Issues, Problems and History

OpenEMR Development
1

sunsetsystems wrote on Friday, July 28, 2006:

I have a client who is asking me to remove Allergies, Medications, Surgeries and Dental as issue types, leaving only Problems, and thus renaming Issues to Problems.  The removed types would instead be represented on the patient’s History page.

I can make this change an optional (install-time) configuration parameter, but if nobody wants issue types other than Problems then it might as well be the only choice.  If you are using issues, I would appreciate hearing from you!

Similarly, what would you like to see different in the History form?  I’m getting the feeling that there will be many different individual preferences with that, and so we may want to make it modular and easily replaceable like the encounter forms are.  Comments?

Thanks,

Rod
www.sunsetsystems.com

2

drbowen wrote on Friday, July 28, 2006:

Having the "problem list" on the front page is required.  A "proble list" should incude medical problems, medications, allergies and surgeries.  Having the immunizations in this page is very nice.

That is not to say all of these have to be managed on the same “issues” screen.  If fact I do’nt think of medications, allergies and surgeries as “issues” though other practice styles might differ.

Perhaps the medical problems "issues" should be seen on the problem list as it is now seen but clicking on the medical problems "issues" area takes you to a different management screen.

This is similar to the way the immunizations work now.

Unltimately it might be better if each of the different areas medical problems, medications, allergies, surgeries, dental problems, and immunizations each has a separate management screen.

For quality of care, they all still need to displayed as a single "problem list" displaying the medical problems, medications, allergies and surgeries all on the first patient summary page.

This is a quick, one page snapshot of who this person is from a medical standpoint.

3

drbowen wrote on Friday, July 28, 2006:

The "History" screen really is a misnomer.  This page reflects both "Social History": like drinking lifestyle and marriage status.  And "Family History" what things run in the patients family.

There is also a small section of "preventive medicine" in terms of what kind of routine screening has already occurred.  This section would be better if it was context dependent based on age, sex, cultural identity, "Issues" such as known diabetes mellitus, hypertension, cholesterol adn family history with known risk factors such as known premature coronary disease. First degree relative with breast cancer, ovarian cancer, colon cancer, melanoma.

4

markleeds wrote on Friday, July 28, 2006:

That’s where form-based history would be useful.  You could pick the form(s) appropriate for the patient.

5

michael_barnett wrote on Sunday, July 30, 2006:

I agree i think it should be moved to history and taken off the encounter form.

Put it in the menu so each can be selected
that way they can look for medications alone or surguries or whatever without it all being lumped onto the same form

6

tekknogenius wrote on Monday, July 31, 2006:

Having it listed on the summary form should remain the same. The fewer clicks one needs to access information the better.

7

drbowen wrote on Monday, July 31, 2006:

I do not like the idea of moving this information to the “history” section. 

The medical problems, medications, allergies and surgeries should be grouped together and displayed as a problem list.

The “history” section is a misnomer and should likely be renamed Social – Family History

The charge codes are grouped to follow the classic form of a medical “History and Physical”. The traditional order is:

Chief Complaint

History of present illness

   location
   quality
   intensity
   duration
   radiation
   exacerbating conditions
   relieving conditions
   station (sitting, standing, lying)
   timing
   associated symptoms

Past Medical History

   Medical Problems
   Medications
   Allergies
   Surgeries

Social History

Family History

Review of Systems

   general
   eyes
   MEN
   Respiratory
   Cardiovascular
   GI
   GU
   Psychiatric
   Neuro
  

Physical Exam

This is how we do our highly organized information gathering.  Its important for billing purposes and organization of information to not deviate to far from this.

The section:

Past Medical History

   Medical Problems
   Medications
   Allergies
   Surgeries

Makes up the “Problem List”.  This is a quick one page summary of who the patient is medically and should always be placed on the most prominent part of the chart for immediately available access at all times.

Moving medications, allergies, surgeries to the “History Section” is not a good idea.

The “medical problems” should perhaps have their own “module” similar to the “Immunizations” since these do lead to new problem specific encounters and could be used to initiate new encounters in a problem specific way.

The Medical Problems still are the first part of the “Problem List”.

Sam Bowen, MD