ABSTRACT
The problem list is a key part of the medical record. At a high level, it lists the patient’s most important health problems and gives the practitioner key information to determine the best treatment plan. Good problem lists are known to improve patient care [1,2] and are used as a resource for clinical decision support tools to prevent medical error [3,4]. Yet, there are issues with problem lists that limit their effectiveness. The three greatest are thought to be:
With the passage of the HITECH act, most of the medical community is now focused on adopting electronic health records that can improve patient care. As problem lists are more readily shared across providers, the above defi cits have become more prominent. Yet, to solve these issues the medical community needs to know more about how practitioners are currently approaching the problem list and the logic behind those decisions. This research is meant to provide such guidance and through this knowledge, encourage the development of a common approach.
