CCHIT - Problem List

anonymous wrote on Sunday, January 24, 2010:

Please review the meaningful use requirements and proposed solution posted at http://www.openmedsoftware.org/wiki/Problem_List/.

Let us know what you think.

anonymous wrote on Sunday, January 24, 2010:

Wiki works a little differently than Web pages. Here’s the good link:

http://www.openmedsoftware.org/wiki/Problem_List

bradymiller wrote on Monday, January 25, 2010:

Thomas,
Is it ok to default to ‘none’ on your database entry. This seems to defeat the purpose of ensuring you ask the patient what problems they have, and then recording ‘none’ if they have none. Otherwise, might as well jsut not have a field and assume ‘none’ if no problems recorded.
-brady

ideaman911 wrote on Monday, January 25, 2010:

Hi All;

The link above shows the Issues for Meaningful Use Certification must have longitudinal - ie across all future visits.  Are we reinventing what already works?  If you check my instructions for Fee Sheet, they explain how to populate the various dropdowns as per the red pointer in the linked page.  By using the concatenate function, both the ICD code AND its description can be in that listing, which makes it easy to click in the dropdown once found using the search within the Add_Issue function.

Once that has been added to a patient record as an issue, it stays there for Ctrl-Click inclusion at any subsequent visit.  What of that process does not conform to the credential requirements?

Joe Holzer    Idea Man    315-622-9241     im@holzerent.com  or  joe.im0602x@gmail.com
http://www.holzerent.com  or  http://www.EMRofCNY.com

anonymous wrote on Monday, January 25, 2010:

Hi Brady,

I already thought about having the doctor to indicate “none” and saw no easy way of doing it without changes to the encounter form or Add Issues. Defaulting it to “none” seems to require the least amount of change/work.

To have the doctor check with each patient, the obvious place is in the encounter form. We can do something like this:

O Add Problem      O None
O Add Allergy      O None
O Add Medication      O None

What do you think?

==

Hi Joe,

There is no change proposed for Add Issues. We are dealing with how to record “none” for a patient.

sunsetsystems wrote on Monday, January 25, 2010:

Hmm.  If you already have ongoing problems recorded as issues, why do you need an indicator in patient_data?

Rod
www.sunsetsystems.com

anonymous wrote on Monday, January 25, 2010:

Hi Rod,

We can hide the “O None” option if the status is not “none” for a patient. So the status field is useful for that reason as well.

bradymiller wrote on Monday, January 25, 2010:

hey,

Seems this all depends on what the following MU phrase means: "At least 80% of all unique patients have at least one entry or an indication of none recorded. "

Are they asking for an 1) explicit none option, or do they simply mean 2) display a none if there are no recorded medical issues.

If 1) is the case, then requires some additional coding, however if 2) is the case, then this is already supported.

The allergy list also has the same issue.

-brady

sunsetsystems wrote on Monday, January 25, 2010:

The absence of issues would be “an indication of none recorded.”  This could be made explicit in the patient summary area (where issues, immunizations and prescriptions are listed) by simply displaying “None” where appropriate.  No way would I interpret this requirement to be one of adding a redundant field to the database itself.

Rod
www.sunsetsystems.com

bradymiller wrote on Tuesday, January 26, 2010:

I agree. Thus to fulfill MU for this, medications and allergies, seems that simply need a None displayed in the patient summary screen if no entries (I’m pretty sure Aron is planning or has already done this per a screenshot I remember seeing somewhere). Probably some work to be done on dealing with Rx vs Prescriptions, but agree don’t see utility in adding the redundant database fields.

-brady

anonymous wrote on Tuesday, January 26, 2010:

How do you measure the percentage then?

Meaningful Use Measures: At least 80% of all unique patients have at least one entry or an indication of none recorded.

Can we assume that no data entry means “none”?

sunsetsystems wrote on Tuesday, January 26, 2010:

Seems to me 100% of patients either have problem entries recorded or not.  Frankly this MU as stated is just dumb… the only way it can be less than 100% is if we don’t always show which is the case.

Rod
www.sunsetsystems.com

anonymous wrote on Tuesday, January 26, 2010:

CMS/ONC is pushing providers to use the Problem List (same with Allergy and Medication lists). So I would go for 1) option below:

Are they asking for an 1) explicit none option, or do they simply mean 2) display a none if there are no recorded medical issues.

This way, they can tell if a provider is actually using the lists.

bradymiller wrote on Tuesday, January 26, 2010:

hey,

There is no mention of ‘none’ in the problem lists, allergies, and medications lists in the tables here (maybe I’m missing something)(If there’s something there, I’d suggest looking at the wording carefully before thinking of using 1) ; going that route seems rather senseless):
http://edocket.access.gpo.gov/2010/E9-31216.htm

-brady

anonymous wrote on Tuesday, January 26, 2010:

Hi Brady,

I’m not sure how Federal Ruling works but I assume that it’s a high-level document. It doesn’t and won’t provide a detailed specification for EHR testing and certification. However, it does mention that EPs need to report quality measures to CMS.

So if we look at CMS document: http://www.openmedsoftware.org/mw/images/8/83/2009-31217_PI.pdf, we can see the required measures on pages 103-108.

bradymiller wrote on Tuesday, January 26, 2010:

hey,

“At least 80% of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry or an indication of none recorded as structured data”

The “indication of none recorded as structured data” has me perplexed. Perhaps 1) is needed here.

-brady

sunsetsystems wrote on Tuesday, January 26, 2010:

Well… if you can run a query “select count(*) from lists where pid = 123 and activity = 1” and the result is 0, can we not say that the 0 is “recorded as structured data”?

Perhaps the intent is to make the user acknowledge that there are no entries when that is the case, but that’s not what it says and I don’t know what that should look like.

Rod
www.sunsetsystems.com

bradymiller wrote on Tuesday, January 26, 2010:

I don’t know the answer here…
All I know is that this is a stupid sentence. Does CMS go into more specifics on this in their 100 page document?
-brady

drbowen wrote on Tuesday, January 26, 2010:

This just goes back to the old rule in medicine that if you do not indicate a negative response it means that you didn’t ask.  I always modify my problem lists to “none” if the patient has no medical problems.  This also applies to “Allergies” NKDA (No Known Drug Allergies), Medications “none” and Surgeries “None”.  This is what we refer to as “pertinent negatives”.  This is very important especially if you ever end up in a court of law.

Sam Bowen, MD

sunsetsystems wrote on Tuesday, January 26, 2010:

OK that makes sense.  So we need a way for the doctor to enter, for each patient and issue type, that he/she has checked regarding issues of that type and knows there are none.

I think this should be done via the Issues panel, but will let Thomas suggest a method.  Keep in mind that issue types are customizable… that is, the array $ISSUE_TYPES in library/lists.inc will be modified for some sites (yeah I know that’s not the ideal method, but that’s how it is now).

Rod
www.sunsetsystems.com