab The Documents Tab

STEP 1 CREATE A CFARS/FARS NOTE STEP 2 CREATE AN ASSESMENT NOTE Select ASSESSMENT NOTE to create the Bio-Psychosocial (or In-Depth)

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Click on NEW ASSESSMENT NOTE

A new window will open. If it’s slow, give it a few seconds.

The first thing you need to do is to select a bill-code. You MUST do this. Select either Bio-Psychosocial or In-Depth New (depending on the age of the client!) Then you MUST select a Note Type. SELECT INTAKE >>>>>

The assessment note will auto-populate below:

In the assessment note, you need to complete:

1. DOS (date of service) 2. Time and Duration (put anything… e.g. 15 min; 30 min; 60 min) 3. Location Code = “12 Home”

4. Complete 3 Tabs on Top: a. Complete the PRESENTING PROBLEM b. In the Clinical Summary tab, you will write your SUMMARY c. In the DSM Justification of Dx tab, you will copy/paste the JUSTIFICATION FOR

DIAGNOSIS (Copy/paste the DSM diagnosis from cheat sheet; we need it to be the actual DSM justification for that particular diagnosis.

5. Complete Tabs on the bottom. In the bottom of the page, you have different tabs: Here’s what we need completed:

Maximize the screen by clicking on the top-square icon of the window. This will make the window bigger so that you can see better

**** WARNING --- Please be sure to only select one note type. If you select the wrong Note-Type by mistake, you must ERASE this section before selecting another Note-Type

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a. Complete MENTAL STATUS EXAM, SEVERITY, and JCO HEALTH SCREENS.

b. Complete either BIO-PSYCHOSOCIAL or IN-DEPTH ASST 0-5 tabs Depending on the age of the client. Do not complete both!

c. Complete the RECOMMENDATIONS, and INTAKE COMMENTS.

d. Complete the SUBSTANCE ABUSE tab and MEDICATIONS tab

e. Complete the DIAGNOSIS tab This data will LINK to the client’s Diagnosis tab on your caseload.

f. When you’re done, the note is ready to be sent to the Supervisor for approval. Simply check the RELEASE FOR REVIEW button

Always press SAVE. And then EXIT to close the note

STEP 3 REMEMBER TO GO TO THE DOCUMENTS TAB

And upload the required intake documents. Your supervisor will look out for this.

STEP 4 DOING THE TREATMENT PLAN Doing the Treatment Plan requires that you complete 2 steps:

Step 1 CREATE THE BILLABLE NOTE

1. Click on PROGRESS NOTE, then NEW PROGRESS NOTE

2. Select the bill-code and Note-Type for the Treatment Plan.

BILL CODE – TX PLAN NEW (H0032) NOTE TYPE – TX PLAN NEW

3. Enter the date. Time does not matter what you input.

4. Location Code always – 11 – OFFICE (not HOME)

5. Complete the required items: DISCHARGE CRITERIA

STRENGHTS/WEAKNESSES

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SERVICE GRID

6. Release for Review, SAVE, and EXIT. Step 2 CREAT THE GOALS/OBJECTIVES In the Treatment Plan Tab, you will create the goals/objectives The screen is divided into 3 sections: NEED, GOAL, AND DATES/STATUS

TOP SECTION / NEED ENTER THE “NEED” Where it says “Need”, type “THERAPY”, and select “Therapy” from the Need Type Menu. MIDDLE SECTION / GOAL This is where you will input 90% of what’s on the Treatment Plan. Highlight each goal and press MODIFY GOAL, or if there are no goals, just click on NEW GOAL

When you click on ADD GOAL or MODIFY GOAL, the window opens up:

NEED

GOAL

DATES/STATUS

For services to be provided, we recommend you put the following items/units: IT 16 units per month for 6 months TBOS 36 units per month for 6 months PSR 300 units per month for 6 months Group 16 units per month for 6 months

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1 Enter the NAME of the problem. Use 1-word. “Depression”, or “Anger”, or “Hyperactivity”.

2 Enter the goal from the client’s point of view, evidence of the problem, and baseline #.

3 Enter at least 2 objectives for this problem. REMEMBER MEDICAID COMPLIANCE.

“Johnny will learn 10 anger management techniques, over a period of 6 months, as reported by weekly sessions and parental reports”

BLUE = WHAT (Measurable)

GREEN = TIME PERIOD (put 6 months)

RED = HOW (How is will we know if the goal is working or achieved)

4 Enter possible interventions for this problem.

5 Enter “Therapist”

6 Enter “Weekly”

7 Enter Start-Date (Intake Date); Target Date (6 months from Intake); and Status “NEW” SAVE LOWER SECTION / DATES Ignore. The information here will auto-populate based on the data you already entered.

SAVE and EXIT your treatment plan!

ALWAYS CHECK

UNDER “RENEWALS” to see when the TPR/CFARS is due, and when a new Consent is due.

UNDER “AUTHORIZATIONS” too see how many units & what bill-codes are available to each client.

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I AM NOT ABLE TO WRITE ANY NOTES!! The system is not letting you write notes? Possible reasons/solutions: REASON SOLUTION

Your liability insurance expired Renew; give to office so that we can re-set in system Your level-2 clearance expired Renew; give to office so that we can re-set in system Your license expired Renew; give to office so that we can re-set in system

You save the same time for another note Avoid overlapping in times for notes. There are no remaining units Contact the office; or Check if you have TBOS units* The Client’s Auth date is expired Contact the office so they can renew the Auth The Client’s Consent is expired Complete; upload; and inform the office to renew it The Client’s Tx Review is expired Complete & wait for Supervisor to approve it I have no bill-codes available Contact the office; they will set that up for you

* If you have TBOS units, please make sure to send your supervisor a Tx Plan Addendum to “Clinically” authorize TBOS.

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