Correctly structured problem lists lead to better and faster clinical decision-making in electronic health records compared to non-curated problem lists: A single-blinded crossover randomized controlled trial

• Published in: International journal of medical informatics (Shannon, Ireland) Ireland), 2023-12, Vol.180, p.105264-105264, Article 105264
• Main Authors: Klappe, Eva S., Heijmans, Jarom, Groen, Kaz, ter Schure, Judith, Cornet, Ronald, de Keizer, Nicolette F.
• Format: Article
• Language: English
• Subjects: Clinical decision making; Electronic health records; Problem list; Problem-oriented medical records; Structured and standardized data capture
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2023.105264

•Acceptance and actual use of the electronic problem list is more likely when the problem list provides healthcare providers a direct incentive, such as time and effort saved, and improves patients’ outcomes.•The results of this randomized controlled trial showed that providers using records with correctly structured problem lists make better and faster clinical decisions compared to records with problem lists that represent current clinical practice.•Organizations need to determine the best strategy for deploying problem list-oriented medical records. Correctly structured problem lists in electronic health records (EHRs) offer major benefits to patient care. Without structured lists, diagnosis information is often scatteredly documented in free text, which may contribute to errors and inefficient information retrieval. This study aims to assess whether EHRs with correctly structured problem lists result in better and faster clinical decision-making compared to non-curated problem lists. Two versions of two patient records (A and B) were created in an EHR training environment: one version included diagnosis information structured and coded on the problem list (“correctly structured problem list”), the other version had missing problem list diagnoses and diagnosis information partly documented in free text (“non-curated problem list”). In this single-blinded crossover randomized controlled trial, healthcare providers, who can prescribe medications, from two Dutch university medical center locations first evaluated a randomized version of patient A, then B. Participants were asked to motivate their answer to two medication prescription questions. One (test) question required information similarly presented in both record versions. The second (comparison) question required information documented on problem lists and/or in notes. The primary outcome measure was the correctness of the motivated answer to the comparison question. Secondary outcome measure was the time to answer and motivate both questions correctly. As planned, 160 participants enrolled. Two were excluded for not meeting inclusion criteria. Correctly structured problem lists increased providers’ ability to answer the comparison question correctly (56.3 % versus 33.5 %, McNemar odds ratio 2.80 (1.65–4.93) 95 %-CI). Median time to answer both questions correctly was significantly lower for EHRs with correctly structured problem lists (Wilcoxon-signed-rank test p = 0.00002, with incorrect answers c