Clinician attitudes toward and use of electronic problem lists: a thematic analysis

Abstract

BackgroundThe clinical problem list is an important tool for clinical decision making, quality measurement and clinical decision support; however, problem lists are often incomplete and provider attitudes towards the problem list are poorly understood.MethodsAn ethnographic study of healthcare providers conducted from April 2009 to January 2010 was carried out among academic and community outpatient medical practices in the Greater Boston area across a wide range of medical and surgical specialties. Attitudes towards the problem list were then analyzed using grounded theory methods.ResultsAttitudes were variable, and dimensions of variations fit into nine themes: workflow, ownership and responsibility, relevance, uses, content, presentation, accuracy, alternatives, support/education and one cross-cutting theme of culture.ConclusionsSignificant variation was observed in clinician attitudes towards and use of the electronic patient problem list. Clearer guidance and best practices for problem list utilization are needed.

Use of an Electronic Problem List by Primary Care Providers and Specialists

“…9,10 It is important to note that PCPs have, in general, used EHR longer than specialists in this network, and that the problem list is integrated so that everyone can see the problems entered by others. This is especially important in light of the substantial financial incentives, which have been invested to increase provider use of EHRs and improve care.…”

“…In a previous qualitative study on the use of problem list by clinicians, none reported receiving specific guidance on problem list utilization. 10 When a provider modifies the problem list, the LMR records the identity of the provider and the clinic they are logged into at the time of the change.…”

“…4,5 However, research has shown that problem lists are frequently inaccurate and out-of-date. [6][7][8][9][10] In a previous study, we demonstrated that common problems were frequently omitted from the problem list at one large hospital network-completeness ranged from 4.7% for renal disease to a maximum of 78.5% for breast cancer. 11 In previous qualitative research, we found that provider attitudes towards appropriate use and content varies widely and problem lists are frequently perceived as inaccurate, incomplete and out-of-date.…”

“…11 In previous qualitative research, we found that provider attitudes towards appropriate use and content varies widely and problem lists are frequently perceived as inaccurate, incomplete and out-of-date. 9,10 In order to shape effective problem list policy and meet "meaningful use goals," it will be necessary to gain an improved understanding of current problem list usage patterns. Based on prior research 9,10 we hypothesized that primary care providers (PCPs) would be the primary problem list users while specialists would use the tool much less frequently.…”

“…9,10 In order to shape effective problem list policy and meet "meaningful use goals," it will be necessary to gain an improved understanding of current problem list usage patterns. Based on prior research 9,10 we hypothesized that primary care providers (PCPs) would be the primary problem list users while specialists would use the tool much less frequently. For the purposes of this paper, "primary care" is defined to include providers specializing in family medicine, internal medicine (excluding subspecialties), geriatrics and pediatrics.…”