Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Abstract

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.

Factors Influencing Problem List Use in Electronic Health Records—Application of the Unified Theory of Acceptance and Use of Technology

“…Lacking content and poor presentation has also been reported by previous studies that examined factors influencing problem list use. 5,7,8,10,21,34,35 These studies also support our findings with regard to the lack of policies and guidelines 5,35 and lack of training. 5,21,34 In our study, we further identified how training can be improved: by involving "champions" in small peer groups.…”

“…[2][3][4] Accurate problem lists that provide a concise summary of patient problems can therefore help physicians to track a patient's status and progress, and organize clinical reasoning and documentation. 3,5,6 Although physicians and patients acknowledge the value of an accurate problem list, 7,8 problem lists often remain incomplete, due to lack of responsibility, incomplete and inaccurate content of the underlying terminology, and because of little technical and administrative support. 5,9,10 Subsequently, physicians often modify these coded problems to their preferences, by adding details for these problems in clinical notes.…”

“…40 However, we are confident that we collected accurate results as we used the validated UTAUT framework, which is commonly used to determine factors influencing acceptance of (new) technologies in medical context 16,22,25,26 we received similar answers among the participants about problem list use and we reached saturation. Additionally, literature 5,7,8,10,21,34 states factors influencing problem list use that correspond to our outcomes. Therefore, although we examined one organization that uses one software system, other hospitals that use the same EHR system or the same approach to populate the problem list might still benefit from the presented results and recommendations.…”

Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

“…In addition to documentation support, clinicians' EHR use is also known to aid in achieving other important goals, such as communicating with team members and synthesizing large amounts of information. 7 However, literature suggests that the introduction of EHRs has not always considered the nature of work in the ED, resulting in transformed and suboptimal workflow leading to substantial frustrations with the systems. 8,9 In the United States, studies investigating the impact of EHRs on clinical workflows suggest that the docu-mentation has increased over the last decade, with 50 to 65% time spent on EHR-related activities.…”

Consensus Development of a Modern Ontology of Emergency Department Presenting Problems—The Hierarchical Presenting Problem Ontology (HaPPy)

“…This focus on reducing the unintentional negative effects of electronic health records (EHRs) is important as EHRs are becoming increasingly linked to physician dissatisfaction and burnout. [7][8][9][10][11] Over the past 15 years, attempts have been made to create a standardized method of recording CCs. 12 Prior attempts have failed to gain widespread acceptance for various reasons: they may not be freely sharable or may not have had the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community.…”