1. 1 Creating Specialty-Specific HPI Content Using CCC Text File Editor Michael Zaroukian, MD, PhD Michigan State University

2. 2 This session is for those who want to… Create custom HPI content for any problem or symptom Customize HPI content by specialty or location of care Get HPI forms you need fast Organize and speed HPI documentation Automate counting of HPI elements for E&M coding Get automatic prose text translation

3. 3 Objectives Overview of HPI-CCC Specialty-Specific Tab –What it looks like –How it works Customizing CCC HPI content for your needs –Creating content –What the finished product looks like

4. 4 Specialty-specific HPI: HPI-CCC Form

5. 5 Spec-specific HPI: Text Translation / Flowsheet

6. 6 Spec-specific HPI Categories you can use –Onset –Intensity –Complains of / Denies –Up to 6 more categories of historical data

7. 7 Spec-specific HPI: HPI-Spec-Specific Editor-CCC Examples of other categories you can use –location –radiation –aggregating / relieving factors –therapy (effective, ineffective) –associated symptoms –risk factors –prior evaluation –PMH / SH / FH –psychosocial factors –problem-specific ROS

8. 8 Additional Features of the HPI Specialty Specific Tab View/Insert Prior HPI (can be specialty-specific) All values can be linked to Obs Terms (structured – can drive decision support) Even if not linked to Obs Term, will automatically calculate and check the appropriate history for E&M Advisor –brief = 1-3 elements –extended = 4 or more

9. 9 Before You Request a New SS-HPI Form Check the catalog for an existing HPI problem or symptom May be one in more than one specialty If you see one you like, ask to have it put in your specialty drop-down list If you see one you want to edit, start with the existing one and make your edits

10. 10 The SS-HPI Catalog Can be viewed at: www…

11. 11 Building SS-HPI Clinical Content Starting with a Worksheet

12. 12 Building SS-HPI Clinical Content Completing the Worksheet Start with the desired HPI end result –Hypothesis-driven questioning? –Evidence-based history? –Inform decision support? –Relevant PMH, FH/SH, ROS –Facilitate E&M coding and compliance? List the diagnoses to be considered Decide what questions to ask –Clinician input ± knowledge source needed Organize into historical categories (Onset + Intensity + 8 other categories)

13. 13 Categories and Number of Required Elements for E&M Coding Timing Severity Signs and symptoms Quality Location Duration Modifying factors Context *Listing status of 3 chronic problems counts as comprehensive HPI

14. 14 SS-HPI Use Case Example: Diarrhea

15. 15 Building SS-HPI Clinical Content Diarrhea Worksheet - Draft

16. 16 Building SS-HPI Clinical Content Winnowing List to 8 (if Needed)

17. 17 Testing Your New SS-HPI: Step-by-step Log in to EMRLog in to EMR Select a patientSelect a patient Start Chart UpdateStart Chart Update –*1-CCC-V8 Select Specialty- Specific TabSelect Specialty- Specific Tab Look for your new problemLook for your new problem SelectSelect categories categories Click RefreshClick Refresh

18. 18 SS-HPI Test Drive Select Onset, Intensity and 1+ items from each categorySelect Onset, Intensity and 1+ items from each category Click to Insert TextClick to Insert Text Inspect Final Text for accuracyInspect Final Text for accuracy Inspect elementsInspect elements View noteView note

19. 19 Questions and Comments