Home Forums Discussions Problems I need problem list access in HPI

Hello All,

As a consultant, my follow up visits involve updating the status of 3-5 of 7-10 problems since I last saw the patient 6 months prior. As all of these diagnoses are in the problem list, it would be nice if I could Right-Click to select which I want to comment on, FROM THE HPI FIELD.

Is there a simpler solution to typing them out for each visit? The problems listed at the last visit aren't necessisarily the ones I'll update at the current visit so overwriting doesn't help me entirely.

Chuck

Chuck:

Try this. Go to the drop-down menu above the Assessment field, and select all the diagnoses that you are going to address at your encounter today. That menu draws from the Problem List under the patient's Summary tab.

It will look something like this:

# DIABETES TYPE II - CONTROLLED (250.0)
# HYPERTENSION - ESSENTIAL (401)
# HYPERLIPIDEMIA - MIXED (272.2)
# HYPOTHYROIDISM - UNSPECIFIED (244.9)
# DEPRESSION (311)

Now, select all, copy all, and paste all in the HPI field. Delete the unwanted verbiage, and you are left with:

# DIABETES:
# HYPERTENSION:
# HYPERLIPIDEMIA:
# HYPOTHYROIDISM:
# DEPRESSION:

Which makes very nice subject headings. I use this in conjunction with a wildcard filler template which fills in personal information, so I start my encounter with this in the HPI:

Mr. Fake Patient is a 39 year-old gentleman with the following problems:
# DIABETES:
# HYPERTENSION:
# HYPERLIPIDEMIA:
# HYPOTHYROIDISM:
# DEPRESSION:

Then I place my cursor after each heading, in turn, and start dictating with Dragon NaturallySpeaking. This has worked well.

Hello Brian,

That solution works for me.

I'm having trouble selecting multiple diagnoses from the list to copy, however. What key strokes do you use?

Chuck

Sorry, Chuck! I've been doing it all so long, it has become unconscious.

Click in "Assessment", hit "Ctrl-Right Click", and you get the option to "Select All", "Copy", "Paste".

With Dragon NaturallySpeaking, you just have to say "Select All" and it works, so I forgot that was a problem.

I was actually telling Jon last week, that we need Ctrl-A to work as "Select All" in the progress notes, as this does cause a lot of confusion.

Hi Brian,

This only copies the issues from the last visit. What I comment on today, may not be the same as last visit.

Does anyone know how I can access the entire problem list and copy into HPI? I can't do it from the Summary page either.

Chuck

Chuck:

Everything in your Problem List on the Summary Sheet should be accessible from that drop-down menu. Did you scroll down? You only have to pick out the ones you want to address.

If the patient has new problems that aren't on your old problem list, choose them with the ICD-9 search tool. They will be automatically added to your Problem List under the Summary tab, and they will also appear in the "Assessment" field. Copy, paste, and continue as above.

If I am misunderstanding your problem, please let me know.

Don't forget you can click and highlight a block of text, then type "Control - C" and that will be as if you right clicked and 'copy' in windows. Now go where you please in AC and click the field you want to paste in and type, "Control - V" and it will paste what you copied.

Ok,

It doesn't seem like I can just copy the entire problem list from the drop down menu. I need to click on an individual problem first, have it appear in the assessment window, THEN copy and paste into the HPI. Is this correct?

Chuck

Yeah, you probably want to just pick the diagnoses you want to comment on from the drop-down menu, or use the ICD-9 search. That way, they are added to the billing feature and/or the problem list.

You don't have to select them, then copy, then paste them, one at a time. Select all of them you want, and then copy and paste the whole block.

If you wanted to, you could go to the Past Encounters tab, select the previous encounter, and you would have the old problem list in a text format, and you could copy and paste the whole chunk.

For completeness sake, I will mention that you can go to the letter writer, act like you're going to type a letter on a patient, and check "Assessment" and the problem list from the last note will appear in text format.

Chuck,

If it makes you feel any better, I have been trying Brian's method tonight for at least an hour, and I have no idea. And, I know a couple of things about keyboarding. Guess I am going to have to go slay me a dragon, lol.

I have explained this until I have no idea how to further explain it. It is not automatic, but it is not hard.

If anyone is in tremendous suspense over this matter, I could perhaps demonstrate it to Bert over GoToMeeting, and he could translate it into English from whatever language I seem to be speaking.

Or, I can demonstrate it at the Users' Convention, and everyone can stare at me, slack-jawed and glassy-eyed, and say "Cotner, that is moronic. Why did you invest so much time in trying to explain that?"

And I will reply, "I have no idea..."

And, then I will get up and go over the instructions I sent everyone origianlly on how to install FAP. And, everyone will say, "How in the world do they have difficulty with that?"

But, seriously, I do think that when something comes naturally or automatically, you assume that the student is aware of one little thing they are missing. This is what makes tech support so difficult.

They have to treat everyone the same. When they talk to me, I am usually into the properties section on a device in device manager waiting on them. But, the next caller is still trying to find the My Computer and has no idea what a right click is. So, to them, right click on My Computer, gets the response, "Why do I want to do anything with your computer?"

Me too. I can't get it to paste the whole list in the Assessment window. When I control right click all I get is the 'paste' option, and then it pastes whatever was already on my clipboard. No way to select all of the problems in the drop down menu.
Which brings up another point Bert has harped on many times...PULEEEZE, can we fix it so only the REAL problems (HTN, DIABETES, HYPERLIPIDEMIA.....) are available in the scroll down menu. I hate having to sort through all the one-time issues to find the diagnoses appropriate for the majority of the visits.

Leslie

Amen!

I just figured out what you are all trying to do, and why it won't work.

You are all correct. You CAN'T select more than one old diagnosis from the drop-down list or from any list, using Dragon or any other means.

I was only trying to demonstrate to Chuck how I create problem-focused headings in my HPI section. I do this by selecting my diagnoses one at a time from the drop-down list in the Assessment section, just like you do, then selecting the whole list, copying and pasting it into the HPI. I then alter it as described above.

Of course, last month's problem list is still going to be in your new encounter when you open it, right? So what you are wanting to do is start a fresh one, using old diagnoses, and you are going to want them in a particular order. So, the best way would be to pick them out one at a time.

Once you have erased the diagnoses from the previous encounter, the quickest way to bring them back again is to go to the Previous Encounters tab, copy a previous Assessment section, and paste it in the Assessment portion of your current encounter.

If you want to clean up the clutter in the drop-down menu, you have to go to the Patient Summary, and mark all those one-shot diagnoses as "Inactive", or else delete them.

Well, at least I understand the process now. I tried it, and it was simple. Thanks Brian.

However, it still seems like a rather convoluted and lengthy workaround. I suppose I would work with it more if my pediatric patients had longer problem lists.

I think AC would work much better with a true face/summary sheet that popped up first. It would contain important facts like meds lists, problem lists, allergies, etc. Maybe you could select the problems you wanted.

This may not make sense, but our physician staff was averaging being behind 34 days on signing off notes and orders on the PowerChart for the hospital. When you signed in your patient list was first and then there was a tab for your signatures. All the hospital did was change the tabs so that your signature list was first. It dropped the lag time to 11 days overnight. Just because it was the first thing you saw, and you didn't overlook it. What does this all mean? I just wonder how much better patient care would be if a face sheet appeared first. I wonder if I would not wonder why a child was running all over the place as much as I do now if I saw on the face sheet he had ASD? Sure, it is in the PMH, but I don't review that first or at all for a simple bronchitis.

Make sense to anyone but me? Probably not.

Bert,
Makes perfect sense to me.
This is one of the reasons that we print a Summary Sheet for each patient to review at each visit; we give them a pen and tell them to correct any inaccuracies. The "patient corrected" Summary Sheet then goes with the patient back to the exam room and it is the first thing that I see. I then turn my attention to AC, correct on the AC whatever the patient has changed on the Summary Sheet (antibiotic Rx that they finished, Tobacco User Dx that is not longer appropriate etc.) and we begin the new visit.
It works great.

Jim,

I like your way. It keeps the patient involved. I have gone back and forth with my Excel spreadsheet idea that I tout on here every so often. Boy, you can make one hell of a face sheet with Excel. Just wish I had one employee that was an Excel guru.

Your way cleans up some of the mistakes. I also wonder how much your patients' seeing "Smoker" helps to cut back on that? Good study?

I have this weird thing that happens on my diagnoses list that maybe Brian can explain. It's rather comical at times although at one time it wasn't. For some reason I cannot explain (unless I was using this diagnosis in Bill Gate's chart -- my play chart -- the diagnosis "ZZ Top" made it into the database. It seems to have spread like a virus. I never notice it, because I don't do the Brian thing with the dropdown UNTIL I order an X-ray or something. Then, there it is, ZZ Top. I wonder how many have gone over, but I assume few, because the radiology department frowns on that diagnosis.

One time, the diagnosis SCAN started getting into charts. Now that is where your system could be either helpful or may not. But, yikes, if they transferred and someone read that.

Yeah, Jim's method is pretty cool, and he seems to get good results with it also.

Bert, I know this is a weird question, but what ICD-9 code number is associated with the diagnosis "ZZ Top"?

(I know there is one heckuva joke here, but I can't seem to come up with it).

ICD09 code: 123.ZZ

WGCAASDM

Don't you mean
EGCBASDM?

Yes, but the girls are now women, lol.

Does that stand for;

Every Girl Considers Bert A Sharp Dressed Man?

It all becomes clear to me now. Bert answers posts by day, then wines and dines super-models and foreign agents by night.

But wait -- Bert answers posts by night, as well!

So, when does he don his $2000 Prada sport coat?

Perhaps "Bert" is the code name for the leader of a secret cadre of Amazing Charts Guardian Angels. This would explain a lot, really.

Bert -- International Man of Mystery.

(P.S. - What was the ICD-9 code for ZZ Top?)

Damn, you are on to me. There are actually three Berts. Which allows me to answer many questions AND to have unique personalities in each, i.e. The EMRUpdate type, the Hijacking type and the nice one.

123.ZZ Has to be five digits and you won't get reimbursed.