Managing Historical Conditions
Introduction
Patient conditions evolve over time. Some resolve, others require diagnostic updates, and many remain relevant as historical context. This article explains how to document past medical history, take an entry back off the chart, resolve active conditions, and change diagnoses in Canvas Medical while preserving important clinical information.
User's Guide
Documenting Past Medical History
The Past Medical History command documents conditions that are no longer active but may still impact clinical decision-making.
To add past medical history:
Add the Past Medical History command to a new or existing note
Complete the command fields:
Past Medical History: Previous medical condition (search by ICD-10 code or text description)
Approximate Start Date: Date when the condition began (e.g., "last week," "3 years ago," "2015," or specific date)
Approximate End Date: Date the condition resolved
Show on Condition List: Toggle on to display the condition in the patient summary
Comments: Additional notes pertaining to the condition (up to 1000 characters)
Click Record to add the medical history to the patient record
Key points:
Searches ICD-10 codes similarly to the Diagnose command
Supports entering the code directly in addition to text search
Use free-text date entries for flexibility
Removing a Past Medical History Entry
The Remove Past Medical History command removes a past medical history condition from the patient's chart and records the rationale why. Reach for it when an entry turns out to be wrong for the patient, for example one brought in by an import or taken from a history the patient has since corrected.
The note that originally recorded the entry is left exactly as it is, so the chart still shows what was documented and when. There is no need to amend or correct that earlier note.
To remove a past medical history entry:
Add the Remove Past Medical History command to a new or existing note. It is in the note's History section.
Complete the command fields. The only required field is the condition.
Condition: Search the patient's resolved conditions and select the one to remove
Rationale: Reason the entry is being removed (up to 512 characters)
Click Record to remove the entry. It comes off the patient's conditions list.
Key points:
Any of the patient's resolved conditions that carry no assessment are offered, whichever command recorded them. That covers Past Medical History entries, and conditions recorded with Add Condition or Diagnose that have since been resolved.
An entry that has an assessment is not offered for removal, because the assessment would be left describing nothing
Active conditions and surgical history are not offered, since each has its own command
To reverse a removal, enter the Remove Past Medical History command in error. The entry returns to the patient's chart.
Resolving Active Conditions
The Resolve Condition command closes active conditions for patients when they are no longer relevant for tracking.
To resolve a condition:
Choose one of these methods:
Add the Resolve Condition command directly to a note
Click Resolve next to the condition in the Patient Summary
If the cursor is not positioned in a note before clicking Resolve, Canvas creates a Chart Review note to store the command.
Complete the command fields:
Resolve Condition: The condition that is no longer relevant
Rationale: Reason for resolving the condition
Show on conditions list: If selected, resolved conditions appear at the bottom of the Patient Summary in gray non-bolded text
Click Record to resolve the condition
Changing a Diagnosis
The Change Diagnosis command allows you to update a condition to a more relevant diagnosis while preserving historical data.
To change a diagnosis:
Add the Change Diagnosis command to a note
Complete the following fields:
Change Diagnosis: Current condition being changed
New Diagnosis: Updated diagnosis (search using natural language or ICD-10; omit the decimal point when searching by ICD-10)
Background: Add additional background information to provide context for the updated diagnosis
Today's Assessment: Document observations made during the current visit reflecting the revised condition
Click Record to update the patient record
Billing implications:
When the note is billable, the Change Diagnosis command ensures the billing footer and claim are updated. The new ICD-10 code is added for the revised condition, and the previous ICD-10 code associated with the original diagnosis is automatically removed.
Historical data preservation:
The Change Diagnosis command creates a new condition with the updated diagnosis while preserving historical data from the original condition. See the article on Assessing and Updating Conditions for details on how timelines are affected.
Configuration & Set Up
No special configuration is required. Past Medical History, Remove Past Medical History, Resolve Condition, and Change Diagnosis commands are available by default in all patient charts.
FAQ & Troubleshooting
Q: What happens when I change a diagnosis?
A: The Change Diagnosis command creates a new condition with the updated diagnosis while preserving the historical data from the original condition. The original condition is resolved with a note indicating the change, and the new condition includes the full assessment history from both diagnoses.
Q: Can I undo a resolved condition?
A: Once resolved, a condition cannot be automatically reactivated. If the condition becomes active again, add a new Diagnose command to document the recurrence.
Q: Can I undo removing a past medical history entry?
A: Yes. Enter the Remove Past Medical History command in error and the entry returns to the patient's chart.
Q: Why isn't the entry I want to remove in the list?
A: The command offers resolved conditions that have no assessment. A condition that carries an assessment is left out, an active condition is resolved with the Resolve Condition command first, and a surgical history entry is handled by the Surgical History command.
Q: How can I see resolved conditions in the patient summary?
A: When resolving a condition, toggle on "Show on conditions list." Resolved conditions will appear at the bottom of the Patient Summary in gray non-bolded text.
Related Resources
Keywords: past medical history, remove past medical history, resolve condition, change diagnosis, historical conditions, ICD-10 update, inactive conditions, billing updates
Categories: Clinical Documentation, Condition Management