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THE PROBLEM LIST was first defined and created by Lawrence Weed in the 1960s at a time when care continuity was its primary purpose. Problem lists have become more widely used as a basis for problem-oriented charting, a methodology for clinical documentation embraced by many in the medical establishment. Problem lists were later required as part of the "meaningful use" Electronic Health Record (EHR) Incentive Program (now referred to as "Promoting Interoperability") and have proliferated greatly in their utilization as a result of the implementation of the EHR.
The Centers for Medicare and Medicaid Services (CMS) has defined a problem list as "a list of current and active diagnoses as well as past diagnoses relevant to the current care of the patient." Maintaining the problem list is one of the core measures under the eligible professional meaningful use initiatives. The objective of this core measure is to have providers maintain an up-to-date problem list of current and active diagnoses. "Up-to-date" is also defined under this core measure as having the problem list "populated with the most recent diagnosis known."1 An accurate problem list is critical to providing better patient care across the continuum of care/settings. A problem list should be maintained in order to ensure accuracy, completeness, and integrity.
EHR certification for eligible professionals and hospitals required EHR products to store problem list entries using a designated "CORE" problem list2 subset of Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) codes.3 The process for adding problem list entries as SNOMED CT codes varies by EHR vendor. The most common method is for clinicians to choose interface terminology terms mapped to SNOMED CT codes from menus that appear during clinical documentation. In other instances, users choose the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code titles during the documentation process that are subsequently mapped to SNOMED CT codes. A few EHR systems use SNOMED CT terms during the documentation process.
Most EHRs "map" SNOMED CT entries in the problem list back to an ICD-10-CM code that is pre-selected based upon the model setup of the EHR. When two or more terminologies are used during the process of generating the problem list, challenges with accurate mappings may occur, although error rate reductions are...