EMR Problem Lists: common failures

I disagree,

The EMR has the ability to inidcate why a problem was deactivated, who deactivated, and for what reason.  EMR's have to have flexable Problem Lists that can be added to and in which the ICD9 codes can be added to and edited by the end user.  Everyone knows, the basic ICD9 Codes are Useless and differ in use by Specialty.  Therefore, it would be better to have a problem list that is detailed, easy to add to and edit while tracking all of the user actions.

The View mode can be simple and customized to practrice type, for example this one for Cardiologist office with ID info taken out.  Clicking on any Edit Item gives you the history realted to this problem and comments thereto:

Or more detailed in Edit Mode

I don't know with whom to agree or disagree...

I personally like Gil's format, but in a more paragraph form. This format is what is seen in most charts and has sufficient to follow a patient closely. I figure that this would be the format that would go into a CCR-like database, no?

Brendon's format is very complete and is seen in many EMRs, but not condensed enough and could be a workflow killer if it forces you to take an extra 5 minutes to put in extra trivia, interesting as it is, for each and every diagnosis. It can lead to mistakes and confusion, too:

• For example, "multiple fractures"- "episodic". What exactly does that mean? I'd rather see something like: "Fx collar bone in '97, fx ankle in '02, fx neck and is now paralyzed in '05."
• "Sciatica" - "episodic"... should be "Sciatica (since 2001).
• "Unspecified Cellulitis"... I would prefer "cellulitis left leg (hosp 4/06, 5/07, amputated 11/07)
• "Arthritis Rheumatoid"... is "continuous", not "episodic".

That's the way we were taught to do things in medical school. I guess I could somehow get used to Brendon's (and Chase brothers) way of doing it... but it would be like going from my Acura to using a Jeep. Just not the same... there are some intricacies of the past medical history that are best done the way we've been taught to do it.

AL,

The physician and nurse simply put in the On-Set Date and the Continue Diagnose gives them a comment field, like Patient is doing better... etc...

Our physicians find it easy to use.  It simply shows the Problems as the Physician has configured them in his drop down list.  We also provide the Text edit at this stage for the Physician that is die hard to typing Linear Noteations untied to any real Problem Code.  None of our Physcians use this function as after one meeting they can usually build there practice defaults.

For your example above, it would display in the comments under history "Left Leg"

 Your linear format is like our On-Set Date, but not exactly.  The data is put in On-Set Order, which is not necessarily Chronological to the events at hand if they were just entered by hand.

In any case, I think we are more talking 6 one way, half dozen the other.

But if you want to know how many patients are of Diagnosis XYZ and using Medication 123 you better have it codified somehow.

Cheers,
Brendon

Medications need to be listed separately only because they need to be used to write prescriptions... The diagnoses don't really need to be listed except for the insurance company pinheads who need the information for P4P..

I don't follow.  All of our primary doctors like to see the Problem List first so they can get a feel for the problems of the patients without having to read through previous notes.

I agree if a note is chonological and just gets longer, maybe this would be somewhat easier.  But then again, what if something important is 3 years back in the note.

I thought Problems being viewed separately by a Physician was a basic need.  Anyone else on this matter.

 DescriptMED handles these with either a Cover Sheet (incorporating Acute & Chronic Problems, Health Maintenance, Presciptions and Discontinued meds - giving a one screen snap shot) or a Problem List screen.   The Problem List screen allows users to cutomize buttons for quick entry and add notes e.g. Treatment.   If a patient has an "open" problem the user is alerted quietly by a change in color of a button or by a label display on certain screens.

Gil,

They don't enter edit mode unless they are entering data or really needing a complex view of the history. 

Al,

They don't have to give a reason for deacivation of a problem, just a medication.  They usually add comments in the deactivation reason if they have time.

The product is relatively simple in that you can get data into the history  of a problem many different ways, but in the end you can view the history with just a double click on the problem and then review in Chronological Reverse Order.

Here is a screenshot of the problems for 20 items on a elderly real Cardiology Patient Deidentified for a 180 patient a day 6 provider Cardiology Practice:

And by double clicking on a problem, like I did on the Blue Highlighted Item there, you can get the history for the item.  By right Clicking you can add items to the problme.  Of course there are many different places where this commentary and history gets updated.   Here is the history, double click, less then a second, then Ok button to close.  I don't really see many of our physicians clicking every Gosh Darn problem in the list.  Oh looks like you had Chicken Pox, let me see when you had it was it age 8 or 9.  Yeah right.

Gil, our practices can configure or add any problems they want to the Practices, Individual Physicians, or All category.  It is easy for say the primary care provider to have one diagnosis for unspecified condition of the heart and for the cardio doc to have 10 entries custom for the same diag code, unspecified condition of the heart.

I think again we are talking 6 one way and a half dozen another.  In the end though all these data elements are used in many different places in different ways by different practices.  So the EMR has to be able to accomodate all these different users needs, not be built around any one mans concepts.

eMedRec is the compilation of ideas from over 50 active Beta Physicians.  In reality we don't know crap about Medical Environments (After 18 years we have learned enough to be dangerous), that is why we let our users tell us what the hell they want and we build it for them after concensus from nearly all the providers.

Regards,
Brendon

I like everything on one form:

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Cheers,

Al