Digital Minute: The Problem Lies with the Problem List
By Walter Reiling, MD, system chief medical information officer, Premier Health; and Mandy Via, system director of access, referral management, and telehealth, Premier Health
The Epic Problem List has been integral to our system since our first go-live almost 18 years ago. Before we had an electronic medical record (EMR), we used the Problem List to help track the issues that affect our patient treatment. With the use of Epic, that part is unchanged, but now it also functions to let the EMR understand the patient's clinical needs. In the early years of our EMR journey, we tapped into this to help us with our notes and, in the ambulatory offices, the diagnosis of the visit. We linked orders and medications to the Problem List, making compliance with the insurance and Medicare rules much easier.
More recently, the information included in the Problem List is being used in decision support tools such as BPAs and advanced analytics. In addition, we now report electronic quality metrics to outside agencies like the Centers for Medicare & Medicaid Services. These are often driven by the disease processes noted on the patient’s Problem List. Proper maintenance of this information is now key in providing quality care for our patients and receiving credit for the care we provide.
We can do better by using this important tool by properly adding new problems to the Problem List when we diagnose patients. Conversely, another area for opportunity is to resolve problems that are no longer active when admitting or discharging a patient. Also, we can evolve a problem as it changes. For example, if a patient is admitted with a diagnosis of acute pulmonary embolism, it should be changed to a history of pulmonary embolism once it is treated. It is easy to see the maintenance of the Problem List as a clerical task taking us away from our patients, but it is truly an integral part of providing the best patient care possible. If we all contribute, the workload will be manageable for all of us.
Back to the April 2024 issue of Premier Pulse
