Epic HELIOS and Jackson Health Network Problem List – Transition to Epic February 2017 The problem list plays a more central role in the Epic EHR where for each patient a single list is visible across all venues of care (ambulatory, emergency department and inpatient). Currently Problem Lists are inconsistently utilized in NextGen as the JHN metrics have been driven primarily from ICD 10 billing codes. To prepare for this transition, JHN worked with the HFAH Epic team and MPM in establishing best practice for consistent use of the problem list prior to transition. Why use the Problem List? The patient’s problem list is shared across the care continuum and multidisciplinary teams. Patient problems are used for clinical decision support such as recommended order sets and as triggers for best practice advisories (clinical alerts). Patient problems are used as criteria for inclusion in chronic disease registries. JHN clinical metric populations will utilize these chronic disease registries with the transition to Epic. The problem list will become an integral part of documentation and facilitate accurate coding, problem oriented charting in the inpatient setting and prompting capture of CMS Hierarchical Condition Codes that drive RAV scores (ambulatory case mix index). The problem list will be visible to patients in the MyChart patient portal. A snapshot of the problem list will be included in the data conversion from NextGen to Epic. What should be included in the Problem List? The following provides definitions that differentiate encounter diagnoses from patient problems. Diagnosis This Visit Problems Active Across Encounters Diagnoses are associated with a particular patient encounter. The problem list is associated with and linked to a patient and crosses encounters. Conditions that are the reason for the patient’s visit, which may also appear on the patient’s problem list. An acute symptom while under active evaluation for a diagnosis, e.g., headache or abdominal pain. Once a diagnosis has been made, it should be replaced on the Diagnosis List as a replacement for the symptom. Acute minor problems that will likely resolve by the next visit, e.g., URI, minor rash, strep throat. Symptoms, unless the symptom is chronic, and a diagnosis has not yet been made, e.g. “chest pain” should be replaced by “angina pectoris.” Conditions that develop during the course of the hospitalization and require evaluation, treatment, monitoring, or increase the length of stay. DO NOT include resolved chronic problems or conditions from the patient’s past medical history that are no longer under treatment or have no bearing on the current medical care. Conditions that extend across encounters, which are usually chronic (e.g., diabetes, hypertension). Any condition requiring the ongoing use of scheduled or ordered PRN medications. Medical conditions requiring frequent laboratory testing for monitoring purposes. Chronic medical conditions that require continued treatment, screening or monitoring. Recurring acute medical conditions requiring evaluation or treatment e.g., recurrent urinary tract infections. An old problem not requiring current treatment which still influences current treatment decisions for other problems, e.g. history of DVT. Active or relapsing chemical dependency or abuse (including tobacco). Positive screening tests that will have an impact on continuing care or disease risk. DO NOT include resolved chronic problems or conditions from the patient’s past medical history that are no longer under treatment or have no bearing on the current medical care.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Epic HELIOS and Jackson Health Network
Problem List – Transition to Epic February 2017
The problem list plays a more central role in the Epic EHR where for each patient a single list is visible across all venues
of care (ambulatory, emergency department and inpatient). Currently Problem Lists are inconsistently utilized in
NextGen as the JHN metrics have been driven primarily from ICD 10 billing codes. To prepare for this transition,
JHN worked with the HFAH Epic team and MPM in establishing best practice for consistent use of the problem list prior
to transition.
Why use the Problem List?
The patient’s problem list is shared across the care continuum and multidisciplinary teams.
Patient problems are used for clinical decision support such as recommended order sets and as triggers for best
practice advisories (clinical alerts).
Patient problems are used as criteria for inclusion in chronic disease registries. JHN clinical metric populations
will utilize these chronic disease registries with the transition to Epic.
The problem list will become an integral part of documentation and facilitate accurate coding, problem
oriented charting in the inpatient setting and prompting capture of CMS Hierarchical Condition Codes that drive
RAV scores (ambulatory case mix index).
The problem list will be visible to patients in the MyChart patient portal.
A snapshot of the problem list will be included in the data conversion from NextGen to Epic.
What should be included in the Problem List?
The following provides definitions that differentiate encounter diagnoses from patient problems.
Diagnosis This Visit Problems Active Across Encounters
Diagnoses are associated with a particular patient encounter.
The problem list is associated with and linked to a patient and crosses encounters.
Conditions that are the reason for the patient’s visit,which may also appear on the patient’s problem list.
An acute symptom while under active evaluation fora diagnosis, e.g., headache or abdominal pain. Oncea diagnosis has been made, it should be replaced onthe Diagnosis List as a replacement for the symptom.
Acute minor problems that will likely resolve by thenext visit, e.g., URI, minor rash, strep throat.
Symptoms, unless the symptom is chronic, and adiagnosis has not yet been made, e.g. “chest pain”should be replaced by “angina pectoris.”
Conditions that develop during the course of thehospitalization and require evaluation, treatment,monitoring, or increase the length of stay.
DO NOT include resolved chronic problems orconditions from the patient’s past medical historythat are no longer under treatment or have nobearing on the current medical care.
Conditions that extend across encounters, which areusually chronic (e.g., diabetes, hypertension).
Any condition requiring the ongoing use ofscheduled or ordered PRN medications.
Medical conditions requiring frequent laboratorytesting for monitoring purposes.
Chronic medical conditions that require continuedtreatment, screening or monitoring.
Recurring acute medical conditions requiringevaluation or treatment e.g., recurrent urinary tractinfections.
An old problem not requiring current treatmentwhich still influences current treatment decisions forother problems, e.g. history of DVT.
Active or relapsing chemical dependency or abuse(including tobacco).
Positive screening tests that will have an impact oncontinuing care or disease risk.
DO NOT include resolved chronic problems orconditions from the patient’s past medical historythat are no longer under treatment or have nobearing on the current medical care.
Epic HELIOS and Jackson Health Network
Problem List – Transition to Epic February 2017
Best Practice Recommendation -
At Every Visit: Review and add, edit or resolve problem list entries appropriately.
Remember: any ICD billing code currently used to identify patients in Compass should transition to the problem list.
Problems that are Important to Identify for JHN Clinical Metrics
Inclusion Diagnoses: Chronic Conditions with JHN Identified Measures*
Diabetes Mellitus
Cardiovascular Diseases
Hypertension
Asthma (intermittent/persistent & severity), COPD
Heart Failure
ADHD
Depression, Anxiety, Bipolar Disease
Exclusion Diagnoses: Conditions that exclude from specific care measures*
Gestational Diabetes, Polycystic Ovaries, Chemically induced diabetes or due to underlying condition
Kidney disease and stage, Renal dialysis or transplant
Pregnancy, Dementia, Hypoglycemia
Respiratory disorders, Immune compromised state
Learn More about Using the Problem List in Epic -
For more information on the use of the problem list in facilitation of care visit e-learnings on Epic’s User Web1
at the following links:
Problem List Introduction
Problem Oriented Charting
This information is provided to demonstrate the importance of a problem list in Epic. Training in use of the
problem list will be included in the upcoming Epic training sessions prior to Go-Live.
If you have any additional questions about the use of the Problem List in Epic, please contact
Dr. Jon Sykes at [email protected]
*Complete identification of
inclusion and exclusion
diagnoses are on the 2017
Clinical Integration Program
Measures table and in the
operational definition for each
measure.
Epic User Web access is required at https://userweb.epic.com/. Use Allegiance Health email to register. 1
Problem List Use: Gateway Users January 2017
Adding a Problem in NextGen There are two ways to add a problem – while adding a diagnosis or through the problem list
Via Diagnostic Search
Click Add/Update → Problem → Identify diagnosis through the IMO Search
Mark Both on the bottom line to add problem to diagnosis coding and problem list
Search for diagnosis and click the + to add the final diagnosis
Diabetes diagnosis will be identified under
o Assessments for capture in current EHR
o Under Problem list for capture in Epic
Identify as Chronic or Resolve via Modify
o Highlight problem
o At bottom identify Chronic or Resolve
Epic HELIOS and Jackson Health Network
Problem List Use: Gateway Users January 2017
Via Problem List Template
Access Problem List template via icon at bottom of Patient Histories column (on right)
Click Add Problem → Search using Key Work → Highlight Problem → Click Select at bottom of template
Identify Problem as Chronic by clicking the box labeled Chronic
Resolving a Problem
Open Problem list via
Dx Icon bottom right
of histories
Highlight problem
Click Resolve
Check below to
validate date and
status resolved
Epic HELIOS and Jackson Health Network
NextGen Problem List 1.12.17
Page 1
Jackson Community Medical Record- Tutorials
Problem Lists
Adding Problem List Data
>Add/Update to search and enter problems on the Problems
Grid > Add to open the problem module
>Add Problem and the Diagnosis Search dialog box displays. >Search for appropriate diagnosis and Select to add the diagnosis
NextGen
Page 2
Document as needed and Accept to add the new problem to the patient’s
record.
Additional options are available for documenting problems. Select Resolve and complete information at needed and Accept.
Related Documents
