Table 1 Details on problem list vignette questions
Question | Category | Potential Controversy | Example |
|---|---|---|---|
What problems should be included (Broad)? | |||
1 Family History | Should family history only be listed in the family history section of the EHR or if important enough be included in the problem list. | Family history of breast cancer; Family history of diabetes | |
2 Social History | Should social history only be listed in the social history section of the EHR or if important enough be included in the problem list. | Construction worker; Non-smoker; Suspected alcohol abuse | |
3 Surgeries | Should surgeries only be listed in the past surgical history section of the EHR or if important enough be included in the problem list. | Appendectomy; Knee replacement surgery | |
4 Hospitalizations | Should hospitalizations only be listed in the prior hospitalization section of the EHR or if important enough be included in the problem list. | Hospitalized - May 2006 - MI | |
What problems should be included (Detailed)? | |||
5 Latent chronic diseases | Should chronic diseases which are currently not receiving medical treatment be included in the problem list? | Asthma, no symptoms, no medications | |
6 Non-medical conditions | Should problems that are not a disease, family history, social history, surgery, or hospitalization be included in the problem list? | Medical anxiety; Medication non-compliance | |
7 Undiagnosed long term symptoms | Should symptoms that cannot be linked to a specific diagnosis of a disease be listed in the problem list? | Chest pain - work up completed, no diagnosable cause | |
8 Multiple occurrences of transitive illness | Should transitive illnesses that occur multiple times be listed in the problem list? | Multiple urinary tract infections | |
9 Sequelae problems | Should a disease caused by an original disease be listed in the problem list? | Coronary heart disease caused by diabetes | |
Terminology | |||
10 Use of acronyms | Should practitioners use acronyms in the problem list or write out the full title of the disease? | DM or Diabetes Mellitus; CHD or Coronary Heart Disease | |
10 Level of detail of problems | What level of specificity should be used to describe a problem? | Diabetes; Diabetes Mellitus; Diabetes Mellitus Type II | |
11 Listing a sequelae | Should a problem caused by an original disease be listed with the original problem on the problem list? | Diabetes Mellitus Type II with renal manifestations | |
When to add or delete problems? | |||
12 Timing (add) | On a problem where it is unclear if it is transitive or chronic, how much time or number of appointments should the practitioner wait until listing it on the problem list? | Back pain | |
13 Timing (delete) | When a chronic disease is cured or no longer receives medical treatment, should it be deleted from the active status problem list and if so, when? | Diabetes Mellitus Type II; Breast Cancer; Migraines | |
Sensitive Problems | |||
14 Whether to include sensitive problems? | Should sensitive problems be included in the problem list? | Depression, HIV/AIDS | |
15 To include sensitive problems when other practitioners have access to the same record | Should all the patient’s practitioners know of all their diagnoses through the problem list in the EHR? | Anorexia Nervosa; HIV positive | |
16 To include sensitive problems when a patient disagrees with a diagnosis | Should a diagnosis that a patient does not believe they have be listed in the problem list? | Depression; Anxiety Disorder | |
17 To include sensitive problems when a patient has access to the problem list through an online patient portal | If a patient has access to their problem list through an online patient portal, should a diagnosis that could potentially hurt the patient’s feelings be listed on the problem list? | Obesity; Depression | |
Who can change the problem list across the following roles: | |||
18 Specialist | Should specialists be responsible for adding or deleting problems that they diagnose or treat? | Asthma; Breast Cancer | |
18 PCP | Should the PCP be solely responsible for adding and deleting all problems, regardless of who originally diagnosed the problem? | All potential problems | |
19 Nurse Practitioner | Should a nurse practitioner be allowed to add and/or delete problems when they care for a patient? | All potential problems | |
20 Other RN | Should an RN other than a nurse practitioner be allowed to add and/or delete problems when they care for a patient? | All potential problems | |