QuickHPI (History of Present Illness)

About This Software

QuickHPI is a tool for recording the History of Present Illness in a concise, easy to read format. Simply fill out the form, click a button and your note is ready. Make changes and update it as many times as necessary. When you are satisfied with your work, paste the text into your favorite EMR, database, or word processor. Enjoy! RR

Design Goals

• Striking a Balance Between Clicking and Typing
• Many HPI forms have too much specificity for use in primary care. They tend to have fields of buttons where a few typed words would be faster and more precise. Quick HPI avoids this trap by using text fields where buttons just get in the way.
• Platform Independence and Best Practices
• The widespread adoption of EMRs has had deleterious effects on the HPI. Each proprietary system has its own set of templates that are generally not accessible for open review and discussion. This inhibits collaboration, quality improvement and research. QuickHPI is open source and available to anyone with a web browser. Based on input from a growing number of users, quickHPI will reflect a consensus on best practices for clinical documentation.
• Support for Problem-Oriented Charting
• Each quickHPI session generates an HPI for a single problem. If there are two or more problems you may go through the process as many times as needed. You should avoid duplication as much as possible. The text generated is compatible with SOAP, APSO, H&P, and other problem-oriented note formats.
• Drawing a Bright Line Between Associated Symptoms and the Review of Systems
• Healthcare in the US is all about rules. This includes documentation required for billing. From a physician's perspective these rules are rather arcane. One casualty has been the outpatient note. In order for coders and auditors to efficiently review our notes, symptoms must be put into categories and certain key phrases must be present. Otherwise we run the risk of not being paid! A sad situation, but there it is. To a coder (and an EMR) a symptom is a symptom is a symptom, regardless of its clinical significance. This has led to the bad practice of including non-relevant symptoms in the HPI. Associated Symptoms (positive or negative) should be pertinent to the problem under discussion. The Review of Systems is just a series of questions without context.
• Format Notes to Facilitate Visual Scanning and Rapid Assimilation of Information
• The phenomenon of Note Bloat is becoming a significant problem in healthcare. EMRs make it easy to build lengthy notes with a paucity of useful information (ie, low signal to noise). Synthesized paragraphs may actually obscure key findings! Even worse are the errors introduced when information is repeatedly copied (garbage in, garbage out—GIGO). QuickHPI generates notes in a structured format that minimizes the amount of non-informative text. This is referred to as the Least Ink Principal…
  • The best clinical documentation is that which gives to the reader the greatest amount of information in the shortest time with the fewest pixels. (Paraphrased from Edward R. Tufte The Visual Display of Quantitative Information)

Click the info buttons for additional documentation.

Built with Bootstrap. Revision History: 1.0 Initial Dev Release November 2014; 1.1b First Stable Beta; 1.2 Added Persistent Data; 1.2r Re-Release with CC License

Bugs and Workarounds: IE9 Textarea Newline Bug (use alternative browser); IOS7/Bootstrap Slow Typing Bug (save as a web app)

A Note About Offline Use: QuickHPI was designed as a Web App. This means you can use it without a network connection. To take advantage of this feature you should Add to Home Screen (iOS) or otherwise save this page on your device. A new icon will appear on your screen. Two things should be different: the App runs separately from normal web pages and it will continue to work even when you are offline. Nice!

There is a problem however when it comes to updates. Because the App page is persistent on the device, it will never download a newer version. Depending on the browser this may also extend to the online web page as well. The solution is to force the device to forget it has a local copy. This generally requires two steps: deleting the app itself and then purging the web data stored by the browser. Once you've done both, just reload the page and save the new App as described above.

About the Author

Richard Rathe, MD was an Associate Professor of Family Medicine at the University of Florida (now retired). He is a former NLM Informatics Fellow at the Harvard School of Public Health. He taught medical interviewing for over twenty years.

Disclaimer

This program is provided as is, free of charge, for use in medical education and patient care. The Author has made every effort to ensure that this program meets all professional and legal standards. However, all software is subject to errors and changing requirements, which leads us to the next paragraph…

There is no guarantee of suitability for any specific clinical, educational or business purpose. The Author nor the University of Florida assume liability for the use or abuse of this program. No patient data are sent to, stored on, or processed by the server. Everything lives in the browser on your device! You should take normal precautions to avoid disclosing patient identities and other health information.