The healthcare industry is transitioning from free-text expression of problems, such as the clinician’s notes, written prescriptions, or office staff’s jotted updates, to encoded, sharable information. In this instance, standardization isn’t a bad thing.
Pick lists can provide more accurate information during patient visits, which makes for more accurate diagnosis and prescription information in the EHR or practice management system. Also known as drop-down lists, these selections are ubiquitous features in EHRs and order entry systems.
Pick lists are designed to save time and make care safer in all settings where they’re used. As the federal Health IT website says, their use affects every aspect of clinical work today, starting with the selection of the correct patient.
Beyond patient visits, these lists facilitate information retrieval for purposes such as capture and storage of patient information in standard coding systems. Systems that use a common code can accurately analyze data, support information retrieval for both common and unique problems, report data to other providers for research, and generate billing information.
However, humans develop and modify pick lists, so they are not foolproof. Patient names and other information must be entered accurately, as well as physicians’ observations of symptoms, treatment recommendations, and referral or follow-up information.
Therefore, use care when developing or updating pick lists for your practice. Well-designed problem lists provide a quick, clear picture of patient issues that require consideration or intervention. They can serve as a “table of contents” for more comprehensive health record details. In addition, these lists serve as a data source for research, quality metrics, and other secondary data-reporting requirements.
The state of standards efforts
National standards are critical to consistent high-quality data that can be exchanged with other stakeholders. Unfortunately, there is no single standard for the structure or content of problem lists. There are some standards that address problem list content, with variations among the standards.
It’s not possible to predict the future, but healthcare organizations of all stripes must ensure their policies and procedures for problem lists designate the standards that best apply to their needs, while ensuring, to the extent possible, the future of health information exchange with other providers and meeting patient needs.
Vendors, providers and others should all be involved in reducing pick-list medication errors, according to a new report from the Office of the National Coordinator for Health IT.
The report, which focuses on improving pick lists in ambulatory care settings, notes that pick lists can save time and reduce some errors, such as typographical mistakes stemming from sloppy physician handwriting. However, they have created new types of medication errors. These errors might be caused by poor design, improper implementation, or erroneous system configuration.
Two common pick-list errors are choosing the wrong patient record and choosing the wrong medication for a patient, according to the ONC report.
The ONC makes six recommendations to reduce these errors:
- Use specific design features to reduce wrong-patient pick-list errors, such as keeping a photograph of the patient in the record.
- Use electronic prescribing guidelines that focus on improving safety when developing pick lists.
- Determine best practices for organization, design, and configuration of pick lists.
- Display a summary review screen before completing a medication order.
- Provide easy-to-use “retract and reorder” functionality as well as functionality to track and identify potential design errors through the use of this information.
- Provide patients with lists of their current medications.
Today’s EHRs include pick lists as a patient-safety measure, to improve usability and implement new features that prevent accidental harm. The ONC’s detailed methodologies for the safe and effective use of pick lists aim to improve medication management and other ordering tasks.
Robust EMRs will provide a set of pick lists for medical and surgical conditions and procedures consistent with the needs of primary care physicians. The list should link to a larger table of ICD-10 codes. If the pick lists are constructed well, review of symptoms documentation can be done almost entirely using point-and-click selection, avoiding the need for free text. Likewise, customizable pick lists for past medical and surgical history can be created from ICD-10 and CPT tables. These lists will be similar to the pick lists for assessment and plan of care.
Optimized pick lists aren’t the whole story when it comes to accurate information, though. Some experts recommend keeping fields for typing “unstructured” data, such as clinician notes, as part of the record. The right drop-down items must be selected, but reserve space for quickly typed notes so that you have accurate, contemporaneous information