Thanks for your post Bert! You raise many important issues.

I agree that the Summary Sheet needs a major overhaul. I don?t use it at all except to check immunizations?I would much prefer that immunizations were included on the Most Recent Encounter tab?just a little button that would open them up would be enough. As much as possible I like to have everything accessible on one screen.

I don?t find a ?Problem List? helpful as a family doc. I use the PMH and Assessment windows. I keep a list of active problems in the Assessment window. When I finish my note I include the colon after the ICD-10 code to activate one or two diagnoses. These then serve as my diagnoses for billing purposes. I can avoid having AC add items to the Summary Sheet, like ?Viral Synd? by just typing it into the Assessment window. This way the items don?t populate over onto the Summary Sheet and aren?t sent to the patient portal.
Assessment window example:
# Viral syndrome (B34.9):
# DIABETES MELLITUS (E11.9)
# CHRONIC ANXIETY
# DEPRESSION
# FIBROMYALGIA
# OBESITY
# Hypothyroidism

In the Plan window I record my plan for each Assessment item in order as below. If I don?t deal with an item during a particular visit, I leave it blank.

Plan window example:
# Rest, fluids, stay warm, otc rx.
# ?.
# Restart counseling. Situation at home discussed.
RTO 2m

The PMH I use as a detailed repository of problems, active and inactive. When I do a physical I review the PMH to see if there are any issues that need to be addressed. Issues which are truly past history, inactive, and won?t become active in the future I put into a section at the bottom of my PMH under the heading ?Inactive Problems?. This would include things like, ?1994. Fracture, left radius.? I organize items using a system of # and a., b., c? As things change over time I can easily reorganize the PMH using this system. I add three special categories to the bottom of my PMH section: Patient Education Handouts (to record handouts that I?ve given to patients?I love handouts!), ?Consultants? (I use this to keep track of all the other doctors and caregivers that a patient sees), Notes (I use this to records various miscellaneous info including code status.

Past Medical History example:
# Morbid Obesity.
a. 8/02. Laparascopic Gastric Bypass (peak weight 363)
b. 2/2004. Reduction mammoplasty, abdominal panniculectomy with liposuction. She had areas under both breasts where the wounds took 8m to heal.
c. 8/08. Iron deficiency. 2012: Restarted on supplements.
# 1998: Diabetes mellitus. Saw Dr._______ once 6/00 but doesn?t want to return. 9/02: after bypass surgery her diabetes resolved.
a. 2011. Diabetes recurred due to weight gain
# Allergic rhinitis, seasonal
# Hypertension. 8/02: resolved after bypass surgery.
# 1988: chest pain secondary to esophageal spasm (clinically).
# Hypothyroidism.

Inactive Problems.
# 5/11. Release right trigger finger, 1st finger
# 5/08. Excision benign lump, left breast
# 1990: tubal ligation.
# 1986: cholecystectomy.

Patient Ed. Handouts
5/2014: DM.
8/15: Insomnia

Consultants.
Counselor: Mrs. Dolly ---------------
Gyn: Dr. -------------

Notes.
Patient since 1988.
Pap q3yr; due 2016
PMP lookup 12/15

The issue of Past Encounters populating with the c.c.?I have a simple work around. We record for c.c. something like: ?f/u bp? or ?physical; f/u DM? or ?UTI?. I record what the patient says in the HPI.

My system using the Assessment and PMH obviates any need for a ?Problem List?. No doubt there are a variety of solutions that others have worked out that fit their practice styles. One of the advantages of the AC design is that it allows each individual physician to customize the chart to their liking in many ways.


John Howland, M.D.
Family doc, Massachusetts