Reconciling the Problem List
The Optimal Vision Care Prototype (OVCP) was a contract funded by the Department of Defense to research how physicians experience modern EHRs. We documented designs and gathered quantitative and qualitative feedback from care providers to inform requirements for the next generation of military medical software.
This case study covers a two-week sprint on the problem list—an issue that surfaced repeatedly while documenting diagnoses in earlier sprints, and turned out to matter far more than we first expected.
Discovery
The Problem List Is a Shared Pain Point
“Problem lists are the problem of all EMRs—no one does a good job of presenting them.”
— Health informatics expert
Physician as designer
The first solution sketch came from an emergency physician. On a call, she argued that diagnoses had to be groupable—and backed it up with a clear Paint prototype.
From there, I iterated a handful of higher-fidelity concepts to turn a noisy list into something clinicians could actually reconcile.
Taking it a step further
Working backward from her consolidated-list vision, the next question was how to start from a flat diagnosis list and arrive there in a few intentional steps.
In a short flow, a physician could open a diagnosis, see it next to others on the list, and choose how to consolidate—secondary to, related to, subset of, and similar options.
Prototyping
Fast, Direct Reconciliation
“Something that lets you somehow update the problem list in a user-friendly way that takes like five seconds.”
— Emergency physician
Direct manipulation
Early concepts supported the right relationships, but they asked for too much navigation—new windows, extra taps, and heavy attention shifts.
Letting clinicians drag one problem onto another to define a relationship became the core of the interaction: fewer steps, less context switching, more time on the clinical decision.
Hick's Law
Too many relationship types slowed people down. I collapsed the set to two high-value options: Similar to for duplicates and close cousins, and Secondary to when one problem was a consequence or symptom of another.
Click-through prototype: Shown to clinical SMEs for qualitative feedback on speed and clarity.
Refinement
Status, Timing, and History
“We sometimes see quiescent inflammation that becomes active, then back to quiescent and back to active.”
— Ophthalmologist
When was it last active?
Recurrence timing often signals when management should change. I explored sort orders that surface last active alongside status tags (putative, active, quiescent, resolved) so the list reads as a timeline, not just a stack of labels.
What's the history of the problem?
An info view could expose the full arc for a diagnosis—labs, referrals, notes—scrubbed through a compact activity strip so clinicians could see quiet and busy periods at a glance.
Linking common workups to a diagnosis could also reduce missed follow-up when the chart is dense.
Later iteration: Resolved filters, info affordances, and calmer hierarchy for review.
Formative feedback
What Clinicians Said
Qualitative sessions validated the direction; together with structured feedback, the program advanced toward summative testing.
“This is a great way to provide a sub-structure to the overall list—a great feature to reduce clutter.”
“I like the tools used to better represent the clinical picture.”