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\u2009years (24\u2009033 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.