Up-To-Date Problem Lists And MU

Sept. 30, 2011

When we ranked the Meaningful Use implementation and use challenges from the Final Rule, July 28, 2010, numbers one and two were clearly CPOE and Maintain Up-to-Date Problem List. Last week, following the CCHIT jury testing process, we tested our product's Problem List capabilities (§170.302b) against the government test procedures, as well as CCHIT Inpatient test scripts. What became immediately clear, and yet not obvious from a distance, is that the government is very serious about the "Up-to-Date" words before the "Problem List" for the inpatient setting. Clearly, creating a one problem Problem List on admission to satisfy the reporting requirement, an approach that more than one CIO asserted would be their approach, will not be "up-to-date" on hospital day two. For example, per TD170.302.c-5, there is an expectation that an acute heart attack be changed from active to inactive.

This point was made by a prominent CIO, Dr. Hal Baker, in his podcast last week as well. Dr. Baker pointed out that the challenges to turning on the Problem List capability within an EMR is easy; and getting a medical staff to use it is complex. These are entirely different issues.

Issue: Historical Reluctance to Use Problem Lists

- Demanding to maintain
- Usually incomplete – so inaccurate
- Often not maintained – results in mistrust
- Problems often linked in a casual way
- Limited classifications, types and status
- Lack of ownership

It stands to reason that, if your goal is to demonstrate Meaningful Use in 2011, creating a shared clinical vision of an up-to-date Problem List is going to be necessary, and will require a campaign and prototype.

To help you get started, here are a few of the benefits you can achieve from evolving toward an up-to-date Problem List:

- Facilitate analysis of potential interaction between patient problems and diagnostic/therapeutic interventions

- Facilitate association of clinical information to a specific medical problem

- Facilitate management of patient chronic conditions

- Support continuity of care

- Improve clinical decision making

- Increase adoption of screening programs and preventive health measures

- Improve communication between health professionals

- Provide a central and concise view of the patient’s medical problems

- Encourage an orderly process of medical problem solving and clinical judgment

- Improve provider productivity, while creating accurate and complete medical records

Installing and turning on certified software is one thing. Achieving and demonstrating Meaningful Use is something more.

What do you think?

Thomas Garthwaite 1007511 120 0 2 Larger

Photo: Dr. Thomas Garthwaite, over a decade ago, led an initiative as Under Secretary for Health at Department of Veterans Affairs, driving problem list usage from 60% prevalence to over 90%, as part of a highly successful and systematic set of initiatives to improve cost, quality and access.