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DxKeeper, part of our Enterprise offering, is a handheld software application that allows a healthcare institution and its individual healthcare providers to maintain an up-to-date problem list for each patient contained in PatientKeeper's Mobile Patient Index (mPI).
Security
DxKeeper adopts the security features of PatientKeeper's Platform and mPI (new browser window opens on mPI security section). You only have access to this application if your institution's IT administrator grants appropriate permissions. Also, the administrator can set up "relationships" and "positions" for you, indicating what data you can access, including access to certain patients.
Accessing Patient Problems
Problems get logged in PatientKeeper's Mobilizer server. When you add a patient to the master patient list in the mPI, you receive all problems for that patient that have already been created by other users, except for those marked "cancelled" or ones that other users have marked "private." The problems may be standard, typical clinical nomenclature references, such as ICD-9 codes or SNOMED codes, or they may be free-text problems entered by the user.
Viewing the Problem List
You can access patient problem list by tapping on the DxKeeper tab within the PatientKeeper mPI. Then you tap on the patient's name to see a list of the problems associated with that patient. One can view the description, rank and status for the problem. Old, unattended or changed problems are highlighted to grab your attention, much the same way as Microsoft Outlook highlights unread e-mails.
You can sort the problems on the patient's problem list in a variety of ways including rank or alphabetic order. This information does not affect the ranking of the problems for any other user.
And, you can filter the list by selecting any problem status, such as all active problems, hidden problems, etc.
As mentioned above, to speed your work, you have the ability to hide a problem on your handheld, so that you do not have to view it on your list for a particular patient. (This functionality does not remove the problem from the patient's problem list, nor does it prevent any other user from viewing the problem from their handheld.)
Viewing Details
Each patient problem has a set of fields associated with it, which help to describe how the problem is being addressed beyond the description and the code (if applicable). Examples of these fields are: a life cycle status of the problem (e.g. active or inactive), the course of the problem (e.g. improving), and the persistence of the problem (e.g. acute or chronic). Each problem may have a number of providers with relationships to it. By default, the user who created the problem has a "recorder" relationship. Another relationship example might be a "responsible provider." You can alter a relationship at any time.
Creating a Patient Problem
Record a patient problem in three ways:
Select a problem from a hierarchical list
Select a standard problem in the "dictionary"
Enter non-standardized free-text as the description of the problem
You determine the categories that DxKeeper contains a hierarchical list. This makes it easy to find your most common diagnoses. The diagnoses in the list can be free-text problems or standard problems. Add individual diagnoses as an initial "category", or have a "most common" initial category, further enhancing the ability to efficiently select a problem.
The problem dictionary can contain several types of code sets, such as ICD-9, SNOMED, and DSM IV. Select one of the code sets on which to search for a code. Also, you may search the dictionary by traversing the hierarchical structure of the dictionary or by using a "sub-string search."
When searching by traversing the ICD-9 hierarchical structure of the dictionary, it's possible to select a major category and then drill down to the most specific code possible. The product will search for any code with a problem description that contains the term you enter, either as a whole word or as a portion of a whole word. All of the problems with that term will be returned to the user, allowing you to select one.
For the ICD-9 codes, there can be multiple definitions for the same diagnosis, making it easy for you to find the correct code. For example, one can enter "aspiration pneumonia" and get the correct code, although it may actually labeled as "food and vomiting pneumonitis" in the ICD book. By default, all created problems are public and can be viewed by anyone with the authorization to view the patient's information. However, anyone has the ability to mark a problem as a "private," thus restricting the viewing of the problem to only that user.
Editing a Problem
You may only edit a problem to which you have a relationship, such as the "recording" or "responsible provider." If you have this access, you may change the value in almost every field associated with the problem. Should you want to cancel a problem to which you have a relationship you can do that too. Note, however, that you can't delete a problem once it has been sent to the Mobilizer server via the synchronization process.
Sharing Problems with Other PatientKeeper Applications
Other PatientKeeper applications need to use diagnoses as part of their processing, such as ChargeKeeper for its charge capture capability. And, you open a problem list when you're in one of these other applications. That's because DxKeeper is integrated seamlessly with the other PatientKeeper applications so that, from a user's standpoint, accessing the problem list or searching for a diagnosis feels like it is being done within one of the other applications. In this mode, the problem list will not contain hidden or cancelled problems.
In addition, you can filter the problem list by:
Problems with an associated standard problem
Problems that are free-text problems
Problems that do not have a particular status (such as "resolved")
For example, you may not want to view free-text problems within ChargeKeeper, since you need ICD-9 related problems for billing.
You may edit the problem from the "calling" application, such as when a user thinks the patient's problem has become more defined. The "add problem" function can be launched from other applications, allowing the user to easily create a problem they need to use within that application and add it to the problem list as well.
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