Long Medical Records: Implications for Optimizing Patient Care in a Data-Heavy World
In 1969, Dr. Lawrence Weed identified that physicians faced a unique challenge when it came to patient care: dealing with the complexity of a multiplicity of problems and discerning from that how to treat a patient.1 He invented the Problem-Oriented Medical Record (POMR) to deal with this complexity and to allow for the information to be organized in a way that cognitively fit with how physicians use information to treat their patients. The POMR led to the formation of the worldwide usage of the SOAP (Subjective, Objective, Assessment, and Plan) note. Unique to the POMR and SOAP note is the inclusion of narrative details that cover the patient’s problems, chief complaints, the physician’s assessment of the subjective and objective details, and a care plan. I believe these narrative components reflect the training, experience, and critical insight that physicians gain through their many years of education and hands-on experience. At the same time, instituting the organization of the POMR forces these narratives to be focused and actionable to facilitate efficient and effective care of the patient.
Fast forward to the Meaningful Use era, and while the SOAP note continues to be promoted within EMRs and within an institution, the mechanism to communicate patient information from one care provider to the next, particular across disparate care settings, is focused on the Summary of Care Record. To accommodate our digital world of EHRs, and to help ensure information could pass more easily between digital systems, the information about patient care has been boiled down to lists of problems, medications, and allergies, along with the “O” part of the SOAP note – the objective measurements like labs and vitals, and the “P” part of the SOAP note – the care plan information. While this is incredibly valuable information, and often quite sufficient for follow-up care, it falls woefully short when a patient is newly diagnosed with cancer, heart disease, or other serious illnesses.
And here is where the challenge lies… Physicians now have two choices. The first choice it to supplement the incomplete data from the Summary of Care Record by relying on the patient’s memory and by repeating tests in order to get the rest of the critical clinical insight they need to treat the patient. The second choice is to pour through a deluge of pages of unstructured, unorganized medical records from many different care facilities. For patients with ongoing chronic illnesses, it is not unusual to see thousands of pages of records. It is like receiving a multi-page email packed with dense text – do you ever read those?
Here is where we need to go back to the lessons from Dr. Weed, and think about how the physician needs to see information to optimize their ability to provide care. It requires ways to create an effective POMR from massive amounts of patient data across multiple care settings. It means preserving that all-important narrative while not overburdening physicians with duplicate and unnecessary information that often comes from cut and paste behaviors in EMRs.
Our brightest clinical minds and engineers are working on this very issue at eHealth Technologies, and we believe we have identified a unique way to extract an effective POMR from all this data. As we work with our distinguished customers to further hone this approach, I will be excited to share our progress.
(1) “Interview with Lawrence Weed, MD – The Father of the Problem-Oriented Record Looks Ahead”, Lee Jacobs, MD, Perm J. 2009 Summer; 13(3): 84-89