So I looked into it. From what I discovered, the problem list seemed like it should be an amazing tool for healthcare providers. Sure, they looked like a mess but they contained a complete snapshot of a patient's medical history!
The problem list came up in several sprints, and every single time it was mentioned, a provider would complain about it or recount a difficult experience with it. It struck me that we should try to do something here.
I had a call with Skype where an emergency physician on our team tried to get across to me what she thought might help her begin to not despise the problem list so much. She mocked up an example of what she thought would work in Microsoft Paint, and we talked through it in the context of a stomach issue.
For example you have pancreatitis and a subset of that is vomiting; it lets you relate things to each other and replace and update.
I feel like there’s no functionality like that in any EMR I’ve ever seen."
- Emergency Physician
The design provided a way to group problems other problems that they were children of (secondary to) or similar to of (duplicates of).
To access this dialog to relate problems, the provider would need to select an "edit" button in the problem list next to the problem.
Something that lets you somehow update the problem list in a user friendly way that takes like 5 seconds."
- Emergency Physician
Instead of requiring the users to click or tap a button, figure out a new window, click or tap again to close/enter their changes, I thought that making the problem list editable directly would work better. Dragging problems on top of one another to create a relationship became the crux of the design.
Another hindrance to speed was the amount of choices available when relating two problems. I consolidated the choices to "similar to" for duplicates and closely related problems, and "secondary to" for problems that were results of or symptoms of others.
How about recurring?? We sometimes see quiescent inflammation that becomes active, then back to quiescent and back to active.
The timing of these recurrences often provides clues to a need for changing management strategies."
Principle, Global Medical Innovation
Based on feedback, I thought that the list could be sorted better to provide more context at first look. When problems were last seen as active as a sorting mechanism combined with problems tagged by their status (putative, active, quiescent, and resolved) gives the provider lots of timing context at a glance.
To give the problem more context, a user can open an Info window about a problem, revealing the it's complete history (labs, referrals, notes, etc.), which they can scrub through using an activity pic-list that displays and links to times of low or heightened activity levels.
This is a great way to provide a sub-structure to the overall list, a great feature to reduce clutter."
"...categorizing redundancies as “similar,” and creating a hierarchical structure where certain problems are secondary to others, support the clinician in efficient and effective problem list reconciliation.
- Physician Informaticist