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mary care physicians. Unlike specialists’ narrower focus of care, primary care physicians require a broader, compre- hensive view of medical histories to design care plans to meet their patients’ needs. Thus, they are more likely to recognize immediate benefi ts from an up-to-date problem list. How to reconcile and update problem lists across the continuum of care is part of the currently ongoing Stage 2 discussions within the HIT Policy Committee, HHS’ offi cial advisory committee on meaningful use. Another challenge is that the historical approach to maintaining an up-to-date problem list was driven by organizations’ needs to accurately capture charges as op- posed to supporting care delivery. This led to a predomi- nant use of cryptic billing codes associated with ICD-9 to document physicians’ diagnoses and treatments. As a result, many physicians have resisted adoption of EHRs in general, and up-to-date problem lists in particular. This hurdle will be overcome when ICD-10 takes effect in 2013, which coincidentally is the expected timeline for beginning the transition to Stage 2. As facilities move to comply with Stages 1 and 2, they will be well served by seeking out EHRs that are ICD-10 compliant and offer ICD-9 to ICD-10 cross-mapping. To be sure, maintaining an up-to-date problem list is a time-consuming and complex endeavor. One of the most important factors to maintenance success is to select an EHR technology that interoperates with legacy healthcare technologies across disparate locations, further enabling coordinated provider updates to the problem list. The alternative is retrofi tting non-interoperable existing EHR solutions with custom application interfaces – a costly op- tion that often fails to deliver the promised data exchange and its associated care improvements.

In addition to selecting the appropriate EHR technol- ogy to facilitate ease of problem list updates, organizations must also discuss problem list expectations with their health professionals, delegating and assigning maintenance responsibilities as agreed upon within the care team. Af- ter institutions achieve consensus, they can deploy and confi gure their problem-centric EHR according to the clinicians’ expressed needs.

The importance of implementing and maintaining an up-to-date problem list can’t be overstated. The problem list is the foundation for improving access to real-time clinical information, increasing care quality and patient safety while reducing wasteful spending. Specifi cally, an up-to-date problem list enables providers to: • Access a centralized and concise view of the patient’s medical problems;

• Associate patient problems with diagnostic/therapeutic interventions;

• Communicate and coordinate with other health profes- sionals;

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• Increase adoption of screening programs and preventive health measures;

• Enhance management of chronic conditions; and • Improve clinical decision making.

The problem list is the foundation for improving access to real-time clinical information, increasing care quality and patient safety while reducing wasteful spending.

As the cornerstone of care coordination, cost ac- countability and clinical effectiveness, the problem list, embedded within problem-centric EHRs, will be at the forefront of meaningful use over the next two years. Healthcare organizations that embrace the technology and its myriad benefi ts will be well positioned to cap- ture maximum meaningful-use incentives, seamlessly exchange health information and effi ciently navigate a reimbursement and care delivery system with an ac- countable care approach.

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