Current state of electronic problems lists in primary care: a rapid scoping review

Clinical Snapshot

Key Findings

• Effect Size: Not applicable (qualitative synthesis)

• Primary Outcome: Electronic problem lists widely recognized as foundational but commonly incomplete, outdated, or inconsistently maintained

• Nnt Or Sensitivity: 103 studies synthesized across seven thematic domains

Clinical Application

High feasibility - findings directly applicable to current Australian primary care EHR implementations Highly relevant to Australian Digital Health Strategy and My Health Record integration. Findings support RACGP digital health guidelines and inform TGA-regulated clinical decision support tool implementations Australian primary care practices using electronic health records, particularly relevant for practices implementing clinical decision support systems

Abstract

BACKGROUND: Electronic problem lists (PLs) are central to the problem-oriented medical record and increasingly underpin clinical decision support (CDS), interoperability, and emerging artificial intelligence applications in primary care. However, persistent concerns regarding PL accuracy, completeness, and governance limit their clinical value. OBJECTIVE: To update the foundational framework proposed by Hodge and Narus by synthesizing contemporary evidence on electronic PLs in primary care and primary care-relevant settings. METHODS: We conducted a rapid scoping review following Joanna Briggs Institute guidance and PRISMA-ScR reporting standards. MEDLINE (Ovid) was searched for peer-reviewed studies published between March 2016 and May 2026. Eligible studies examined digital PLs or extractable PL-related practices relevant to primary care. Findings were synthesized using a hybrid inductive-deductive approach and mapped to the seven Hodge and Narus themes. RESULTS: A total of 103 studies were included. Across settings, PLs were widely recognized as foundational for longitudinal care, safety, and coordination. However, incomplete, outdated, or inconsistently maintained PLs remained common. Persistent challenges included unclear ownership, workflow misalignment, and variability in what constitutes a "problem." Emerging technologies-including CDS, natural language processing, and machine learning-were increasingly used to support PL generation, curation, reconciliation, and organization, with greatest benefit when embedded within clinician-led workflows. CONCLUSION: Despite technological advances, the clinical value of electronic PLs in primary care continues to depend on governance, workflow integration, and shared accountability. Updating the Hodge and Narus framework highlights the need for sociotechnical approaches to PL improvement as PLs become integral to CDS and artificial intelligence-enabled care. Problem lists (PL) are a key part of electronic health records. They provide clinicians with a quick overview of a patient's important health issues—such as long-term conditions, past diagnoses, and current concerns—and help support safe and informed care. When PLs are accurate and up to date, they can improve communication and decision-making. However, in everyday clinical practice, many PLs are incomplete, outdated, or difficult to maintain. As electronic health records are increasingly used to support clinical decision support tools and new digital technologies, the quality of PLs has become more important than ever. Poor-quality PLs can lead to missed information, duplicated work, or unsafe care decisions. To better understand how PLs are working in modern healthcare, we conducted a rapid scoping review of research published between 2016 and 2026. We examined studies that looked at how PLs are used, how accurate they are, what challenges clinicians face in keeping them updated, and what solutions have been proposed. In total, 103 studies were included. Across these studies, several common problems were identified. Important health conditions were often missing or out of date, and clinicians were frequently unsure who was responsible for updating the PL. Time pressures and busy clinical workflows made regular maintenance difficult. Some studies explored new digital tools, such as automated text analysis, to help identify or update problems, but these approaches are still developing and require careful evaluation. Improving PLs will require clearer standards, shared responsibility among healthcare teams, and EHRs that make updating information easier. Thoughtful use of new technologies may also help reduce clinician workload while improving patient safety. This review highlights where PLs are working well and where improvements are still needed, offering guidance for future research, technology design, and improvements in primary care practice.

References

1. 1.Nair, R., Bekker, I., Singer, A., & Lau, F. (2026). Current state of electronic problems lists in primary care: a rapid scoping review. Family Practice. https://doi.org/10.36834/cmej.81831