Managed Lists

Overview

‘Managed List’ is a common term for lists of specific kinds of patient data that attempt to capture an current and/or ongoing picture of the patient state. Common examples:

• (master) Problem list

• Allergies & alerts list

• Medication list

• Vaccination list

• Family history

• Past procedures

• Patient preferences

Some of these are semantically true ‘singletons’ as their contents are intended to closely reflect something about the individual patient: Medications list describes the medications currently and/or previously being taken by the patient (i.e. possibly in the patient’s body); Allergies & alerts list is a list of propensities for the patient to react to certain substances, organisms, foods etc. Similar for Vaccinations and family history.

There is however usually a level of subjective choice as to what is relevant to be included on any such list, since not every ‘problem', allergy, or previous medication has a bearing on current care. These lists are therefore considered ‘managed’ in the sense of being curated from primary data, rather than being simply the result of brute-force queries that would return all diagnoses, medications, all recorded allergies, etc. Often there is no data in an EHR for e.g. childhood tetanus shots or courses of antibiotics, and indeed even when questioned, patients will not reliably remember most mundane medications or minor procedures. This is not normally considered a problem for patient care.

A list of ‘problems’ is challenging in additional ways: there are levels of problem, from headline diagnoses (e.g. vertigo) to problems/issues of daily living (e.g. risk of falling, difficulty on stairs). In modern care, there tend to be multiple Problem lists, each oriented to a category of care; one of these is ideally a master Problem list, containing a definitive list of medical diagnoses.

Common Semantics

Because a managed list is curated, it requires its own content structure, along with the ability to refer to or cite the primary data items that are to be logically included in the list. This is even true in cases where the EHR does not contain original diagnosis, medication record etc, for particular problems or medications, because such problems or medications are represented as new primary Entries in the record created based on patient-supplied information (e.g. when registering in a clinic for the first time).

Architectural Concept

xxx

• Managed List structure

• citations

• Transaction service interface

Specific Types