A patient EHR may contain multiple so-called problem lists, each with a different purpose. One would normally act as the master problem list, and contain a definitive list of medical diagnoses and other key issues for the patient. The others may be established for other reasons and by specific care groups, including:
specialty-based, e.g. Renal problem list
episodic e.g. Problem list for admission 24/08/2017
care context related e.g. nursing problem list, which will refer to issues directly related to patient daily management, e.g. mobility, continence, memory etc.
A given patient EHR might contain any number of these care delivery oriented lists, along with the master problem list.
Each specific problem list is curated by the healthcare professionals it concerns, while the master problem list will usually be curated by the patient’s long-term GP, specialist, or care team.
Each problem list item refers to a previously committed Entry in the EHR, usually an Evaluation representing a diagnosis and/or other issue, but potentially an Action recording past procedure (e.g. prostate ablation as a proxy for risk of incontinence).
Any previous recorded problem or other Entry in the record may be referred to by multiple problem lists, as shown below (.drawio source file).
Key requirements:
any number of problem lists
master problem list can be set up as a single source of truth in shared (e.g. national, regional) EHR, with transactional interface
a new problem list can be populated by importing the contents of another problem list (or a copy)
items in multiple problem lists may refer to the same primary EHR Entry
programmatic view of problem list is intuitive
ensure no double query inclusion problem
can be embedded in other kinds of reports, e.g. Discharge Summary
Conceptually, we propose to model a problem list as a Heath Thread containing one or more Health Issues (terminology from ISO 13940, Contsys).