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.
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, or visit the
Rational History of Present Illness Website.
Built with Bootstrap. Revision History:
1.0 Initial Dev Release November 2014;
1.1b First Stable Beta;
1.2 Added Persistent Data
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 is an
Associate Professor of Family Medicine at the University of Florida. He is a former NLM Informatics Fellow at the
Harvard School of Public Health. He has taught medical interviewing for over twenty years.
Dr. Rathe currently splits his time between patient care, medical education and EMR development.
He can be reached at rrathe at ufl dot edu, subject "quickHPI".
This program is provided as is, free of charge, for use in medical education and patient care.
It is part of ongoing research and development at the University of Florida.
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 and the University of Florida assume no 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.
Every HPI begins with a chief complaint (CC)—a concise statement of the patient's concern(s).
It is often useful to quote the patient directly (eg, "a flutter in my chest").
Avoid medical jargon unless a diagnosis is already established.
You should record location and radiation when relevant.
Recording the context for the encounter is essential:
Is the patient new or established? Was the patient recently discharged from the hospital?
Is this the first visit for the current problem or follow-up?
Characterize the presentation as one of the following...
Use a brief demographic prolog to further contextualize the history.
You should also note the source of the information when that source
is someone other than the patient.
The HPI is a story that unfolds over time.
It is important to establish how long the symptoms have been there. (Duration)
Was their onset sudden or gradual?
What was happening when the symptoms started? (Context)
Are they getting better or worse? (Progression)
If symptoms are episodic, how long does each episode last? (Duration again)
How often do they occur? (Frequency)
More than any other, this section attempts to capture the patient's subjective experience.
Quality is how a symptom feels to the patient and can best be summarized by recording
the patient's own words. Severity attempts to quantify how strong the symptom is.
The ubiquitous ten-point scale is overused in my opinion.
It is appropriate for following painful conditions over time (eg, post-op pain, arthritis).
For other symptoms a simpler three-point scale will often suffice.
Both scales are available here.
Severity often varies over time.
When this occurs it is prudent to use more than one scale. QuickHPI provides three:
when the patient was seen (now); at its worst; and at its best.
An alternative way to quantify severity is its effect on function.
How much does it interfere with the patients daily life?
This is where pertinent positives and negatives are recorded.
Everything in this section should be related to the chief complaint in some way!
For example, you could document that a patient with chest pain is also short of breath.
The organ system categories are the same used by Medicare and professional coders.
Do not confuse this section with the general Review of Systems shown below.
This section is simple, but very important.
What makes the problem worse? What makes it better?
If better, how much better?
Save ongoing treatments (such as medications) for the next section.
This section is reserved for treatments recommended by you or another healthcare professional.
Treatment is not limited to medications—you may enter any prescribed intervention (eg, heat, exercise, diet).
Also note the response to treatment, if known.
For a chronic condition you may wish to document whether you consider it
well-controlled, resistent to treatment, or uncontrolled. (Status)
Research repeatedly shows that non-adherence is common,
so it is important to document any barriers to treatment you discover.
Certain key facts from the patient's past may be relevant to the current problem.
Known risk factors should be recorded (eg, "strong family history of cancer").
For many patients the most important risks are smoking and alcohol,
so there is a special section for each. It is also good practice to identify any other sources of
historical information you reviewed, such as lab tests and outside records.
Just as with associated symptoms above, non-pertinent historical items should not be recorded here!
This optional section was included to make life easier for clinicians and coders.
Under current E&M documentation rules, the first Associated Symptom counts
towards the HPI, any others may be counted as part of the Review of Systems (ROS)
(even if there is no section labeled "ROS").
It is common for EMR systems to copy down
symtoms from the HPI to the ROS. This leads to a small amount of useful redundancy.
The reverse practice of promoting up from ROS to HPI is not so
benign. It obscures the connection between symptoms and the chief complaint, degrading both
the accuracy and validity of the note.
Pretty simple... click the button, generate an HPI.
Only the Structured and Compact formats are available at this time.
Richard Rathe, MD ~ © 2014 U of Fla