ProblemListItem

An entry on a patient's problem list representing an ongoing health concern requiring clinical attention and active management. Tracks the complete lifecycle of each problem from initial addition through ongoing review and resolution.

Overview

ProblemListItem manages a patient's longitudinal problem list - the active health conditions requiring ongoing attention. Each item links to an underlying Diagnosis, tracks its status (active, inactive, resolved), priority, and position on the list. The entity captures the full lifecycle including when problems were added, reviewed, and removed, with accountability for each action. This supports chronic disease management, care coordination, and clinical quality metrics.

Key Concepts

Problem Status

The status field tracks the problem's list state:

Status	Description	Management
`active`	Currently requires attention	Active management needed
`inactive`	Not currently active	Monitor but not actively treat
`resolved`	No longer a concern	Can be removed from active list

Priority Levels

The priority field indicates clinical urgency:

Priority	Description	Attention Level
`high`	Critical health concern	Primary focus
`medium`	Significant but stable	Regular monitoring
`low`	Minor or well-controlled	Periodic review

Problem Ranking

The rank field provides numeric ordering:

Lower numbers = higher priority
Customizable per patient
Reflects clinical judgment
Guides care plan focus

Problem Lifecycle

Full tracking of problem list changes:

Phase	Fields	Purpose
Addition	`addedDate`, `addedBy`	When/who added to list
Review	`lastReviewedDate`, `lastReviewedBy`	Currency tracking
Removal	`removedDate`, `removedBy`, `removalReason`	End of tracking

Review Tracking

The review fields support quality metrics:

lastReviewedDate - When last verified
lastReviewedBy - Who reviewed
daysSinceReview (calculated) - Staleness indicator

Underlying Diagnosis

The diagnosis field links to Diagnosis:

Contains the clinical coding
Tracks clinical status and severity
Provides onset and resolution dates
Connects to supporting evidence

Use Cases

Adding Problem to List

When identifying ongoing condition:

Create or reference underlying Diagnosis
Create ProblemListItem linking to diagnosis
Set status: "active"
Assign priority based on clinical significance
Set rank for list position
Document addedDate and addedBy

Prioritizing Problems

When organizing the problem list:

Review all active problems
Assign priority (high/medium/low)
Set numeric rank for ordering
Consider clinical urgency
Reflect patient's primary concerns

Periodic Review

During patient encounters:

Review each problem on list
Verify status is current
Update lastReviewedDate
Record lastReviewedBy
Add notes on current management
Adjust priority/rank as needed

Resolving a Problem

When condition resolves:

Update status: "resolved"
Set removedDate
Record removedBy
Document removalReason
Update underlying diagnosis status
Problem remains in history

Monitoring Stale Problems

For quality assurance:

Query problems by daysSinceReview
Identify problems needing review
Flag overdue reviews
Generate review reminders
Track review compliance metrics

Related Entities

Entity	Relationship	Description
Patient	References	Owner of problem list
Diagnosis	References	Underlying clinical diagnosis
Practitioner	References	Added by, removed by, reviewed by

Calculated Fields

Field	Type	Description
`isActive`	boolean	True when status equals 'active'
`daysSinceReview`	number	Days elapsed since lastReviewedDate

Enums

status

Value	Description
`active`	Problem requires active clinical attention and management
`inactive`	Problem is not currently active but remains on list for tracking
`resolved`	Problem has been resolved and no longer requires management

priority

Value	Description
`high`	Critical health concern requiring primary focus
`medium`	Significant condition requiring regular monitoring
`low`	Minor or well-controlled condition for periodic review

15 properties

Schema

Properties

Property	Type	Mode	Description	Required
patient	Patient	stored	Reference to the patient whose problem list contains this item, establishing ownership and ensuring problems are associated with the correct individual across all care contexts Example: `"Patient/patient-12345"`	Required
diagnosis	Diagnosis	stored	Reference to the underlying diagnosis entity that this problem list item represents, linking the problem to its complete clinical definition including codes, onset, severity, and supporting evidence Example: `"Diagnosis/diagnosis-67890"`	Required
status	string	stored	Current lifecycle status of the problem on the patient's list, indicating whether it requires active management, has become inactive but unresolved, or has been fully resolved Values: `active, inactive, resolved` Example: `"active"`	Required
priority	string	stored	Clinical priority level indicating the urgency and significance of this problem relative to other health concerns, helping care teams focus on the most critical issues first Values: `high, medium, low` Example: `"high"`	Optional
rank	number	stored	Numerical ordering position of this problem within the patient's problem list, supporting customized prioritization and display sequences that reflect clinical judgment about problem importance Example: `1`	Optional
addedDate	DateTime	stored	Date and time when this problem was first added to the patient's problem list, establishing the starting point for tracking the problem's duration and lifecycle within active care management Example: `"2024-01-15T09:30:00Z"`	Required
addedBy	Practitioner	stored	Reference to the healthcare practitioner who added this problem to the patient's list, providing accountability and enabling follow-up questions about the clinical rationale for inclusion Example: `"Practitioner/practitioner-11111"`	Optional
removedDate	DateTime	stored	Date and time when this problem was removed from the active problem list, marking the endpoint of active tracking whether due to resolution, transfer of care, or determination of irrelevance Example: `"2024-06-20T14:45:00Z"`	Optional
removedBy	Practitioner	stored	Reference to the healthcare practitioner who removed this problem from the patient's list, establishing accountability for the removal decision and enabling quality review of list maintenance practices Example: `"Practitioner/practitioner-22222"`	Optional
removalReason	string	stored	Free-text explanation of why this problem was removed from the active list, documenting clinical reasoning such as resolution, error correction, transfer to another list, or determination that the problem no longer requires active management Example: `"Condition successfully managed and resolved after completion of treatment protocol"`	Optional
lastReviewedDate	DateTime	stored	Date and time when this problem was most recently reviewed by a clinician to confirm its continued accuracy, relevance, and appropriate status, supporting quality assurance for problem list currency Example: `"2024-03-10T11:20:00Z"`	Optional
lastReviewedBy	Practitioner	stored	Reference to the healthcare practitioner who most recently reviewed this problem list item, establishing accountability for ongoing problem list maintenance and clinical oversight Example: `"Practitioner/practitioner-33333"`	Optional
note	string	stored	Free-text clinical notes specific to this problem's status on the patient's list, capturing important context such as management approach, patient preferences, care coordination details, or special considerations that influence how this problem should be addressed Example: `"Patient prefers conservative management. Monitoring response to lifestyle modifications before considering medication."`	Optional
isActive	boolean	calculated	Indicator of whether this problem currently has active status, computed by evaluating if status equals 'active', providing a simple boolean check for filtering and displaying current health concerns	Optional
daysSinceReview	number	calculated	Number of calendar days elapsed since the last review date, calculated from the difference between current date and lastReviewedDate, supporting quality metrics and alerts for problems requiring periodic reassessment	Optional

Examples

Example 1

{
  "@type": "ProblemListItem",
  "patient": "Patient/patient-78901",
  "diagnosis": "Diagnosis/diagnosis-type2-diabetes",
  "status": "active",
  "priority": "high",
  "rank": 1,
  "addedDate": "2023-06-15T10:00:00Z",
  "addedBy": "Practitioner/practitioner-dr-smith",
  "lastReviewedDate": "2024-11-15T14:30:00Z",
  "lastReviewedBy": "Practitioner/practitioner-dr-smith",
  "note": "Patient managing with metformin 1000mg BID. HbA1c trending down. Continue current regimen and lifestyle modifications.",
  "_comment": "isActive: true, daysSinceReview: 15"
}

Example 2

{
  "@type": "ProblemListItem",
  "patient": "Patient/patient-45632",
  "diagnosis": "Diagnosis/diagnosis-acute-bronchitis",
  "status": "resolved",
  "priority": "medium",
  "rank": 5,
  "addedDate": "2024-10-05T09:15:00Z",
  "addedBy": "Practitioner/practitioner-dr-jones",
  "removedDate": "2024-10-25T16:00:00Z",
  "removedBy": "Practitioner/practitioner-dr-jones",
  "removalReason": "Symptoms completely resolved after antibiotic course. Follow-up exam shows clear lung fields.",
  "lastReviewedDate": "2024-10-25T16:00:00Z",
  "lastReviewedBy": "Practitioner/practitioner-dr-jones",
  "note": "Completed 10-day course of azithromycin. Patient reports full resolution of cough and no shortness of breath.",
  "_comment": "isActive: false, daysSinceReview: 36"
}

Example 3

{
  "@type": "ProblemListItem",
  "patient": "Patient/patient-99887",
  "diagnosis": "Diagnosis/diagnosis-severe-chest-pain",
  "status": "active",
  "priority": "high",
  "rank": 1,
  "addedDate": "2024-11-29T18:45:00Z",
  "addedBy": "Practitioner/practitioner-dr-emergency",
  "lastReviewedDate": "2024-11-30T08:00:00Z",
  "lastReviewedBy": "Practitioner/practitioner-dr-cardiology",
  "note": "URGENT: Patient admitted with acute chest pain. Troponin elevated. Cardiology consult ordered. Monitoring in CCU pending catheterization.",
  "_comment": "isActive: true, daysSinceReview: 0"
}