Inconsistent problem list practices create problems for providers
Inconsistent practices for maintaining problem lists create challenges for sharing health records and standard policies should be adopted to address the issue, according to research published Nov. 11 by BMC Medical Informatics and Decision Making.
As EHRs become more commonplace in healthcare and the industry moves toward a standard of shared records, organizing information consistently will be essential to making it useful, according to the study’s authors. Various organizations, such as the Joint Commission and the American Health Information Management Association, offer guidance on problem lists, but their impact has not been measured, it is not clear how widely used they are and inconsistencies remain. For instance, one provider may feel it is important to include a family history of breast cancer on a patient’s problem list, whereas another provider may feel a note in the family history section of an EHR is sufficient.
“Practitioners' ability to quickly appreciate the most important facts about their patients impacts their ability to provide high quality healthcare,” wrote lead author Casey Holmes, a consultant working with Brigham and Women’s Hospital and Partners HealthCare, both in Boston. “Therefore, when problems are left out or hidden within a long and cluttered list, the problem lists’ effectiveness is compromised. In order to improve patient care and reap further benefit from the problem list as a data resource, the medical community needs to create clear, consistent, complete and accurate problem lists. Unfortunately, the medical community’s current approach to the problem list makes inconsistency and error the standard.”
To gauge variations in problem list practices, researchers surveyed 97 providers and conducted in-person interviews with 14, asking questions regarding ownership of EHRs and what problems should be included. While responses indicated a consensus on some items, such as inclusion of family history (76 percent) and surgeries (73 percent), providers were split on the inclusion of other items, such as hospitalizations (50 percent) and non-medical conditions (64 percent).
Based on their findings, researchers made several suggestions, advising healthcare organizations to develop specific policies detailing who has control over problem lists, who can enter information into problem lists and when problem list items should be removed. They also suggested HIPAA be modified to clarify how privacy can be maintained when problem lists are widely accessed and available to many providers.
“Without consistency across problem lists, patients cannot receive the full benefits problem lists bring to patient care, namely better practitioner compliance with best practices and the complete utilization of clinical decision support and population management tools,” concluded Holmes et al. “The medical community needs to work towards standardization through the development of policies about how the problem list should be used as well as tools built into the EHR that can help practitioners comply with those policies.”