1. CERNER MILLENNIUM Diagnoses and Problems
In this demonstration we’ll review the distinction between diagnoses and problems, and how to record both.
This demonstration has been updated to reflect the appearance & functionality of MPage 6.9.
This has been prepared for Millennium code level & MPage Subsequent updates may display cosmetic & functional changes. Use the keyboard or mouse to advance. Any patient names displayed are fictitious.

2. Diagnoses vs Problems
Diagnosis: AKA Billing Diagnosis—What you’re seeing the patient for today. Your charges are based upon this. These are ICD 10 codes.
Problem: AKA Chronic Problems or Problem List—Problems that need to be recorded as part of the medical history, even though you may not be addressing them today. These are SNOMED codes.

3. There are two places you can record diagnoses & problems
There are two places you can record diagnoses & problems. One is on the Table of Contents Menu.
The other is on the workflow tabs, or MPages.
We’ll start with the Table of Contents. This may not be the one you use the most in your day-to-day encounters, but it includes a bit more detail, & it’s a little easier to introduce the difference between “Problems” & “Diagnoses” there.

4. Billing Diagnoses are at the top. The Problem List is at the bottom.
Unfortunately, Cerner misuses the term “Problem” in parentheses on the diagnosis list at the top. Please disregard the word “problem” on the top list.

5. To add a billing diagnosis, click in the search box & start to type
To add a billing diagnosis, click in the search box & start to type. Select your desired match as it appears. If you know it, you can also search for the ICD 10 code.
This “IMO Search Box” is by far the easiest way to perform your search. Start to type, & pick your preferred selection as it displays.

6. An older search method is to use the +Add button
An older search method is to use the +Add button. You don’t want to use this. It is much more tedious & time-consuming than using the IMO Search Box shown above.

7. Once you’ve made your selection from the search results, it is added to the billing diagnosis list.
You can use the Modify button to update the details on the diagnosis; this is also available via right-clicking on the diagnosis.

8. You use the same approach to search for problems, either through the search box here, or via the +Add button. Again, using the “IMO Search Box” shown here is the far preferable option. But remember the Problem List uses SNOMED codes, so you can’t search for ICD 10 codes here.

9. If there are no chronic problems, you should select the No Chronic Problems button.

10. You can update details or resolve a problem
You can update details or resolve a problem. Select a problem, then click Modify.

11. You can add comments, specify age or date of onset, & add other details. In this example, we’ll change the Status to Resolved.

12. When done click OK.

13. You can set the Problems Display to only display Active problems, & the resolved problems won’t appear.

14. You can convert a diagnosis into a problem
You can convert a diagnosis into a problem. For example, if you first diagnose hypertension today, you could click Convert to add it to the Problem List as well.

15. It works the other way around as well
It works the other way around as well. If hypertension were on the Problem List & you were addressing it today, you could click Convert to add it to today’s Billing Diagnoses.

16. Now let’s look at the Problem List as displayed on workflow MPages, which uses some different terminology. You have a search box, which has an Add as dropdown list in front of it.
Here, This Visit means Billing Diagnosis (ICD 10), while Chronic means Problem List. And you can set your selection to both the Billing Diagnoses & Problem List at the same time by picking This Visit and Chronic.

17. If your patient has no chronic problems, click the No Chronic Problems button to enter that fact.

18. We’ll add hypertension to the Problem List
We’ll add hypertension to the Problem List. With Add as set to Chronic, click in the search field & begin to type your search terms. Results display as you type. Notice that you can type partial terms. Click on your preferred selection when you see it.

19. Your choice is added.
Also notice there are two buttons here: This Visit & Chronic. In this case the Chronic button is selected, since we searched for Add as Chronic.

20. Similar to the Convert button we saw before, you can also click the This Visit button to add this to the Billing Diagnoses for today.
You can also Resolve a chronic problem from here.

21. To see resolved problems, you can expand the Resolved Chronic Problems section.
There is also an All previous This Visit problems section you can expand. This can come in handy if you want to quickly reuse a prior billing diagnosis instead of searching for it.

22. There is also a dropdown list to set the Classification to Medical and Patient Stated or All. (We’ll talk more about Classification in a few minutes.)
But notice that this combination of dropdown lists & expandable/collapsible sections gives you much the same functionality that the display filters give you on the Table of Contents version of the Problem List shown above.

23. And if you click an item on the Problem List, its details will display in a sidebar to the side, with a button that gives you access to all the Modify options you saw above.

24. You should almost always find your desired problem/diagnosis searching on the MPage. But if not, you can click the Problem List heading to take you to the full Table of Contents approach previously demonstrated.

25. It doesn’t matter which method you choose
It doesn’t matter which method you choose. Just remember: Billing Diagnosis = This Visit = Diagnosis = ICD 10 Problem List = Problems = Chronic

26. You or your staff may enter Problem List items as you’re taking the patient’s medical history. You may well come back & add Billing Diagnoses after you’ve evaluated the patient. Make sure to populate both lists before generating your visit note, so they will be included in your note.

27. Lagniappe Following are a few other tips about the Problem List.

28. What belongs on the Problem List?
There is a little philosophy & personal preference involved here, & Cerner provides you the latitude to decide how you wish to use the Problem List.
Probably the most common interpretation is that the Problem List is for active, chronic problems—things that you expect to be enduring, if not lifetime, issues for the patient. Anything you address at a visit that is not a chronic problem is just recorded as a billing diagnosis for that visit.

29. An alternate interpretation would be to include even temporarily “problems” on the Problem List—things that you expect to have to address for several visits, but to eventually resolve.
Following that interpretation, one might, for example, put Pregnancy on the Problem List (in addition to using Pregnancy as a billing diagnosis).
If you take that approach, however, you need to remember to use Modify to resolve the problem once it is over with.

30. Change Status to Resolved
Change Status to Resolved. You can also update other details & add Comments as desired.
And recall there is a Resolve link on the MPage Problem List as well.

31. There are a number of details on the Problem List
There are a number of details on the Problem List. Though many may not be per pertinent on any given problem, it is helpful to be familiar with the available details.
Many details will display on the columns to the right, though you may have to scroll to see them. And to see the full list of details, select a problem & then click Modify.

32. Feel free use the many available details and the Comments field to fully “tell the story.”

33. And remember all these details are accessible on the MPage Problem List sidebar as well.

34. One detail you’ll sometimes need to notice is Classification
One detail you’ll sometimes need to notice is Classification. When you manually add an item to the Problem List, the Classification will be Medical. And you usually don’t even have to think about that.

35. But there are other options on the list that sometimes come into play.

36. On patients who have been hospitalized, you may see items on the Problem List with the Classification of Interdisciplinary or Nursing. These are often not things you would think of putting on the typical “medical record” Problem List. Some may be very wordy or not readily clear. They’re problems that are added during the hospitalization through nursing documentation or quality-based rules. In the days of paper medical records, these would be recorded elsewhere, but in Unity they’re added to the Problem List, distinguished by the Classification.

37. You may also see problems with the Classification of Patient Stated
You may also see problems with the Classification of Patient Stated. Though it is possible use of this Classification will be expanded in future updates, the most common example seen today is Tobacco Use, which is automatically added when this fact is recorded via the Social History.

38. An important thing to understand is that only problems with the Classification of Medical appear in encounter notes. So you don’t have to worry about the other Classifications ending up in your notes.
But what if, for example, you wanted Tobacco Use to appear in your visit note? Select it & click Modify.

39. Then change Classification to Medical
Then change Classification to Medical. It will now appear in your encounter documentation.

40. You can filter what you see on the Problem List.
Sometimes the Problem List can grow very long, to the point it appears cluttered & requires scrolling to view everything. This may especially happen on patients who have had multiple, involved hospitalizations. So you might want to filter the display to see the things that you’re most interested in.

41. You can click the Display dropdown to see a list of options
You can click the Display dropdown to see a list of options. This list will probably initially be short, & may not give you all the options you’d like.
You can add other filtering options by clicking the Ellipsis Button.

42. In particular, notice that you can filter by both Status & Classification. To create a new display filter, click New.

43. In this example, we’ll create a new filter that shows only Active problems, with Classification of Medical or Patient Stated. We’ll type that name at the top, then select only the Active checkbox.

44. Select Available Classifications & use the Add or Remove buttons to place Medical & Patient Stated on the Available Classifications list.
You can set this as your Default display filter if you like.
When done, click Save.

45. Now only Active Medical & Patient Stated problems display on the list
Now only Active Medical & Patient Stated problems display on the list. So you see what will appear in your note, & what Patient Stated problems you might want to change to the Classification of Medical to make them appear in your note as well.

46. Your newly-created filter will also now appear on the Display dropdown list for rapid use.

47. You don’t have quite all those filtering options on the MPage Problem List, but the combination of the Classification dropdown list & the Resolved Chronic Problems section give you a concise presentation of the most commonly used options.

48. In Conclusion
It’s easy to be overwhelmed by all these details, so remember you usually don’t need to think about most of them. Just be aware of when they can be used to your advantage, or to add information you would otherwise have no way to record.
Using the MPage Problem List will usually be quicker while conducting & documenting your encounters, so make that your first choice. But feel free to use the Table of Contents version if that is more comfortable to you. Anything you add will display in both places.