ABSTRACT
ADAM WRIGHT, JOSHUA FEBLOWITZ, FRANCINE L. MALONEY, STANISLAV HENKIN, AND DAVID W. BATES
6.1 INTRODUCTION
The patient problem list comprises an essential part of the modern electronic medical record. Improved problem list documentation has been associated with a higher quality of care and greater adherence to evidence-based guidelines. [1] Effective clinical decision support (CDS) interventions also frequently depend on the problem list, since many CDS rules require accurate, coded problem entries. [2] An electronic problem list can also be a valuable tool for quality and research initiatives as it facilitates the rapid creation of patient registries. [3]
As part of Stage 1 and 2 “meaningful use” guidelines, providers are required to actively “maintain an up-to-date problem list of current and active diagnoses,” with 80% of patients having at least one problem recorded
or an indication of no known problems. [4,5] However, research has shown that problem lists are frequently inaccurate and out-of-date. [6-10] In a previous study, we demonstrated that common problems were frequently omitted from the problem list at one large hospital network-completeness ranged from 4.7% for renal disease to a maximum of 78.5% for breast cancer. [11] In previous qualitative research, we found that provider attitudes towards appropriate use and content varies widely and problem lists are frequently perceived as inaccurate, incomplete and out-of-date. [9,10]
In order to shape effective problem list policy and meet “meaningful use goals,” it will be necessary to gain an improved understanding of current problem list usage patterns. Based on prior research [9,10] we hypothesized that primary care providers (PCPs) would be the primary problem list users while specialists would use the tool much less frequently. For the purposes of this paper, “primary care” is defi ned to include providers specializing in family medicine, internal medicine (excluding subspecialties), geriatrics and pediatrics. Our goal was to assess the differences in problem list use across specialties and subspecialties and to quantify these differences for the fi rst time.
