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| − | The problem list needs to be far more flexible to be relevant to the
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| − | logged in user. The user's problem list should be created by a combination of
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| − | two types of actions: 1) explicit "promotion" of a clinical entity
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| − | (preferably one that has standard coded terminology behind it) by the logged in
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| − | user and 2) automatic promotion because of clinical rules that pertain to the
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| − | logged in user's practice group.
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| − | The problem list always need to be "filterable" by attributes such as
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| − | "active", "inactive", "resolved", etc.
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| − | The problem list should be composed of "actionable" entities, so that
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| − | changes to the problem status are more easily rendered and so that an
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| − | individual problem may be facilely linked to other activities such as
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| − | ordered services. Another example of actions to be taken is creating
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| − | the links between problems (see Dr Rose's discussion of "nesting" below);
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| − | again, this should be specific to the logged in user since we all have varying
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| − | ideas about how such nesting should be enacted - the important thing is
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| − | to have the nesting tool within the user's grasp. Other actions can
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| − | include attaching "comments" to the problem list entity (such as how could Dr
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| − | Osler think that Mr Agony had "fibromyalgia", when it is clearly
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| − | "somatization" disorder, signed Dr Jung (always electronically signed - no anonymous
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| − | comments allowed!)
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| − | There should always be an opportunity to review a "composite" problem
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| − | list for any patient within an enterprise (by the way, enterprise is very
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| − | broadly defined; it could include a state-wide deployment). That composite list
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| − | would be a listing of all problems that have been promoted to any
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| − | authorized user's problem list. Display of that list should not be irritating; if
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| − | 15 authorized users have "hypertension" on their problem lists, display
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| − | "hypertension" once with a drill down for all of the instances of its
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| − | instantiation. By the way, the display could/should also permit the
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| − | logged in user to see any other clinician's problem list for the patient in
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| − | focus.
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| − | If one adheres to these simple principles, the squabbling between users is both well documented but is
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| − | non-intrusive. Dr Osler continues to have "fibromyalgia" on Mr Agony's
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| − | problem list and user Dr Jung continues to have "somatization disorder"
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| − | on Mr Agony's problem list. Neither has to see what the other has entered
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| − | unless they choose to look at the composite list. Moreover, for Joint
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| − | Commission reviews, there is a total problem list for any patient.
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| − | Moving on to discontinuing medications. In general, good housekeeping
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| − | suggests that the following care team members receive notification of
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| − | changes to prescribed medications (including dose changes as well as
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| − | discontinuations): 1) prescribing clinician; PCP; listed supervisor of
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| − | non MD clinician.
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| − | [[Category:EMR]]
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