title: Effect of implementation of a coded problem list entry subsystem.
abstract: OBJECTIVE
  Complete patient problem lists may improve the quality of care. To improve the completeness of the lists at our institution, we implemented the coded problem list entry subsystem (CPLES) in our electronic medical record system. Subsequently, physicians used the CPLES instead of handwritten notes to document coded problem lists and progress notes. We evaluated the effect of implementing the CPLES on the completeness of problem lists.
  
  
  METHODS
  We compared the completeness of coded problem lists input after CPLES implementation with that of problem lists handwritten before CPLES implementation and determined the differences. Moreover, the efficiency and usability of the CPLES were evaluated.
  
  
  RESULTS
  The efficiency and usability of CPLES were acceptable. However, the completeness of problem lists was reduced after CPLES implementation. The possible reasons for this reduction, namely system usability, efficacy, incentives, leadership, and education, were crucial for successful CPLES implementation and are discussed in the text.
  
  
  CONCLUSIONS
  CPLES implementation reduced the completeness of problem lists. Institutions may learn from our experience and carefully implement their own coded problem list systems to avoid this consequence.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; College of Medicine Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chung-Hsin
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yen-Chun
authors.initials: YC
authors.lastname: Peng
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Sek-Kwong
authors.initials: SK
authors.lastname: Poon
authors.affiliation: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Shih-Che
authors.initials: SC
authors.lastname: Huang
authors.affiliation: College of Medicine Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. Electronic address: jaak88@gmail.com.
authors.forename: Yu-Chuan Jack
authors.initials: YC
authors.lastname: Li
mesh_terms: D057286:Electronic Health Records; D006801:Humans; D011787:Quality of Health Care; D014584:User-Computer Interface
keywords: Electronic medical record; Meaningful uses; Problem oriented medical records; SNOMED CT