Maybe. Whether the contents (to a specific viewer) are the same or not, the way in which they are presented will differ between disciplines. And I expect that clinicians will have strong views about what should be ‘in the list’ from their perspective - and what is unimportant to them, and so appears as clutter.
I would disagree - I think the relative importance of items on a list would change based on perspective - but the list itself would likely stay the same.
Its really about defining a cross disciplinary minimum data set.
A rehab specialist might note the item of poor social connection with a higher ranking than a surgeon, as a surgeon might note prior surgeries higher - in terms of using the list - but the list would remain the same.
I think everyone likes a central comprehensive listing (at least amongst clinicians). I say this because I have recently learned from registrars here in ChCh, that no matter what service you are
on, you always try and find if there is a Medical Oncology letter (not tooting my own specialities horn, but …) because it is the place that will have a comprehensive new patient letter that includes all these details. I’ve heard this is common practice
regardless of run you are on, because no other place will have a complete listing of all the issues a patient has…
Maybe. Whether the contents (to a specific viewer) are the same or not, the way in which they are presented will differ between disciplines. And I expect that clinicians will have strong views about what should be ‘in the list’ from
their perspective - and what is unimportant to them, and so appears as clutter.
Perhaps a better way of expressing it is that in the design of the list there needs to be some mechanism for supporting personalisation of presentation if the list is to be used by a wide range of specialties - in addition to the clinical characteristics of the items in the list.
I have no immediate thoughts about how that can be done, but I recall building a protoype of a problem list for some specialists at middlemore a little while ago, and this ‘viewing customizing’ was a high priority requirement for them. And that was just for conditions that were added by hospital specialists - not primary care or the patient themselves…
[Matthew Strother](https://u1980013.ct.sendgrid.net/wf/click?upn=KFL5ItWFbQhXGlA8EdfEZ7OjpLWhnuogorrzvtKUpwx5qUuihWyQoX9MDyruuk23-2FDe07bhrEwmFfblACP5P-2Fw-3D-3D_UZ-2Fw3Bg8EOda-2F-2BSazO07kev1gUT-2F4gCy5SRjJrFYxKmAIO1mLriHox3hpg8YrOx2jNmjJTSRP9pp9y5LL5XSwL7zzF7Y-2B64vYdJap81Ehn5LJGNCcKb9WDflEdU6d0z9snzNjswoy1lstbq6eAOy3X7Xw0MSrOtUPtRIXDjmrlx5SO6JudAHG4nXvf2mVi3WGyZXB6bMSXYCWw1jNR2UNYpb-2BwNKFQv4zR7czcgipUk-3D)
NZ Clinical informatics Leadership Network Member
July 22
I think everyone likes a central comprehensive listing (at least amongst clinicians). I say this because I have recently learned from registrars here in ChCh, that no matter what service you are
on, you always try and find if there is a Medical Oncology letter (not tooting my own specialities horn, but …) because it is the place that will have a comprehensive new patient letter that includes all these details. I’ve heard this is common practice
regardless of run you are on, because no other place will have a complete listing of all the issues a patient has…
It is good to flesh out what we need to have by this list.
Are you saying you would want to have a list outside your normal workflow. i.e. you would see the patient list your goals and outcomes and then update the list?
Part of the reason for having this list is to have an idea of the current issues people are working towards. In part with the hope that this will overcome the issues when people focus on just their specialty
Also you do however touch on two other issues that we need to clarify.
A list is only useful if it is being used and rather than having to rely on a generalist to curate it, how long standing will the list be. I believe having a list of the active issues that you are working on resolving/ monitoring is a useful lens. You want the whole elephant not just the trunk, however how do you keep if focused. So do you encourage people to only have 5 main issues and if they have more than use it as a training opportunity.
What is the focus of this list? is this a list for secondary care to better co-ordinate delivery of care for patients. Would GP’s want to be able to curate this list. My gut feel is this is a list to ensure we look after the elephant better and, in this iteration at least, should be a list of active items specialists/allied health / nursing are working on
David it would need to be one list
Now we are talking, with the reveal the elephant button. So i can get an idea of all the work underway, how great would it be to see all the issues other parts of the team are working on that are important.
I still think that the prerequisite for this list though should be that there is an ongoing action on your part, because if you are not monitoring or treating it then should not be relevant (unless it is a decision clearly not to do anything, e.g for palliative care, these decisions would need to be documented elsewhere within Advance Care Plans)
I would argue that a list would serve more as a central repository of active issues - I think it is not correct to frame this as ongoing monitoring or actively resolving - I think there are a lot of issues in medicine that we don’t resolve or fix, but we do need to be aware of. for instance - I have a lymphoma patient. He needs chemo or he will die of lymphoma. but he also has heart failure. now, normally, as an oncologist I try to avoid knowing anything about the heart. however, the typical treatment for lymphoma involves anthracycline, which is associated with a cardiotoxicity, a cardiotoxicity that is lethal if given in the context of an already dysfunctional heart. So if I had a oncology context specific view of the list - I wouldn’t know this - and would kill the patient. Whereas if I had a general list, I would say - in this instance - it matters that they have heart failure. This is play example, but captures the idea.
I also think that the quote of my comment is a little out of context. You may not be treating it but if you are treating a patient that has heart failure they would be on the list of the cardiology team and i.e. in the “elephant view”. I would argue that given the potential of cardiotoxicity the decision not to use anthracycline would mean potential signs of heart failure would be on the list of things you would be monitoring.
The issue here is trying to prevent a five page list and to keep it relevant to the user and provide a view of other issues that are being actively treated.
Do we need two lists,
Active diagnoses that have would have an impact to patients care and treatment decisions moving forward
issues being monitored and worked on to address these and potentially other items that may not have a formal diagnoses?
All very good, but things we need to be clear on function. I think by focusing on items relevant now may help prevent things become to cluttered
Also would you need to be able to cut and paste parts of your action list into your letters, or would you have your letters populated from this action list?
I agree on the need for rules and curation. I’ve seen similar list (e.g. in the HealthOne tab on HCS ) that have left toe laceration from 20 years ago listed.
Curation is tricky - I think GPs are in the best position - but I think it will take time, and they operate in a fee for service environment. unless funds are earmarked to do this, it is not likely to get done. I think specialists are also a risk, though, because they will preference to speciality.
I think the two lists concept is more in lines with what @david.hay was talking about with different filtered views.
In effect - I think there is a master list - that is more populated, but with some rules around what stays on this list and curation. That’s the initial thing to agree upon. Then the UI portion of the discussion is really a later step in process.
Hey Guys,
I’m gravitating towards the notion of multiple lists which feed up to a “master list”. Not sure if this is the right solution, but it warrants further exploration. Maybe using the multiple lists concept would allow us to actually get value from the primary care/secondary care split because we could use it as a natural time to curate the list?
I note also that some of my surgical and GP colleagues have talked about having a “procedures” component to the problems list. i.e. “appendicetomy 1994” is not an active problem… until the patient comes to hospital with a bowel obstruction. Similarly, the history of procedures performed during a current hospital admission is of significance to the receiving clinician.
Thoughts?
Would a wiki framework work for this - e.g. something that allows edits, but documents the time/place of edits, and would allow identification of the timeline/nature of edits?
In light of the competing lists/users concept - I wonder if an initial step of identifying lists across craft groups, and then looking for similarity. Overlaps would have good strength in being on a list.
In light of the competing lists/users concept - I wonder if an initial step of identifying lists across craft groups, and then looking for similarity. Overlaps would have good strength in being on a list.
