Home Forums Discussions Feedback and Recommendations Adding all problems to assessment

It would be nice to have a button/box to click that would add all the pts problems to the note instead of having to choose each one separately. (such as happens when you click the "add updated med list button" to the plan)

It would also be cool if only your current diagnosis populated the diagnosis section of the order, i.e. I was called by radiology wondering why they were doing an MRI and MRA of the brain for eczema.

Hadn't the heard about the new connection?

Yeah - the eczema-brain connection - neurodermatitis. Can be a serious problem in the Alzheimer's patient.

I use <Ctrl>C and <Ctrl>V alot in AC. I'll just copy the list of diagnoses from a past encounter and paste it into the assessment area. I also have all the medicare screening codes as a template in the orders screen so I don't have to look those up for the Welcom to Medicare Physicals.

Hey Kevin,

How's Venice. I lived in Jacksonville and Orlando for 20 years. Yeah Ctrl C and V are nice. In fact, you don't have much of an option, because right-clicking brings up the templates. I still keep clicking it though. Old habits....

It's the whole blood-brain barrier thing.

Venice is great. Warm and sunny and quiet. Gulf coast retirement place, so everyone has at least 50% Medicare.

I would LOVE it if ALL the problems did NOT show up in the drop down box. They are there even when I make the problem inactive.

I would have to agree. I have no idea how this happened and I was able to fix it, but once the diagnosis "suspected child abuse and neglect" kept finding its way into the list. Wow, I am glad I caught that in a hurry. I would have had a lot of explaining to do after record transfers.

I find myself having to clean up the problem list pretty frequently . Short term problems don't seem to automatically go away like they do in real life. So the patient always has "ACUTE MAXILLARY SINUSITIS" on their summary page if I don't go through and inactivate these.

I can't think of an easy way to handle this. Perhaps a radio button in the ICD-9 chooser, designating acute or chronic? Automatically inactivate acute problems after 2 weeks?

Kevin,

I have always thought that there needs to be sort of a face sheet the way a paperchart has one. I could have forgotten since medical school, but PMH, diagnoses and a Problem List are all
different:

Diagnoses list with dates not included:

OM
URI
Sinusitis
Eczema
Fifth's disease

It's good to be able to have a running list to print out and also keep track of frequent illnesses such as ear infections.

PMH

Varicella
Asthma
RSV hospitalization
Myringotomy tube placement
Lobar pneumonia

While URI is a diagnosis, you don't need to include "cold" or URI in the PMH. It just isn't significant. But, by the same token, while you may want to know the patient has a history of Chicken pox -- for school entry or diagnosis of Shingles or pneumonia times one, these wouldn't necessarily be active problems.

I tend to define active problems as 1) conditions that can be included under assessment if addressed and 2) conditions I and, more importantly, my partner needs to be aware of to treat the patient effectively:

Diabetes
Hypertension
ADHD
Pulmonic stenosis
Autism

I don't know how many times I have seen a patient where there wasn't an updated problem list, and I have tried to order an Echo and the parent tells me, oh yeah, he has PS. Or, I see my partner's patient and think the patient has different behaviors, and she is autistic.

So, my point is these three things need to be separate. The PMH has a place. The only place the diagnoses are is in the "problem list" in the summary sheet which isn't a real problem list. It's a diagnoses list.

There is no real problem list.

What I would like is to open the chart, and the first window would be a "face sheet" which contained a list of diagnoses, a problem list with active and S/P, the active medication list and the inactive medication list and the allergies. You could then tab to the present encounter.

Finally, while we are on the subject, I think it would be cool if while on the sheet on the bottom there was a window which read, "Last assessment and plan." I know this is my laziness, but it is human nature to deal with what is in front of us. So, I see the patient for fever and diagnose it and sign the chart, and then the parent reminds me that the plan was to do an immune workup or get a CBC the next time he/she has a fever. That would have been in his/her last assessment and plan.

Sorry for the length of the post. Please correct me if I am off on the PMH, problem list and DXs.

Sorry, I forgot to say, obviously some of the above mentioned examples overlap, i.e. Asthma may be a PMH and an active problem.

That's ideal for kids, where the recent diagnoses are more important and the chronic problem list might be short. I actually don't use the summary sheet myself, since I would rather have a recent H&P, or the last detailed encounter. But the summary sheet is ideal for a partialist who can then see the chronic problems, recent acute problems, current meds and past meds. But if all the acute problems (really diagnoses since they are in ICD-9 form) are still in the active list, then it is just confusing. A lot of things that are PMH, but may not have much impact on medical care can be left off the geriatric PMH.

It just needs a major overhaul.

I could not agree more. This is a major irritation to me. As an Internist, I deal with a lot of the same chronic problems over and over. It would be so nice to just populate the Assessment field with the Summary problems (chosen either in total or individually selected) which should not include Ingrown Toenail. On the other hand it, as Kevin suggested, would be terrific to have some place I could go to see all of the the recurrent diagnoses I ever gave this patient. For instance, if this is the patient's 200th UTI I probably need to be alerted to this.

Leslie

And, at least you would be alerted to it if the Visit History went by diagnosis and not chief complaint.