Background. We have developed an interdisciplinary problem list for use in the electronic patient record of our 4 medical/surgical ICUs. Previous experience in developing problem lists suggests that terminology should be familiar to clinicians, be based on current clinical practice and be developed with clinician input[l,2,31. Our goal was to develop a problem list that would be consistently used and updated by all clinicians in the critical care setting.

Patients and physicians often choose specially consultants with only limited knowledge of the available options. Access to information about specialists that was directly relevant to patient and clinician preferences could improve the effectiveness of the referral process. We have developed a prescriptive representation of the process of selecting consultants. This "referral map," based on decision theory, uses patient and provider preferences elicited through a literature review and interviews with physicians and provides a formal framework for representing referral knowledge and for evaluating referral options. Our method suggests that the goals and processes of selecting consultants can be managed more systematically using explicit repositories. Such systematic management promises to have a beneficial impact on the delivery of health care, as well as on patient satisfaction.