A few months ago, Dr. Michelle Rasmussen wrote an article regarding how the ambulatory problem list is affected when altered in the inpatient setting. Many of us were surprised to learn that and now ask ourselves, "How do I use the problem list appropriately for my inpatients without adversely affecting the ambulatory patient list?"
Test these suggestions out in your own Epic screen:
First, declutter your view. If you don’t want to see past problems on your Problem List screen, hide them by unchecking the “Show Past Problems” box in the top right of the screen.
To minimize the impact on the patient’s PCP (or others in the ambulatory setting), we suggest hiding rather than deleting problems in case the ambulatory provider(s) might want a comprehensive history. Deleting a problem removes it both in the hospital and the ambulatory settings. Resolving a problem will usually be your better option, since the problem will still be on the list.
Second, prioritize your problems. If you hover over an active problem, you will notice an icon appears that looks like two little gears. Click on that icon, and more action choices will appear. Here you may choose to resolve a problem, share it with your patient (in MyChart), delete it, etc. You may also mark an active problem as a “hospital problem” or the “principal problem.” You have the option to prioritize them as high, medium or low.
Third, review past problems. Hovering over a problem under “Resolved Problems and Past Medical History” will give you that same gear icon, but a different set of options will appear. You can add the problem to the problem list as active or as resolved, add it to the medical history, delete it from the past medical history, etc. Remember that if you want to see these past problems, you must re-check the box at the top right of the screen that we unchecked in our declutter step.
You may tag the problem as a “hospital problem” by clicking on the diagnosis name, then on "details." Here you may choose to answer multiple questions about the problem.
Again, be very careful not to delete a problem that should be listed in a patient’s history since that will affect the chart whether inpatient or ambulatory. Resolving a problem allows it to remain on the list where it can be reactivated if needed.
Finally, if you’d like to use the problem list in your assessment and plan, you may do so by typing .shprobl. This will pull the problem list in so that you may document your plan under each problem. It will not be refreshable, but it does allow you to use the work you’ve put into your patient’s problem list.