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Topic starter
By way of introduction, I work with Health First Physicians in Melbourne, FL.
Recently, our Medical Director posed a question about standard practice for Centricity users.
What components are generally accepted for inclusion with the following templates:
- Past Medical History
- Family History
- Social History
I am particularly interested in components included where Centricity users have opted to create their own versions of these categories.
Kindly,
Steve King, MBA, MEd
Posted : April 4, 2012 5:02 am
If I understand what you are asking, we seem to different opinions about this among our 45 physicians. The majority feel that past medical history is problems that are not currently active. We have developed our own forms and collect the family history and social history that each specialty wants.
Posted : April 12, 2012 3:03 am
Topic starter
mbellis said:
If I understand what you are asking, we seem to different opinions about this among our 45 physicians. The majority feel that past medical history is problems that are not currently active. We have developed our own forms and collect the family history and social history that each specialty wants.
Hello,
Yes, this is helpful. My Medical Director has been trying to ascertain current ideology.
Thank you.
Posted : April 15, 2012 11:08 pm
Agree completely that Past Medical History is best used for historic information "a narrative" of the patient's history. I do not believe that it should be used to simply list active problems. There are much better places (e.g. the problem list) to document active issues and their assessments and plans.
The best approach I've seen is to use PMH as a place to collect historic details like "Cardiac cath done at the VA in 2003 showed 3 vessel disease so PCTA done by Dr XYZ". Such a narrative will be correct and useful over time. It is best not to include time sensitive information like future plans and short term issues because these might be incorrect the next time the patient is seen.
Good to set up this understanding in advance because there is a common misunderstanding about the intention of PMH. Remember, we providers are all conditioned from dictating admission H&P's during residency training. Those traditionally start with HPI (current issue) and PMH (patient's problem list) so it is understandable why providers equate the PMH with the active problem list. In the EMR this element of an H&P is done using both the Active Problem List and the PMH. Then you've covered all the bases.
Sue
Susan Thomas MD FAAFP
Posted : April 16, 2012 3:52 am
Topic starter
DrSue said:
Agree completely that Past Medical History is best used for historic information "a narrative" of the patient's history. I do not believe that it should be used to simply list active problems. There are much better places (e.g. the problem list) to document active issues and their assessments and plans.
The best approach I've seen is to use PMH as a place to collect historic details like "Cardiac cath done at the VA in 2003 showed 3 vessel disease so PCTA done by Dr XYZ". Such a narrative will be correct and useful over time. It is best not to include time sensitive information like future plans and short term issues because these might be incorrect the next time the patient is seen.
Good to set up this understanding in advance because there is a common misunderstanding about the intention of PMH. Remember, we providers are all conditioned from dictating admission H&P's during residency training. Those traditionally start with HPI (current issue) and PMH (patient's problem list) so it is understandable why providers equate the PMH with the active problem list. In the EMR this element of an H&P is done using both the Active Problem List and the PMH. Then you've covered all the bases.
Sue
Susan Thomas MD FAAFP
Dr. Thomas,
Thank you for a very thorough answer to my query.
Posted : April 16, 2012 4:10 am
I agree with what I think are Sue's main points (she and I have discussed this more than once, right Sue?):
- The problem list is more like an index of current and past problems. It can provide an overview. It is also composed of tagged data and therefore lends itself better to automated data processes like point of care decision support, generation of letters or reports, audits.
- The PMHx is more like the story of the patient's medical journey. It can be nicely granular and can give a much more useful picture than an index or list.
There are some caveats:
- As she says, it is essential that all the users be on the same page about how to use this. People do not like having their carefully crafted narrative nuked by a copy-paste or quick-text list.
- It requires doing some work twice. It is pretty common to have significant differences between the two sources of information, with some problems appearing in only one of the two places. This means clinicians potentially need to enter information twice, in two places, and review information twice, in two places, to make sure they are not missing something.
- Almost everything generated for letters and reports comes off the Problem List, not out of PMHx. This means that what many of us use for transmission of information during transitions does NOT include the more detailed and useful information in the PMHx.
Peter
Posted : April 16, 2012 5:16 am
Topic starter
eliasp said:
There are some caveats:
- As she says, it is essential that all the users be on the same page about how to use this. People do not like having their carefully crafted narrative nuked by a copy-paste or quick-text list.
- It requires doing some work twice. It is pretty common to have significant differences between the two sources of information, with some problems appearing in only one of the two places. This means clinicians potentially need to enter information twice, in two places, and review information twice, in two places, to make sure they are not missing something.
- Almost everything generated for letters and reports comes off the Problem List, not out of PMHx. This means that what many of us use for transmission of information during transitions does NOT include the more detailed and useful information in the PMHx.
Dr. Elias,
Thank you for your additional insight. I am married to a provider who shares the frustration that duplicity of effort seems unavoidable. It is a good point that culled information arises from the Problem List and not out of the PMHx - thereby effectively eliminating that information in transition.
Posted : April 16, 2012 5:23 am
