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Open Access Highly Accessed Open Badges Research article

Healthcare provider attitudes towards the problem list in an electronic health record: a mixed-methods qualitative study

Casey Holmes135*, Michael Brown4, Daniel St Hilaire135 and Adam Wright1235

Author Affiliations

1 Brigham and Women’s Hospital, 1 Brigham Circle, Boston, MA, 02120, USA

2 Harvard Medical School, Boston, MA, USA

3 Partners Healthcare, Boston, MA, USA

4 Harvard University, Health Services, 75 Mt. Auburn St, Cambridge, MA, 02138, USA

5 Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

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BMC Medical Informatics and Decision Making 2012, 12:127  doi:10.1186/1472-6947-12-127

Published: 11 November 2012



The problem list is a key part of the electronic health record (EHR) that allows practitioners to see a patient’s diagnoses and health issues. Yet, as the content of the problem list largely represents the subjective decisions of those who edit it, patients’ problem lists are often unreliable when shared across practitioners. The lack of standards for how the problem list is compiled in the EHR limits its effectiveness in improving patient care, particularly as a resource for clinical decision support and population management tools. The purpose of this study is to discover practitioner opinions towards the problem list and the logic behind their decisions during clinical situations.

Materials and methods

An observational cross-sectional study was conducted at two major Boston teaching hospitals. Practitioners’ opinions about the problem list were collected through both in-person interviews and an online questionnaire. Questions were framed using vignettes of clinical scenarios asking practitioners about their preferred actions towards the problem list.


These data confirmed prior research that practitioners differ in their opinions over managing the problem list, but in most responses to a questionnaire, there was a common approach among the relative majority of respondents. Further, basic demographic characteristics of providers (age, medical experience, etc.) did not appear to strongly affect attitudes towards the problem list.


The results supported the premise that policies and EHR tools are needed to bring about a common approach. Further, the findings helped identify what issues might benefit the most from a defined policy and the level of restriction a problem list policy should place on the addition of different types of information.

Problem list; Problems; Electronic health record; Standardization; Provider attitudes; EHR