# HPI - Quality



## cbuster (Jul 20, 2018)

I am hoping someone can help clarify something for me re: the definiton of "Quality". 

I found the definition of quality = characteristics (examples given are: inflamed, dark, splotchy, brown) 

Our EMR system is counting the word "New" as a quality. (Example  "the lesions are *new* and mild in severity and present for months". 

Can "New" be counted as a quality ? Any supporting resources / doucmentation would be appreciated as well.

Thank you in advance for your help!


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## thomas7331 (Jul 20, 2018)

EMR systems are notorious for not correctly counting E&M elements - I recommend against relying on this function in an EMR and in the practices I've worked with this has either been disabled or is simply not used.  

'New' does not give any information about quality - if anything, 'new' is related to duration.  In your example, I'm not sure how a lesion could be both 'new' and 'present for months', although perhaps the provider means that is it 'new since the last visit'.  Either way, it only gives information about the duration, not the quality.  (I also don't see how a lesion could be 'mild in severity' when there is no symptom documented for which the description 'mild' would apply, but that is another matter.)  Quality should be a term that descriptive of the patient's symptom(s) - your definition and examples are correct.


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## twizzle (Jul 21, 2018)

*E/M HPI element 'quality'.*



cbuster said:


> I am hoping someone can help clarify something for me re: the definiton of "Quality".
> 
> I found the definition of quality = characteristics (examples given are: inflamed, dark, splotchy, brown)
> 
> ...



While I have to admit to sometimes being over-creative when it comes to HPI elements, there is no way that 'new' can be construed as quality or anything else really. If the documentation was 'patient reports lesions are new, first appearing yesterday' we at least have duration' or 'itchy lesions are new and first appeared yesterday' we have quality and duration, but 'new' alone cannot be used. It doesn't say anything.

Got to love these EMR's for trying to push the boundaries though.


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## Pathos (Jul 23, 2018)

I agree with the two previous posters above, *Quality *describes the problem or symptom. Whether the issue is new has nothing to do with *Quality*.

Per CMS guidelines:
"_*Quality *(example: aching, burning, radiating pain)_"

Instead, by using the example given: "_the lesions are new and mild in severity and present for months_" - you could put *Mild *under *Severity *and *Present for Months* under *Duration*. But I do not recognize anything that would fit into *Quality*.


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