Medicine & Health Sciences

Clinical Problem Lists in the Electronic Health Record
Editor: Adam Wright, PhD

Clinical Problem Lists in the Electronic Health Record

Published. Available now.
Pub Date: December 2014
Hardback Price: $179.95 US
Hard ISBN: 9781771880916
Pages: 348pp with index
Binding Type: hardbound

This important and timely book presents a variety of perspectives on the organization of patient medical records around patient problems, presenting a more effective problem-oriented approach rather than the traditional data-oriented approach.

Edited by a professor at Harvard Medical School who has extensive experience in this field, the Clinical Problem Lists in the Electronic Health Record is comprehensive, covering the history and importance of the electronic health record, the attitudes toward and use of problem lists, strategies to improve the problem list, and applications in practice of the problem list.

The book’s extensive coverage begins with the history and importance of the health problem list, its origins and how it developed, and goes on to present important evidence that an accurate problem list is associated with improved health care quality. The chapters discuss studies that look at healthcare provider attitudes toward the problem list from different perspectives, including those of physicians, nurses, and other health care providers, and how problem lists use differs significantly by specialty.

Strategies for improving the problem list approach are presented, including a data-mining method for identifying problems, the development of a knowledge base for inferring problems from data, clinical decision support intervention to alert clinicians to gaps in the problem list, and an automated system that fires when medications are added without a corresponding health indication. Also included are several case studies that demonstrate the accurate use of problem lists.

The goal of this book is to inform and inspire researchers, healthcare providers, administrators, software developments, and policymakers interested in understanding and improving problem lists, electronic health records, and healthcare itself, leading to better documentation, better use of information and, ultimately, safe and high quality healthcare.

Part I: History and Importance
1. Bringing Science to Medicine: An Interview with Larry Weed, Inventor of the Problem-Oriented Medical Record
Adam Wright, Dean F. Sittig, Julie McGowan, Joan S. Ash, and Lawrence L. Weed
2. Medical Records That Guide and Teach
Lawrence L. Weed
3. Clinical Implications of an Accurate Problem List on Heart Failure Treatment
Daniel M. Hartung, Jacquelyn Hunt, Joseph Siemienczuk, Heather Miller, and Daniel R. Touchette

Part II: Attitudes and Use
4. Clinician Attitudes Toward and Use of Electronic Problem Lists: A Thematic Analysis
Adam Wright, Francine L. Maloney, and Joshua C. Feblowitz
5. Healthcare Provider Attitudes Towards the Problem List in an Electronic Health Record: A Mixed-Methods Qualitative Study
Casey Holmes, Michael Brown, Daniel St Hilaire, and Adam Wright
6. Use of an Electronic Problem List by Primary Care Providers and Specialists
Adam Wright, Joshua Feblowitz, Francine L. Maloney, Stanislav Henkin, and David W. Bates
7. Distribution of Problems, Medications and Lab Results in Electronic Health Records: The Pareto Principle at Work
Adam Wright and David W. Bates

Part III: Improving the Problem List
8. An Automated Technique for Identifying Associations Between Medications, Laboratory Results and Problems
Adam Wright, Elizabeth S. Chen, and Francine L. Maloney
9. A Method and Knowledge Base for Automated Inference of Patient Problems from Structured Data in an Electronic Medical Record
Adam Wright, Justine Pang, Joshua C. Feblowitz, Francine L. Maloney, Allison R. Wilcox, Harley Z. Ramelson, Louise I. Schneider, and David W. Bates
10. Improving Completeness of Electronic Problem Lists Through Clinical Decision Support: A Randomized, Controlled Trial
Adam Wright, Justine Pang, Joshua C. Feblowitz, Francine L. Maloney, Allison R. Wilcox, Karen Sax McLoughlin, Harley Ramelson, Louise Schneider, and David W. Bates
11. Computerized Physician Order Entry of Medications and Clinical Decision Support Can Improve Problem List Documentation Compliance
William L. Galanter, Daniel B. Hier, Chiang Jao, and David Sarne
12. Randomized Controlled Trial of an Automated Problem List With Improved Sensitivity
Stéphane M. Meystre and Peter J. Haug

Part IV: Applications of the Problem List
13. Incomplete Care: On the Trail of Flaws in the System
Tejal K. Gandhi, Gianna Zuccotti, and Thomas H. Lee
14. Leveraging Electronic Health Records to Support Chronic Disease Management: The Need for Temporal Data Views
Lipika Samal, Adam Wright, Bang Wong, Jeffrey Linder, and David Bates
15. Indication-Based Prescribing Prevents Wrong-Patient Medication Errors In Computerized Provider Order Entry (CPOE)
William Galanter, Suzanne Falck, Matthew Burns, Marci Laragh, and Bruce L. Lambert

About the Authors / Editors:
Editor: Adam Wright, PhD
Assistant Professor of Medicine, Harvard Medical School, Boston, Massachusetts

Adam Wright, PhD, is an Assistant Professor of Medicine at Harvard Medical School, Boston, Massachusetts. His research interests include electronic health records, clinical decision support, and data mining. In addition to research, Dr. Wright teaches introductory medical informatics at Harvard Medical School as well as clinical epidemiology and healthcare policy to medical students. He is also a member of the leadership team for the Agency for Healthcare Research and Quality-Funded Clinical Decision Support Consortium, which is focused on developing methods for sharing clinical decision support content. Adam has a PhD in Medical Informatics from the Oregon Health and Science University and a BS in Mathematical and Computational Sciences from Stanford University.

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