Managing the Flood of Codes: maintaining patient problem lists in the era of Meaningful Use and ICD10

In a medical record, the problem list is a centralized place where healthcare providers can summarize key clinical information about patients. While problem-oriented medical records have been promulgated since Larry Weed described them in 1968, recent advances in health information technologies, evolution in clinical workflows and the emergence of several federal programs have elevated the importance of up to date problem lists. However, each of these forces have also added requirements to how problem lists are structured, formatted and used. For example, current federal programs encourage healthcare providers using electronic health record systems to document problem lists using either SNOMED CT or ICD-9, while federal reimbursement practices are migrating towards ICD-10. None of these problem list standards have been demonstrated to be usable for direct problem list entry. Busy healthcare providers have found it challenging to maintain patient problem lists that accommodate these requirements while also performing other necessary tasks, such as electronic prescribing and test ordering. In this presentation, we will discuss the state of science around creating and maintaining structured problem lists that accommodate numerous external requirements, and demonstrate examples of tools that put this science into practice.