What is the History of Present Illness (HPI)?

The history of present illness (HPI) is a set of interview questions that a healthcare provider will ask a patient about their chief complaint in order to assist with diagnosing the patient. HPI questions are designed to give a clinician an accurate history of the patient's concern. In many cases, a diagnosis can be made from an analysis of the HPI, a review of systems (ROS), and a physical examination. HPI becomes a component of the patient's medical record.

What Questions Are Asked in an HPI?

While there are many variations on the HPI format, most include a common set of questions. A popular example is summarized by the acronym OLD CARTS:

• Onset

• Location

• Duration

• Characteristics

• Aggravating factors

• Relieving factors

• Treatments tried

• Symptoms associated

The Centers for Medicare and Medicaid Services (CMS) has defined criteria for a reimbursable HPI. Here is CMS's list and how each entry relates to the OLD CARTS method:

• Timing Onset

• Location

• Duration

• Quality (Characteristics)

• Severity (Characteristics)

• Content (Onset)

• Modifying factors (Aggravating and Relieving factors)

• Associated signs and symptoms (Symptoms associated)

Appropriate Questions for HPI

A brief HPI questioning process can provide valuable data to facilitate appropriate care for medical problems. An extended HPI may include additional questions to expand on what information is obtained and what risk factors exist.

Some sample questions may include:

• What brings you in today?

• What medical symptoms do you have?

• When did you begin to see these symptoms?

• Do you have a family history of the specific type of illness, 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?

From this information, medical providers then extend questions based on answers. For example, they may ask a person experiencing chest pain about the severity or the location. If there is a past medical history, follow-up questions may center around any follow-up care the patient received from their other provider.

When patients have numerous symptoms, or there is no clear or obvious evidence to lead to a diagnosis, practitioners may wish to expand further, including asking for a chronological description of the development of the patient's symptoms.

History of Present Illness in Today's Healthcare

Since the combination of the HPI and a physical exam has proven useful in diagnosing the cause of patient complaints, the questions are still in wide use today.

Many health IT systems recognize the usefulness of the HPI and provide some sort of digital tool for administering and recording the questions. Accuracy in recording these symptoms and entering them into a medical record can prove critical in ensuring the information is accessible to all providers as a patient's care continues to develop and advance to more providers.

Accuracy and efficiency tend to be priorities in this process. Electronic methods have helped to further enhance the process of maintaining patient privacy while also working to support patient care. By providing strategies for enhancing the collection of valuable data and sharing it in the appropriate manner, care providers can move through patient care efficiently without missing key information that could be critical to the diagnosis and treatment.

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 the next group to gather such information in emergent situations.

HPI questions are also applicable in standard doctor office care. Nurses and practitioners ask these questions as a way to further enhance knowledge of the patient's health, potential screening needs, and provide early diagnosis of health risks. Digitally recording this information in a streamlined manner allows for continuous management of that information over time, enabling primary care providers to develop in-depth understandings of patient care needs.

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 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.

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.