HPI (History of Present Illness)

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 an accounting of the patient’s symptoms, from when they began to what makes them worse.

There are 8 components of an HPI: Location, Duration, Severity, Quality, Context, Modifying Factors, Associate Signs and Symptoms, and 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. The Enterprise product by Allscripts is delivered with noteforms specific to the HPI and is broken into two different categories: HPI: Symptom and 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 AutoConfiguration”, “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 collection past medical history or leave the medical history components in the noteforms. The second decision they will need to make is whether or not to Show Dictation Marker and Show Previous History in the noteforms. When modifying noteforms 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.