Problem List Audit

When to Use This Skill

Use when a clinician needs to validate the accuracy and completeness of a patient's active problem list by cross-referencing against medications, lab results, and encounter history.

Clinical Workflow

1. Use fhir_search to pull all Condition resources (active, resolved, inactive) for the patient
2. Use fhir_search to pull active MedicationRequest resources -- infer expected diagnoses from medications (e.g., metformin implies diabetes, levothyroxine implies hypothyroidism)
3. Use fhir_search to pull recent Observation (laboratory) results -- infer conditions from abnormal lab patterns (e.g., elevated HbA1c implies diabetes, elevated TSH implies hypothyroidism)
4. Use fhir_search to pull recent Encounter resources and their associated Condition resources (encounter diagnoses) to find conditions documented in visits but missing from the problem list
5. Cross-reference all sources: flag medications without a supporting active problem, lab patterns without a corresponding diagnosis, encounter diagnoses not on the active problem list, and active problems with no supporting evidence in recent encounters/medications/labs

FHIR Resources

• Condition -- Problem list entries with clinicalStatus, verificationStatus, code (ICD-10/SNOMED), onset, abatement
• MedicationRequest -- Active medications implying diagnoses
• Observation -- Lab results with patterns suggesting undiagnosed conditions
• Encounter -- Recent visits with encounter-specific diagnoses

FHIR Query Examples

Pull All Conditions

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&_count=200")

Pull Active Medications

fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active&_count=100")

Pull Recent Encounter Diagnoses

fhir_search(resourceType="Encounter", queryParams="patient=[patient-id]&date=ge[12-months-ago]&_sort=-date&_count=50")

Clinical Guidelines

• CMS requires accurate problem list maintenance for quality reporting and risk adjustment (HCC coding)
• ICD-10 coding specificity requirements: prefer specific codes (E11.65 T2DM with hyperglycemia) over unspecified (E11.9)
• SNOMED CT preferred for clinical documentation; ICD-10-CM required for billing

Interpretation Guide

• Categorize findings as: Missing Diagnoses (medication/lab evidence but no problem list entry), Potentially Resolved (active condition with no supporting evidence in 12+ months), Coding Gaps (non-specific codes that should be updated), and Duplicate Entries (same condition coded multiple ways)
• Rank findings by clinical impact: HCC-relevant conditions first, then safety-relevant, then administrative
• For each finding, provide the evidence source and recommended action (add, resolve, update code, merge duplicates)

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges