I'm a new user of AC. I had previously developed my own "EMR" system, which consisted of a database (with demographics, problem list and rx list), together with the actual chart -- a large pdf file containing all scanned reports and visit notes. I was fairly happy with it, but obviously it was in no way CCHIT certifiable, and also didnt do eprescribing and rx interaction checking. I was resistant to most systems I saw because they didnt seem to suit my needs, but when I found AC it seemed to fit. I'm now in the process of transferring my records to AC, which is fairly straightforward and takes about 15 minutes per patient, since everything is already in pdf format and I just need to input the demographics, rx and problem list.

I have one issue I would like to bring up: the distinction between diagnosis lists and problem lists. A few examples:

Diagnosis: 414.00 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL
Problem: CAD - s/p cabg 2005, no angina, last ETT 2009 or
Problem: CAD - long history chronic stable angina

Diagnosis: 250.00 DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION
Problem: DM, longstanding, prone to hypoglycemia or
Problem: DM easily controlled with diet and weight loss


Diagnosis lists are vital for billing, for drug-dx interactions, for searching, for quality control etc. However, I find them not particularly helpful when trying to look at a concise description of a patient's problems. Problem lists are much better for this.

Most diagnoses correspond to a problem on the problem list, but not all. Some diagnoses may not have a corresponding problem (079.9, viral syndrome, doesn't necessarily need to be on the problem list), and some problems may not be pertinent to the diagnosis list (difficult family situation, problem paying for medication).

I have solved this issue for myself, at least for now, by including the problem list in the ROS field. This works ok, but it involves duplicate work, since anytime a new diagnosis/problem pops up, I have to add it to both places.

Suggestion: add a field to the diagnosis list which would contain free text, and would essentially be the problem description corresponding to the diagnosis. If a diagnosis has no corresponding problem list entry, leave the field blank. If the problem has no corresponding diagnosis, create a dummy ICD code for misc. problem.

Anyone else have thoughts about the diagnosis-problem dichotomy?

Michael Jacobson, MD
New York, NY