In a recent webinar, physician informaticist Jim Thompson, MD, drew a compelling parallel between the EHR’s problem list and the dashboard of a plane or car. Since few of us have piloted an aircraft, we’ll focus on the latter.
At any given time, a car’s dashboard displays the information that is relevant, current, and readily understood by the driver. The speedometer and fuel levels, for example, are kept front and center, while less important information is hidden from view. Now, imagine that the problem list did the same for the clinician.
The problem list has long served as the source of truth for each individual patient, but it can also be a source of frustration. A long list of unorganized problems shifts the clinician’s attention and time from the patient to the screen. Duplicate entries and outdated problems add clutter and confusion to an already disjointed workflow. And a problem list that is disconnected from other elements of the patient chart means the clinician must devote time she doesn’t have to finding information that may or may not exist.
If the problem list is going to work for the clinician, as opposed to making the clinician work, tools to improve the user experience must be explored and implemented. Below are four promising areas of focus.
1) Bridge the gap between coding and clinical terminology
EHRs need to allow clinicians to document using intuitive, natural language. In other words, let clinicians speak clinician. Clinical interface terminology solutions free the user to type as they would talk, while connecting to the appropriate standardized codes behind the scenes.
2) Create modular, flexible problem list displays
Flexibility is key when it comes to problem list presentation. After all, not every user needs to see the same information. For example, the display could be customized to meet the needs of a primary care physician and then adapted to suit an anesthesiologist. Similarly, a modular design would allow for problem lists to be organized according to categories, such as musculoskeletal or neurology. While attempts at this modular approach have been made using SNOMED-CT® or ICD-10-CM, it is actually quite difficult to use the hierarchies in those reference vocabularies to create the appropriate clinical groups needed. (For more on this, watch the webinar, or just skip ahead to 23:51 for a compelling example using abscess of the pharynx.)
If the problem list is going to work for the clinician, as opposed to making the clinician work, tools to improve the user experience must be explored and implemented.
3) Develop tools to clean and simplify the medical problem list
The EHR does an excellent job at aggregating patient data. There is room for improvement, however, when it comes to parsing out what needs and deserves the clinician’s attention. Is the patient still pregnant four years after it was documented? Not likely. Then let’s figure out how to clear away the clutter of transient and duplicative problems, and keep clinicians focused on what matters.
4) Link the problem list dashboard to other parts of the chart
A truly effective problem list dashboard should allow the clinician to easily and intuitively connect to other parts of the EHR instead of jumping from screen to screen in order to find and piece together the appropriate details. The ability to bring it all forward into a single visual and then link to relevant information – like lab results or medications – can save precious time and minimize frustration.
The bottom line? The problem list doesn’t have to be just that: a list of problems. It can and should be a clinically meaningful tool that can increase clinician satisfaction, efficiency, and ultimately, patient safety.
