Problem-Oriented Charting: 3 Questions with IT Physician Leader Timothy Brannon, MD, MS

While handwriting paper progress notes as a neonatology resident in the late 1980s, Timothy Brannon, MD, MS, knew there must be a better way.

“It took a few more years for computer technology to catch up, but in 1996 I learned of an early medical record software program actually written by a neonatologist specifically for the NICU. I was his ‘customer No. 1’ and provided input on some enhancements to the program,” says Dr. Brannon. “That led me to medical informatics graduate school at UT Houston — at age 42! — and the rest is history.”

Today, Dr. Brannon is the Clinical Systems Office Medical Director, Inpatient, and supports the Problem List Adoption Initiative as IT physician leader. He is currently rolling out the updated problem-oriented charting tool across Cleveland Clinic. He sat down with us to answer three quick questions about the initiative and the future of healthcare:

For those unfamiliar with problem-oriented charting, what is it?

Problem-oriented charting uses the patient’s problem list as the basis for writing the clinical notes. A problem can be a precise diagnosis when known, but also it can be a patient’s complaint, a symptom or an abnormal physical exam or lab finding. As more information is obtained during a workup, the name of that complaint, symptom or finding can be changed from a problem to a more precise diagnosis.

For example, the name of the “chest pain” problem can be changed to “myocardial infarction” based on the enzyme results, and then to “myocardial infarction of anterior wall” based on the cardiac cath findings. These aren’t three different problems; they’re all the same problem, refined to a diagnosis. Problem-oriented charting uses the provider’s assessments and plans for each problem as the narrative of clinical notes. A patient may have just one primary problem, but often they have other problems that must be addressed.

What do you wish others understood about this initiative?

That it is not just about revenue. Problem-oriented charting facilitates recording of the patient’s story over time in a way that is accessible at each encounter, ambulatory or inpatient. This makes it much easier for another provider to understand the story, without reviewing multiple old notes from different encounters. It also makes the plan of care much easier to identify and follow when you handoff to another provider.

What keeps you excited about the future of healthcare?

I keep reading about the topic of physician burnout, and how the electronic health record (EHR) is considered to be a contributor. That was never the way it was intended to be, and that must change. The EHR should make the physician’s work-life better. That is my basic challenge, and it’s what drives me forward.

Dr. Brannon is the Clinical Systems Office Medical Director, Inpatient, and staff in the Department of Community Pediatrics.