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

Holmes et al.

Holmes et al. BMC Medical Informatics and Decision Making 2012 12:127   doi:10.1186/1472-6947-12-127

Open Data