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Problem and Medication List Review: More Than Checking a Box?

Jodi Simon1, Jeffrey Panzer, Abbey Ekong

  • 1Author Affiliations: Research & Evaluation, AllianceChicago, Chicago, Illinois (Dr Simon, Dr Panzer, and Ms Ekong); Rush University Medical Center, Chicago, Illinois (Mr Driscoll); American Medical Association, Chicago, Illinois (Dr Sinsky); and Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Wright).

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Summary
This summary is machine-generated.

Clinician attestation of problem and medication list review does not ensure lists are shorter or less duplicative. This "check-the-box" activity may increase clinician cognitive burden without improving list accuracy.

Keywords:
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Area of Science:

  • Health Informatics
  • Clinical Workflow Optimization
  • Electronic Health Records (EHR)

Background:

  • Maintaining accurate problem and medication lists is crucial for quality care but can be time-consuming.
  • This process contributes to clinician cognitive load and burnout.
  • Accurate lists were a core measure in the Meaningful Use EHR incentive program.

Purpose of the Study:

  • To investigate the relationship between clinician attestation of problem and medication list review and the actual length and duplication of these lists.
  • To understand the cognitive burden associated with list review.

Main Methods:

  • Retrospective analysis of EHR data from 24 Federally Qualified Health Centers for patients with at least two visits.
  • Survey data collected from providers to assess cognitive burden of list review.
  • EHR data spanned June 1, 2021, to May 30, 2022; surveys were conducted December 2022 to March 2023.

Main Results:

  • Analysis included 362,436 patients and 1,346,645 encounters.
  • Eighteen percent of patients had >20 items on their problem list; 1% had >20 on their medication list.
  • No meaningful correlation found between list length/duplication and clinician attestation; high cognitive effort reported for reviews.

Conclusions:

  • Clinician attestation does not guarantee shorter or less duplicative problem and medication lists.
  • The attestation process may be a "check-the-box" activity, increasing cognitive burden without achieving the goal of accurate, uncluttered lists.
  • Findings suggest a disconnect between EHR metrics and actual clinical practice improvements.