Accelerating the Benefits of the Problem Oriented Medical Record

Buchanan, Joel R.

doi:10.4338/aci-2016-04-ie-0054

Cited by 18 publications

(15 citation statements)

References 12 publications

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“…Organizing the PL around other relevant patient data besides diagnoses and injuries could help support physician clinical thinking and coordination of care. [8][9][10]13 Our results confirm findings of previous PL research [14][15][16][17][18][19]21,28 that completeness and accuracy are two important characteristics of the PL. The PL should be designed to support overlapping information needs between physicians involved in the complex pediatric trauma care process as most participants mentioned the PL goal of communicating with others and PL characteristic of completeness (►Tables 1 and 2).…”

Section: Discussionsupporting

confidence: 90%

“…9 For example, the problem-oriented model allows EHR users to click on the PL and view a dynamic display of relevant labs, imaging, procedure data, and consultant notes. 10 Another approach is problem-based documentation, where clinicians document assessments and plans for each problem on the PL. 11,12 The increasing use of the EHR may help to implement Weed's vision and better support physician work so that recorded problems are connected to the relevant patient information in other parts of the EHR.…”

Section: Emergence Of the Electronic Problem Listmentioning

confidence: 99%

“…11,12 The increasing use of the EHR may help to implement Weed's vision and better support physician work so that recorded problems are connected to the relevant patient information in other parts of the EHR. 10,13 Research on the Electronic Problem List: Outpatient Settings Most studies on the electronic PL are performed in outpatient care settings. [14][15][16][17][18][19][20][21] Makam et al 18 reported that 70% of primary care providers (PCPs) who responded to a survey on the use of and satisfaction with the EHR thought that the PL was helpful.…”

Section: Emergence Of the Electronic Problem Listmentioning

confidence: 99%

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Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

et al. 2019

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Objective To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. Methods We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline. Results We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. Conclusion Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.

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Section: Discussionsupporting

confidence: 90%

Section: Emergence Of the Electronic Problem Listmentioning

confidence: 99%

Section: Emergence Of the Electronic Problem Listmentioning

confidence: 99%

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Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

et al. 2019

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“…It has also been conveyed that correct and complete Problem Lists resulted in better care. 43 A reason already reported in the literature is the need to update the list manually 44 and lack of time to do so was the main obstacle reported among respondents, so they are not duly kept up to date, 45 deteriorating data quality, considered to be poor. 7 Discussions on the way data are presented on EHR would result in differences from current models but more pressing than this there is a need to fix current issues with EHR, to produce clear records that can be shared and understood.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record and Problem Lists in Leeds, United Kingdom: Variability of general practitioners’ views

Martin¹,

Sbaffi

2019

Health Informatics J

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Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as ‘Active Problems’, and presents it to the user. Variability on its content is a known issue. To explore general practitioners’ views on their use of ‘Active Problems’ and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners’ views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve.

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“…However, our experience demonstrates feasibility for a medical informaticist to build an initial candidate rule for defining a condition, then identify any clinical inclusion/exclusion questions for vetting with a clinician specializing in the condition [9]. For multi-institutional and/or specialty society vetting, a Modified Delphi technique can be employed, as successfully used by Buchanan previously to gain working consensus across institutions [59]. Our vision is that increasingly intensional value sets are produced as a byproduct of clinical guideline and eCQM authoring, dramatically reducing the need for individual institutions to "re-invent the wheel" (Figure 3).…”

Section: Scope Of This Paper's Analysismentioning

confidence: 99%

SNOMED CT Concept Hierarchies for Computable Clinical Phenotypes From Electronic Health Record Data: Comparison of Intensional Versus Extensional Value Sets (Preprint)

Chu¹,

Kannan²,

Basit³

et al. 2018

Preprint

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Background: Defining clinical phenotypes from EHR-derived data proves crucial for clinical decision support, population health endeavors, and translational research. EHR diagnoses now commonly draw from a finely-grained clinical terminologyeither native SNOMED CT, or a vendor-supplied terminology mapped to SNOMED CT concepts as the standard for EHR interoperability. Accordingly, electronic clinical quality measures (eCQMs) increasingly define clinical phenotypes with SNOMED CT value sets. The work of creating and maintaining list-based value sets proves daunting, as does vetting that their contents accurately represent the clinicallyintended condition. Objective: To compare an intensional (concept hierarchy-based) vs. extensional (list-based) value set approach to defining clinical phenotypes using SNOMED CT encoded data from EHRs, by evaluating value set conciseness, time to create, and completeness. Methods: Starting from published CMS 2018 high-priority eCQMs, we selected ten clinical conditions referenced by those eCQMs. For each, the published SNOMED CT list-based (extensional) value set was downloaded from the Value Set Authority Center (VSAC). Ten corresponding SNOMED CT hierarchy-based intensional value sets for the same conditions were identified within our EHR. From each hierarchybased intensional value set, an exactly equivalent full extensional value set was derived enumerating all included descendant SNOMED CT concepts. Comparisons were then made between (a) (VSAC) downloaded list-based (extensional) value sets, (b) corresponding hierarchy-based intensional value sets for the same conditions, and (c) derived list-based (extensional) value sets exactly equivalent to the hierarchy-based intensional value sets. Value set conciseness was assessed by the number of SNOMED CT concepts needed for definition. Time to construct the value sets for local use was measured. Value set completeness was assessed by comparing contents of the downloaded extensional vs. intensional value sets. Two measures of content completeness were made: for individual SNOMED CT concepts, and for the mapped diagnosis clinical terms available for selection within the EHR by clinicians. Results: The 10 hierarchy-based intensional value sets proved far simpler and faster to construct than exactly equivalent derived extensional value set lists, requiring a median 3 vs. 78 concepts to define, and 5 vs. 37 min to build. The hierarchy-based intensional value sets also proved more complete: in comparison, the 10 downloaded 2018 extensional value sets contained a median of just 35% of the intensional value sets' SNOMED CT concepts and 65% of mapped EHR clinical terms. Conclusions: In the EHR era, defining conditions preferentially should employ SNOMED CT concept hierarchy-based (intensional) value sets, rather than 1 extensional lists. By doing so, clinical guideline and eCQM authors can more readily engage specialists in vetting condition subtypes to include and exclude, and streamline broad EHR implementation of condition-specific ...

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Accelerating the Benefits of the Problem Oriented Medical Record

Cited by 18 publications

References 12 publications

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Electronic Health Record and Problem Lists in Leeds, United Kingdom: Variability of general practitioners’ views

SNOMED CT Concept Hierarchies for Computable Clinical Phenotypes From Electronic Health Record Data: Comparison of Intensional Versus Extensional Value Sets (Preprint)

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