Core Measure 3
Maintain Problem List
Objective:
Maintain an up-to-date problem list of current and active diagnoses.
Measure:
More than 80 percent of all unique patients seen by the eligible professional have at least one entry or an indication that no problems are known for the patient recorded as structured data.
CMS Resources
The following resources are available to help you meet the Maintain Problem List meaningful use core measure:
Related CMS EHR Incentive Program Frequently Asked Questions
Lessons from the Field
“Due to the dynamic nature of a problem list, we follow a model of several checks and balances to ensure a patient's problem list is accurate and all-inclusive.”
— Dr. Mary Landwehr, MD, Family Physician and Director, Sunrise Family Care Clinic 
A patient problem list is subject to change during each appointment, whether it is by adding new information or removing outdated information. Providers utilize their nursing staff by having them review the problem lists when prepping the patient's chart. Any notes regarding rehabilitation or specialty care trigger an in-depth review to ensure the patient problem list is all-inclusive. Providers also utilize clinical summaries as a mechanism for review and correction of problem lists, encouraging their patients to be active in their care and identify when there might be outdated information such as obesity or smoking status.
"Utilizing an EHR problem list at the point of care is paramount to providing our community with the best clinical decision making support available and ensures that our patients receive the appropriate and necessary level of care."
— Jonathan Everett, Manager of Health Information Technology, Chinese Community Health Care Association
Prior to using EHRs, providers depended on paper charts and faxes to make sure their patients had accurate problem lists. Now, with EHRs, problem list maintenance is easier and provides a much needed view of a patient's history. Provider acceptance in using shared electronic chronic problem lists can be difficult, but it can be helpful to demonstrate how the functionality can improve care, reduce redundancies for patients, and decrease office staff time.
Related CMS EHR Incentive Program Frequently Asked Questions
- #2881 - To meet the meaningful use objective "maintain an up-to-date problem list of current and active diagnoses," are EPs, eligible hospitals, and CAHs required to use ICD-9 or SNOMED-CT®?
- #3307 - How does an EP determine whether a patient has been "seen by the EP" in cases where the service rendered does not result in an actual interaction between the patient and the EP, but minimal consultative services such as just reading an EKG? Is a patient seen via telemedicine included in the denominator for measures that include patients "seen by the EP"?
- #3309 - When a patient is only seen by a member of the EP's clinical staff during the EHR reporting period and not by the EP themselves, do those patients count in the EP's denominator?
- #3065 - Should patient encounters in an ambulatory surgical center be included in the denominator for calculating that at least 50 percent or more of an EP's patient encounters during the reporting period occurred at practices/locations equipped with certified EHR technology?
- #3077 - If an EP sees a patient in a setting that does not have certified EHR technology but enters all of the patient’s information into certified EHR technology at another practice location, can the patient be counted in the numerators and denominators of meaningful use measures?
For additional questions around meaningful use, visit the CMS EHR Incentive Program Frequently Asked Questions (FAQs).
