title: Healthcare provider attitudes towards the problem list in an electronic health record: a mixed-methods qualitative study.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Brigham and Women's Hospital, 1 Brigham Circle, Boston, MA 02120, USA. cholmes6@gmail.com
authors.forename: Casey
authors.initials: C
authors.lastname: Holmes
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
authors.forename: Daniel St
authors.initials: DS
authors.lastname: Hilaire
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
mesh_terms: D001291:Attitude of Health Personnel; D001900:Boston; D003430:Cross-Sectional Studies; D003657:Decision Making; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D036301:Qualitative Research; D011795:Surveys and Questionnaires