Two algorithms for the reorganisation of the problem list by organ system

Abstract

Objective: Long problem lists can be challenging to use. Reorganisation of the problem list by organ system is a strategy for making long problem lists more manageable.

Methods: In a small-town primary care setting, we examined 4950 unique problem lists over 5 years (24 033 total problems and 2170 unique problems) from our electronic health record. All problems were mapped to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and SNOMED CT codes. We developed two different algorithms for reorganising the problem list by organ system based on either the ICD-10-CM or the SNOMED CT code.

Results: The mean problem list length was 4.9±4.6 problems. The two reorganisation algorithms allocated problems to one of 15 different categories (12 aligning with organ systems). 26.2% of problems were assigned to a more general category of 'signs and symptoms' that did not correspond to a single organ system. The two algorithms were concordant in allocation by organ system for 90% of the unique problems. Since ICD-10-CM is a monohierarchic classification system, problems coded by ICD-10-CM were assigned to a single category. Since SNOMED CT is a polyhierarchical ontology, 19.4% of problems coded by SNOMED CT were assigned to multiple categories.

Conclusion: Reorganisation of the problem list by organ system is feasible using algorithms based on either ICD-10-CM or SNOMED CT codes, and the two algorithms are highly concordant.

Keywords: ICD-10-CM; SNOMED CT; electronic health records; problem list; problem-oriented medical record; usability.