Cooperative documentation: the patient problem list as a nexus in electronic health records

The patient Problem List (PL) is a mandated documentation component of electronic health records supporting the longitudinal summarization of patient information in addition to facilitating the coordination of care by multidisciplinary medical teams. In this paper, we report an ethnographic study that examined the institutionalization of the PL. Specifically, we explored: (1) how different groups (primary care providers, inpatient hospitalists, specialists, and emergency doctors) perceived the purposes of the PL differently; (2) how these deviated perceptions might affect their use of the PL; and (3) how the technical design of the PL facilitated or hindered the clinical practices of these groups. We found significant ambiguity regarding the definition, benefits, and use of the PL across different groups. We also found that certain groups (e.g. primary care providers) had developed effective cooperative strategies regarding the use of the PL; however, suboptimal usage was common among other user types, which could have a profound impact on quality of care and safety. Based on these findings, we provide suggestions to improve the design of the PL, particularly on strengthening its support on longitudinal and cooperative clinical practices.