A data model that captures clinical reasoning about patient problems

We describe a data model that has been implemented for the CPMC Ambulatory Care System, and exemplify its function for patient problems. The model captures some nuances of clinical thinking about patients that are not accommodated in most other models, such as an evolution of clinical understanding about patient problems. A record of this understanding has clinical utility, and serves research interests as well as medical audit concerns. The model is described with an example, and advantages and limitations in the current implementation are discussed.