Current state of electronic problems lists in primary care: a rapid scoping review

Electronic problem lists (PLs) are central to the problem-oriented medical record and increasingly underpin clinical decision support (CDS), interoperability, and emerging artificial intelligence applications in primary care. However, persistent concerns regarding PL accuracy, completeness, and governance limit their clinical value.

To update the foundational framework proposed by Hodge and Narus by synthesizing contemporary evidence on electronic PLs in primary care and primary care-relevant settings.

We conducted a rapid scoping review following Joanna Briggs Institute guidance and PRISMA-ScR reporting standards. MEDLINE (Ovid) was searched for peer-reviewed studies published between March 2016 and May 2026. Eligible studies examined digital PLs or extractable PL-related practices relevant to primary care. Findings were synthesized using a hybrid inductive-deductive approach and mapped to the seven Hodge and Narus themes.

A total of 103 studies were included. Across settings, PLs were widely recognized as foundational for longitudinal care, safety, and coordination. However, incomplete, outdated, or inconsistently maintained PLs remained common. Persistent challenges included unclear ownership, workflow misalignment, and variability in what constitutes a "problem." Emerging technologies-including CDS, natural language processing, and machine learning-were increasingly used to support PL generation, curation, reconciliation, and organization, with greatest benefit when embedded within clinician-led workflows.

Despite technological advances, the clinical value of electronic PLs in primary care continues to depend on governance, workflow integration, and shared accountability. Updating the Hodge and Narus framework highlights the need for sociotechnical approaches to PL improvement as PLs become integral to CDS and artificial intelligence-enabled care.