problem list

A problem list is a document that states the most important health problems facing a patient such as nontransitive illnesses or diseases, injuries suffered by the patient, and anything else that has affected the patient or is currently ongoing with the patient. The list also usually identifies when an injury or illness occurred or was discovered and when it was resolved. A well-designed medical problem list provides a clear picture of a patient's health problems that require consideration or medical intervention.

The benefits of a problem list to patient care include:

  • The problem list helps practitioners provide customized care by helping them identify the most important health factors for each patient.
  • The problem list can be used to identify disease-specific populations because it is easier to analyze the data and find all patients with a common illness through ICD-10 coded problems or illnesses in the EHR.
  • Health centers conducting quality improvement programs can use problem lists to identify their disease-specific patient populations, provide follow-up care, and ensure all patients are receiving care that meets best practices in treatment.
  • The problem list can also serve as the basis for determining standard measures or report cards for practitioners and healthcare institutions.
  • The problem list can also be used to identify patients for potential research studies.

In order to facilitate information retrieval and meet meaningful use requirements -- which encourages the implementation of EHRs by paying incentives to eligible healthcare professionals and hospitals -- many in the healthcare industry are transitioning from written medical problem lists to encoded problem lists. In other words, a list of health problems with their corresponding ICD-10 codes.

The administration of problem lists can present challenges. Many organizations struggle to define responsible and accountable for deciding what should and should not be included in order to maintain an accurate and updated medical problem list. Therefore, healthcare providers need to figure out how to structure, manage, and identify what content to include in a problem list.

One major point of debate is which illnesses should be included in a problem list and which should not.  Most healthcare organizations have left this decision up to their practitioners and, as a result, a shared record system often contains many different styles of problem lists.

Another point of discussion surrounding the problem list is the inclusion of highly sensitive patient information that may not be need-to-know information for everyone within the healthcare organization. For example, a healthcare organization with a behavioral health division must determine how much behavioral health information should be shared across the entire organization. At organizations without an official policy, this decision is left up to the judgment of the practitioner and since the problem list is rarely filtered the information can be viewed by most people and departments within the organization that have access to EHRs.

As a result, healthcare organizations must carefully consider state and federal patient privacy requirements because failure to incorporate and implement patient privacy rules in the design of the problem list could cause privacy breaches. It is important that healthcare organizations clearly define what should and should not be included on the list of health problems so that appropriate confidentiality of patient data is maintained.


This was last updated in November 2011

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