The EHR problem list, as defined by the American Health Information Management Association (AHIMA), should serve to “facilitate continuity of patient care by providing a comprehensive and accessible list of patient problems in one place.”
Ideally, those problems should be relevant to the patient’s current health status, and they should be presented in a way that makes sense for the clinician viewing the list. For example, a pulmonologist should have access to a list that includes illnesses and injuries that could have an impact on their patient’s respiratory system. They should also be able to readily find important details about previous treatments – including lab results and any medications that may have been used to resolve those issues. The problem list, in the end, should save the clinician time and improve the quality of patient care.
The trouble is that many problem lists don’t function the way they should. As AHIMA notes, the “administration and maintenance of problem lists can present challenges, and most organizations struggle to define content, responsibilities, and accountability” for ensuring lists are accurate and up to date. That pulmonologist doesn’t need to know their patient went to the emergency room 10 years ago for a broken finger. But if there’s no way to easily remove that entry, or if it’s not clear who’s responsible for deleting it in the first place, there’s a chance they’ll find it right next to the entry on the patient’s recent bout with pneumonia.
Problem list governance can resolve such issues by establishing clear policies and guidance on everything from what should and shouldn’t be included on the list, to how individual lists should be organized. A good governance strategy ensures that the job of list maintenance seamlessly integrates into the clinician’s workflow and includes a well-designed plan for improving lists over time.
