PracticalDermatology

Introducing the Dermatology Problem List

A simple method to improve efficiency and quality of care in the dermatology clinic.

By Erin M. Dodd, BA, Brittney Schultz, MD and Ronda S. Farah, MD

Effective clinical documentation is central to providing continuous, high-quality patient care. Electronic health records (EHRs) have been instrumental in improving care but have also contributed to the phenomenon of information overload.¹ Clinical documentation and patient data are often scattered across several platforms, making efficient navigation difficult. This overwhelming amount of data may obscure important patient information such as skin cancer history, follow-up plans, and medication safety monitoring.² Even for the most diligent provider, the fast-paced clinic environment often does not allow time to filter through complex charts. This problem is compounded in an academic setting where multiple providers and trainees follow patients, thereby complicating continuity of care.

Figure 1. Snapshot of the top portion of the dermatology record at the University of Minnesota Health demonstrating the Dermatology Problem List located at the start of the record. The University of Minnesota uses Epic as the EHR, however, this formatting could be utilized in any electronic health record with free-texting capabilities.

Our institution addressed this challenge by implementing a Dermatology Problem List (DPL) at the top of all dermatology outpatient clinic visit notes. The DPL serves as a synopsis of the patient’s dermatological history, including diagnoses, prior treatment regimens, and requisite monitoring. It also serves as a reminder to obtain safety-monitoring tests, perform screening skin exams, or monitor suspicious lesions (Figure 1). Furthermore, direct incorporation eliminates the need to exit the current clinic note to search for other documentation in a large collection of historical patient records. The standardized location preceding clinical documentation allows providers to rapidly review important details without scrolling through less pertinent information. For example, the provider can easily see that the patient is up to date with skin exams and is due for a screening eye exam next month (Figure 1).

The DPL can be incorporated into any type of EHR—either as a “free-text” or template—depending on the needs and preferences of the clinic or institution. Successful implementation requires agreement among providers on the type of information to include and instructions for others, such as residents and medical students. This is a shared responsibility, and each clinician is responsible for updating the list during the visit.

In summary, the Dermatology Problem List enhances efficiency by presenting relevant patient information in an easily accessible location, while communicating important findings or tasks to the next provider. Thus, this simple intervention can potentially improve quality of care in the dermatological outpatient setting. n

The authors received no Funding/Support and reported no Financial Disclosure.

Erin M. Dodd is a Research Fellow and Medical Student at the University of Minnesota Medical School, Minneapolis, MN. Brittney J. Schultz, MD is a resident in the combined Medicine-Dermatology residency program at the University of Minnesota, Minneapolis, MN. Ronda S. Farah, MD is Division Director of Medical Dermatology at the University of Minnesota Health Maple Grove Clinics and Assistant Professor at the University of Minnesota. She also founded and acts as the Director of the University of Minnesota Health Cosmetic Center, Dermatology.

1. Beasley JW, Wetterneck TB, Temte J, et al. Information chaos in primary care: implications for physician performance and patient safety. J Am Board Fam Med. 2011;24(6):745-51.

2. Koopman RJ, Steege LM, Moore JL, et al. Physician information needs and electronic health records (EHRs): Time to reengineer the clinic note. J Am Board Fam Med. 2015;28(3):316-23.