HIM 480 Module 3 Literature Review Short Paper Example

Five Themes in Problem List Research: A Literature Review for the Hollis Ridge Capstone

[Student Name]

Southern New Hampshire University

HIM 480: Health Information Management Capstone

Literature Review

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Five Themes in Problem List Research: A Literature Review for the Hollis Ridge Capstone

This review supports a capstone project to measure and improve problem list accuracy in adult primary care at Hollis Ridge Health. The search combined the terms problem list, electronic health record and completeness in PubMed and CINAHL, limited to English-language studies, and then followed the citations in two major reviews to find older work. The review is organized around five themes that appeared across the studies: the extent of incompleteness, ownership and attitudes, record design and terminology, decision support interventions and the list's role in clinical reasoning.

Theme 1: Lists Are Often Incomplete, and the Degree Varies

Studies agree that problem lists frequently omit conditions that the rest of the record supports, but they disagree on how much, largely because they measure differently. Wright et al. (2015) compared lists with medications, laboratory results and billing codes at ten sites and found completeness for common chronic conditions varying widely from site to site. Poulos et al. (2021), auditing a single hospital, found many conditions recorded in notes but absent from the list. Both studies depend on a reference standard built from other parts of the record, which means their estimates depend on how that standard is defined. For the Hollis Ridge audit, this theme argues for explicit, condition-specific rules and for reporting completeness separately by condition rather than as one number.

Theme 2: Nobody Agrees Who Owns the List

A second theme explains why gaps persist. Holmes et al. (2012) surveyed and interviewed clinicians and found disagreement about who should maintain the list, whether specialists should add problems outside their field and what belongs on it, from diagnoses to social concerns. Klappe et al. (2020) applied a technology acceptance model to problem list use and found that clinicians' use depended on whether they expected the list to help their work, how much effort it took and whether colleagues used it. Read together, these studies suggest that incompleteness is less a knowledge problem than a coordination problem: each clinician assumes someone else will update the list. That points the capstone's interviews toward questions about responsibility and perceived value, not only training.

Theme 3: Design and Terminology Shape Use

The record itself can make the list easier or harder to keep. Hodge and Narus (2018) analyzed the literature on problem list success and identified recurring factors, including clear ownership, usable interfaces, standardized terminology, integration with workflow and organizational policy. Simons et al. (2016) reached similar conclusions in a review of determinants for a successful problem-oriented record, stressing agreed definitions of what a problem is and training that shows clinicians the list's value. Standard terms matter because a list built from free text cannot drive decision support or quality measures. For Hollis Ridge, this theme suggests auditing not only whether a condition is listed but whether it is listed with a codable term.

Theme 4: Decision Support Can Close Gaps

The strongest evidence for an intervention comes from a randomized trial. Wright et al. (2012) built rules that inferred likely missing problems from medications and laboratory results and suggested them to clinicians, who could accept or dismiss each suggestion. Clinics that received the suggestions added far more of the targeted problems to lists than control clinics. The design is attractive because it uses data the record already holds and leaves the clinical judgment with the clinician. The trial was conducted at academic practices with strong informatics support, however, so its effect in a smaller system with fewer informatics staff is less certain.

Theme 5: The List Is Clinical Reasoning, Not Only Data

A final theme reminds readers why the list exists. Weed (1968) proposed organizing the record around the patient's problems so that each could be followed through data, assessment and plan, making the record a tool for reasoning and teaching. Kaplan (2007) argued that the problem list, done well, expresses a clinician's synthesis of the patient, and that its decline into an unordered collection of codes reflects a loss of clear clinical thinking. This perspective warns against solutions that treat the list only as a data field to fill: an intervention that adds codes without supporting clinical judgment may raise completeness while lowering usefulness.

Summary of Evidence

Table 1 summarizes the main sources by theme.

Table 1. Sources by Theme

Note. Compiled by the author.

Quality of the Evidence

The evidence base is uneven. Only one intervention study in this review used a randomized design; most others are cross-sectional audits, surveys or reviews that describe problems rather than test solutions. Several studies come from the same research group, which strengthens consistency of methods but narrows the range of settings studied. Measurement also varies: some studies judge completeness against billing codes, others against medications and laboratory results and others against clinician notes, so their numbers cannot be compared directly. These limits do not weaken the overall message that problem lists are often incomplete, but they caution against promising a specific improvement at Hollis Ridge based on another organization's results.

Gaps the Capstone Can Address

Three gaps stand out. Most studies measure whether conditions are missing, while fewer measure currency, such as resolved problems still marked active, which affects portal summaries and decision support just as much. Evidence comes mainly from large academic systems, leaving smaller community systems like Hollis Ridge less studied. And patients' role in reviewing their own lists through portals has received little attention. The capstone's audit will measure currency alongside completeness, report results from a community system and ask whether patient review could help.

Conclusion

The literature describes problem lists as widely incomplete, poorly owned and shaped by design, with decision support offering one proven way to close gaps and a reminder that the list should serve clinical reasoning. These themes will organize the Hollis Ridge audit, interview questions and solution design.

References

Hodge, C. M., & Narus, S. P. (2018). Electronic problem lists: A thematic analysis of a systematic literature review to identify aspects critical to success. Journal of the American Medical Informatics Association, 25(5), 603-613. https://doi.org/10.1093/jamia/ocy011

Holmes, C., Brown, M., Hilaire, D. S., & Wright, A. (2012). Healthcare provider attitudes towards the problem list in an electronic health record: A mixed-methods qualitative study. BMC Medical Informatics and Decision Making, 12, Article 127. https://doi.org/10.1186/1472-6947-12-127

Kaplan, D. M. (2007). Clear writing, clear thinking and the disappearing art of the problem list. Journal of Hospital Medicine, 2(4), 199-202. https://doi.org/10.1002/jhm.242

Klappe, E. S., de Keizer, N. F., & Cornet, R. (2020). Factors influencing problem list use in electronic health records: Application of the unified theory of acceptance and use of technology. Applied Clinical Informatics, 11(3), 415-426. https://doi.org/10.1055/s-0040-1712466

Poulos, J., Zhu, L., & Shah, A. D. (2021). Data gaps in electronic health record (EHR) systems: An audit of problem list completeness during the COVID-19 pandemic. International Journal of Medical Informatics, 150, Article 104452. https://doi.org/10.1016/j.ijmedinf.2021.104452

Simons, S. M. J., Cillessen, F. H. J. M., & Hazelzet, J. A. (2016). Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature. BMC Medical Informatics and Decision Making, 16, Article 102. https://doi.org/10.1186/s12911-016-0341-0

Weed, L. L. (1968). Medical records that guide and teach. New England Journal of Medicine, 278(11), 593-600. https://doi.org/10.1056/NEJM196803142781105

Wright, A., McCoy, A. B., Hickman, T.-T. T., Hilaire, D. S., Borbolla, D., Bowes, W. A., Dixon, W. G., Dorr, D. A., Krall, M., Malhotra, S., Bates, D. W., & Sittig, D. F. (2015). Problem list completeness in electronic health records: A multi-site study and assessment of success factors. International Journal of Medical Informatics, 84(10), 784-790. https://doi.org/10.1016/j.ijmedinf.2015.06.011

Wright, A., Pang, J., Feblowitz, J. C., Maloney, F. L., Wilcox, A. R., McLoughlin, K. S., Ramelson, H., Schneider, L., & Bates, D. W. (2012). Improving completeness of electronic problem lists through clinical decision support: A randomized, controlled trial. Journal of the American Medical Informatics Association, 19(4), 555-561. https://doi.org/10.1136/amiajnl-2011-000521