HPI (History of Present Illness)

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HPI stands for History of Present Illness. The HPI component of a note is required for all four levels of service. The history of present illness is the point of the patient’s visit where the health care provider obtains a subjective accounting of the patient’s symptoms, starting from when they began to what makes them worse.

There are 8 components that make up the HPI:

  • Location
  • Duration
  • Severity
  • Quality
  • Context
  • Modifying Factors
  • Associated Signs and Symptoms
  • Timing

The Evaluation and Management code allowed to be billed by the provider is affected, among other note sections, by the number of HPI components captured during the interview process. Allscripts Enterprise EHR is delivered with noteforms specific to the HPI section and is broken into two different categories:

  • HPI: Symptom
  • HPI: Problem

The HPI: Problem delivered content includes pertinent medical history components (Family, Social, Past Medical, etc.) that may be otherwise captured through the ACI in the EHR. Form properties are also defaulted to “Show Dictation Marker”, “Participate in AutoConfig”, “Show Brief by Default” (when one exists), and “Show Previous History”. Each organization will need to determine if they want to drive their users to the ACI to document past medical history or leave the medical history components in the noteforms.

  It is recommended to capture patient histories via the ACI, which will  
  populate the associated lists in the Clinical Desktop. This will reduce the 
  need for possible duplicate documentation of patient histories on future notes as well as capture these 
  patient histories as discreet data elements which means this data can be tracked and reported on in the future.

The second decision each organization will need to make is whether or not to 'Show Dictation Marker' and 'Show Previous History' in the noteforms. When modifying noteforms, the best practice is to “Copy” the noteform, make changes, then inactivate the delivered noteform.

Each section of the note holds a specific role in the documentation of the patient’s visit. History of Present Illness is an important part of the history collected for what the provider is evaluating the patient for. Ensuring that this note section receives some special attention is a worthwhile activity.