Problem lists form the foundation of organized patient care, yet according to EHR usability studies, over 60% of problem lists contain errors, duplicates, or outdated problems that were never resolved. AI-assisted problem list generation extracts clinical problems from notes and organizes them into prioritized active problem lists that improve care coordination and clinical decision support.
Problem List Quality Checklist
What Makes a High-Quality Problem List
| ✅ Include | ❌ Exclude |
|---|---|
| All active chronic conditions | Resolved past conditions (move to history) |
| Acute problems currently being treated | Duplicates with different wording |
| Specific diagnoses ("Type 2 DM with nephropathy") | Vague symptoms ("Pain") |
| Mental health diagnoses | Normal variants or findings |
| Substance use disorders | Past procedures ("s/p appendectomy") |
| Relevant social determinants | Administrative entries |
Problem Prioritization Order
Standard Priority Ranking
| Priority | Category | Example |
|---|---|---|
| 1 | Acute life-threatening | Acute coronary syndrome, sepsis |
| 2 | Acute non-life-threatening | Acute kidney injury, pneumonia |
| 3 | Chronic unstable/poorly controlled | Uncontrolled diabetes (A1c 10%) |
| 4 | Chronic stable requiring management | Hypertension on stable meds |
| 5 | Chronic stable/maintenance | Hypothyroidism on levothyroxine |
Specificity Examples
Vague vs. Specific Problem Documentation
| ❌ Vague | ✅ Specific |
|---|---|
| Diabetes | Type 2 diabetes mellitus with diabetic nephropathy |
| CHF | Heart failure with reduced ejection fraction (EF 30%) |
| Kidney disease | CKD Stage 3b (GFR 35) |
| Anemia | Iron deficiency anemia, chronic blood loss |
| Elevated blood pressure | Essential hypertension, Stage 2 |
Problem List Template
**ACTIVE PROBLEM LIST** Reviewed: [Date] **ACUTE:** 1. [Acute problem] - onset [date] 2. [Acute problem] - under evaluation **CHRONIC - ACTIVE MANAGEMENT:** 3. [Chronic condition] - [control status] (e.g., "Diabetes, A1c 7.2%") 4. [Chronic condition] - on [therapy] 5. [Chronic condition] - [relevant parameters] **CHRONIC - STABLE:** 6. [Stable condition] - on [maintenance therapy] 7. [Stable condition] - monitoring [frequency] **BEHAVIORAL HEALTH:** 8. [Mental health diagnosis] - on [therapy] 9. [Substance use] - [status: active, in remission] **SOCIAL DETERMINANTS (if relevant):** 10. [Barrier affecting care] - [intervention plan]
Problem List Maintenance
- ☐ Review at every encounter
- ☐ Add new problems as identified
- ☐ Resolve cured conditions with date ("Resolved 2/15/2026")
- ☐ Update diagnoses as workup progresses (symptom → diagnosis)
- ☐ Consolidate duplicates to single preferred term
- ☐ Reconcile during care transitions
Common Problem List Errors
Errors and Fixes
| Error | Problem | Fix |
|---|---|---|
| Duplicates | "CHF," "Heart failure," "Congestive heart failure" | Consolidate to single preferred term |
| Outdated problems | "Pneumonia" from 5 years ago | Move to past medical history |
| Vague terms | "Pain," "Abnormal labs" | Specify location, diagnosis, or findings |
| Missing mental health | Depression not listed | Include all diagnoses affecting care |
Frequently Asked Questions About Problem Lists
Should I include resolved problems?
No—move them to past medical history with resolution date. Active problem lists should contain only conditions requiring current management. "Pneumonia (resolved 2/15/2026)" belongs in history, not active list. Keeping resolved problems clutters the list and misleads providers.
How specific should diagnoses be?
As specific as confirmed information allows. "Type 2 DM with nephropathy" enables better clinical decision support than "Diabetes." Specificity improves quality metrics, billing accuracy, and care coordination. Update as diagnostic information accumulates.
Should mental health diagnoses be on the problem list?
Yes—integrated problem lists improve comprehensive care. Depression, anxiety, substance use disorders, and other mental health conditions affect medical care and belong alongside physical diagnoses. Artificial separation harms patient care.
When should symptom-based problems become diagnoses?
Update as workup progresses. "Chest pain, etiology unclear" is appropriate during evaluation. Once GERD is confirmed, update to "Gastroesophageal reflux disease." Problem evolution should parallel the diagnostic process.
Can AI help generate problem lists?
Yes, AI tools like River's Problem List Generator extract and prioritize problems from clinical notes. Input your notes, and the AI identifies diagnoses, organizes by priority, and suggests ICD-10 codes. Always verify against patient records.
Accurate problem lists enable quality care. Use River's Problem List Generator to create comprehensive, prioritized active problem lists that improve care coordination.