Topic

Level

Presenter(s):

Bob Murry, PhD, MD

VP Clinical Product Management

Problem Based Charting in KBM 8.3.10

200

CME Disclosures

Learning Objectives - After completing this activity, attendees should be able to:

- List two techniques for utilizing EHR templates to manage multiple chronic medical problems.

The planners and presenters of this activity have no relevant financial relationships to disclose. No commercial support was received for this activity.

NextGen Healthcare is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

NextGen Healthcare designates this educational activity for a maximum of 1.25 PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CNE Disclosures

Learning Objectives

After completing this activity, attendees should be able to:

- List two techniques for utilizing EHR templates to manage multiple chronic medical problems.

The planners and presenters of this activity have no relevant financial relationships or conflicts of interest to disclose.

NextGen Healthcare designates this educational activity for 1.25 nursing contact hours.

To receive CNE credit you need to: 1) Attend the entire session; and 2) Complete and submit the session evaluation that will be emailed to you, within two weeks of the email date.

NextGen Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

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Outline

• The Problem Oriented Medical Record

• Tour of HPI Chronic Conditions template

• Use of template in real workflows

• Demos

The Problem-Oriented Medical Record

Problem-Oriented Medical Record

• POMR originally defined by Dr. Larry Weed in 1960’s

• Contrasting “source-oriented” medical chart

• Complete and accurate problem list organizes chart and

clinical activities,

• Active/inactive

• Notes & “backstory” for each problem

• Subjective & Objective data for each problem

• Plan for each problem

• Especially important in team-based care environments

POMR hints

• Define each problem at its highest level of defensibility

• Decide WHO will “maintain” the problem list

• Editing problem notes, keeping mappings up to date, and resolving problems are routine activities

• Consider overall assessment (or plan) as opportunity to synthesize problems into cohesive whole, and establish priorities

In NextGen, use the new (in KBM 8.3.10) Chronic Condition HPI template

HPI Chronic Conditions

KBM 8.3.10

• SNOMED-CT® Problem List• Ability to edit Problem List without opening module

• On Home Page, Histories, Assessment & Chronic Conditions HPI templates

• Ability to modify the Problem description

• Ability to see (and change) the ICD code and description (also editable) associated with Problem

• Better display and editing of Problem Notes

• Chronic Conditions HPI template• New, enhanced, single HPI template for charting on chronic

conditions

• Better layout and tighter functionality

• Template is not a popup, so can open other sections of EHR while charting

Template Overview & Tour

Launching Chronic Conditions HPI

Launch from SOAP (or Intake)

HINT – Remove “chronic conditions” from

reason for visit list

On “Framework Content” system template

Chronic Conditions Addressed Today

Not a popup – keeps SOAP open

can open other modules

Template Overview & Tour

Panel Overview:

Main panel

Medical Chart Summary

Care Guidelines

Main Panel

Main panel – expand problem list

Main panel – problem descriptions and

mappings

Main panel, problem notes

Main panel - HPI

Main panel - Plans

Medical Chart Summary panel

• Check previous HPIs and Plans

• View diagnostics, labs, vitals, PEs

Template Overview & Tour

Documents

Document – HPI section

Document – Problem List

Document – Assessment/Plan section

Document – Patient Plan

Workflow & Demos

Workflow – Adding new problems

Notice they automatically have status ‘chronic’

Workflow – mappings & descriptions

Icon showing problem description has been edited

ICD description will show on patient plan, should be

patient-friendly

Workflow – mappings & descriptions

• Note icon showing problem description has been edited

• ICD description will show on patient plan, should be

patient-friendly

Workflow – Keeping notes up to date

[Need screenshot]

• Each user only has ONE note per problem

Workflow – Notes HPI

Demo

Workflow HPI Plans

Workflow – jumping problem to problem

Workflow – “Oh, by the way”

Workflow – billing • Statuses are key

• Can use overall notes to describe multiple problems at once

Workflow – screening questions

Workflow – screening questions

Workflow - Lab Review

Workflow – Lab Review

Workflow - Exclusions

Demo

Workflow – other places to maintain Problems

• Assessment template (Add/Update Assessment)• Edit problem description

• Re-map Problem ICD code

• Edit ICD description

• View / edit problem notes

• Home Page & Histories Page – problem list panel• All above

• Edit onset date, clinical status, side site, etc.

• Resolve problem by entering resolved date; prompt for resolved to Past Medical History

• Problem Module• All above (except resolve to PMHx)

• Edit Responsible Provider, mark recorded elsewhere, etc.

Assessment Template

Workflow –Home Page/Histories panel

Resolve problem to past medical history

Workflow – what’s left for the module

• Hint – click on Problems badge in Patient Info bar or Inbox

• Hint – Right-click “ungroup” / “group”

• Remap problem to another code as condition evolves

Demo

Workflow – ICD-10

• You can convert all problems to ICD-10 from module

• SNOMED ICD-10 mappings are not always great.

Use the remap diagnosis functionality on

• Chronic Conditions HPI

• Assessment Template

• Home Page or Histories Page

What’s coming in 8.3.11 (tentative)

• Able to copy previous chronic condition HPIs

• Able to copy previous assessments and plans

• Care guidelines changing back to link at top

• Problem list hover in PAQ (UD3)

Conclusions

• Keeping an accurate and up to date Problem List can

help you organize your charts and your visits

• The KBM 8.3.10 Chronic Conditions HPI template has

features making this a natural part of everyday charting

Any Questions?

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