What is the History of Present Illness (HPI)?

The history of present illness (HPI) describes the symptoms and details of the patient’s current condition or complaint, obtained via a set of interview questions. These questions are essential for determining the root cause of the complaint. 

HPI questions are often asked in combination with a review of systems (ROS), which assesses various organs and systems, and a physical examination. The HPI questions often uncover key insights that improve the accuracy of the diagnosis.

Once established, the HPI becomes a component of the patient’s medical history, helping to determine future treatment choices.

Why the History of Present Illness (HPI) is Crucial in Medical Diagnostics

HPI is an essential aspect of medical diagnostics because not everything is visible on the surface, and even thorough physical examinations don’t always provide all the facts. A patient can tell you where their pain is, if they’re experiencing fatigue, or any emotional component of the complaint — facts that are impossible to uncover without proper questioning.

For physicians who use the SOAP (Subjective, Objective, Assessment, Plan) framework or thought process for notes, HPI is part of the “Subjective” section — because the information is all provided based on the experience of the patient or their representative.

Discovering the Root Cause of Symptoms

Even brief HPI questions help determine the root cause of symptoms. For example, if someone’s chief complaint is abdominal pain, you could ask, “When did this pain start?” and “What did you eat that day?” This might lead to tests for food allergies or intolerances.

Reducing Diagnostic Errors and Unnecessary Testing

Extended HPI questioning reduces the need for unnecessary tests. If a patient has bruising, but you ask if they’ve had any falls or slips lately, you may uncover that the bruising is due to a tumble and unrelated to the complaint. Without questioning, you might send the patient away for procedures that are both uncomfortable and unnecessary. 

Narrowing Down Differential Diagnoses

Extensive yet focused questioning can narrow down a single diagnosis when symptoms may indicate several possible root causes. For example, chest pain is often assumed to be heart-related. Thorough questioning may uncover a recurrent problem with gastric acid and no history of heart trouble. There may be associated signs that also point to a digestive complaint. As long as there are no dangerous symptoms, the physician may then go on to prescribe treatments for gastric ulcers or investigate accordingly.

Better Documentation

HPI allows a clinician to ensure their patient records reflect an accurate history and are packed with data that will help the next person who sees that patient. If a physician can quickly see that during the last examination, the patient advised they had recently started a vegan diet, they don’t need to ask questions about possible dairy intolerances, for example. This saves time and frustration for the patient and helps move toward positive outcomes faster.

What Questions Are Asked in an HPI?

While mnemonics like OLD CARTS are popular (Onset, Location, Duration, Characteristics, Aggravating factors, Relieving Factors, Treatments tried, Symptoms), they can be restrictive. Examining physicians should tailor their questions to the patient and use one piece of information to springboard into another. For example, if the patient says “Yes” when you ask if they’ve been coughing, you can next ask if the cough is productive, painful, or leaves them short of breath.

Examples of Appropriate Questions for HPI

Some sample HPI questions healthcare providers may use to understand a patient’s story include:

• What medical problems bring you in today?

• What medical symptoms do you have?

• When did you begin to see these symptoms?

• Do you have a past medical history of the specific type of illness/symptoms, or has a close family member experienced these symptoms?

• Do the symptoms get better or worse or remain consistent?

• Have you had any major procedures or illnesses in the previous 12 months?

• What helps relieve the symptoms, and what makes them worse?

• Have you experienced any weight loss or gain?

When patients have numerous symptoms, or there is no clear evidence to lead to a diagnosis, practitioners may wish to expand further. This may include asking for a chronological description of the development of the patient's symptoms to help understand the risk factors associated with various symptoms or possible root causes.

History of Present Illness in Today's Healthcare

Since the combination of HPI questioning and a physical exam has proven useful in diagnosing the cause of patient complaints, questioning in this way is still a vital aspect of patient assessment.

Many health IT systems providers recognize the usefulness of the HPI and offer various types of digital tools for administering and recording the questions and related answers. These may include forms or templates to aid physicians in recording accurate data. Accuracy in recording these symptoms and entering them into a medical record can prove critical in ensuring the information is accessible to all providers, particularly as a patient's condition continues to develop and requires the input of more providers.

The Role of HPI in Modern Diagnostic Processes

While technology may play a major role in today’s diagnostic processes, HPI is a firm reminder that interactions between patients and providers are of utmost importance. HPI questioning uncovers data on pain levels, discomfort, and quality of life. It can help physicians understand if they need to fill out forms to send to insurers to get pre-authorization for urgent treatment. HPI questions can also reassure patients that they’re getting the best of care, and even uncover other, unrelated conditions that can be referred to the right professionals or departments.

When Is HPI Utilized?

HPI questions occur from initial contact with the patient onward. EMTs may gather key initial symptom information to facilitate immediate medical care needs. Paramedics, emergency room professionals, and trauma physicians are often the next group to gather information in emergency situations.

HPI questions are also common practice in standard doctor’s office visits. Nurses and practitioners ask similar questions as a way to further understand the patient's health, comfort levels, potential screening needs, and even to provide early diagnoses of health risks. Digitally recording this information in a streamlined manner allows for continuous management of that data over time, enabling primary care providers to develop an in-depth understanding of patient care needs.

When providers have the right data about a patient, they can make more informed decisions about treatment programs and procedures — optimizing patient outcomes and resource allocation.

How TempDev Can Help With HPI

TempDev's team of NextGen consultants, developers, and trainers support your needs whether you’re looking to implement, switch, or even upgrade your current electronic health record (EHR) system. From dashboards and revenue cycle consulting to automation and workflow redesign, TempDev offers the tools you need to make the most of your NextGen EHR system, with top tips and tricks that will ensure your success now and in the future.

Customize your EHR Workflows to Prioritize HPI and Other Medical Record Data

If your facility depends on HPI questioning to create meaningful records, reports, and treatment plans, you want EHR systems that support those needs. Talk to TempDev about customizing your workflows to match those needs and prioritizing accurate record-keeping. 

With TempDev's NextGen dashboards, templates, and reports, you can better support your patients' needs. Our team is here to help you design, organize, and implement the whole system and offer tips and guidance based on industry best practices.

Contact us here or by calling us at 888.TEMP.DEV to get the help you need.