Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record

Wright, Adam; Sittig, Dean F.; McGowan, Julie J.; Ash, Joan S.; Weed, Lawrence L.

doi:10.1136/amiajnl-2014-002776

Cited by 41 publications

(23 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Electronic medical records (EMRs), first implemented in the 1960s, were quickly recognized as a revolutionary data-communication system that could improve patient safety as well as the quality and efficiency of patient care 1 . Numerous EMR systems have been developed since that time, and such systems have become increasingly robust in their capabilities to capture and organize patient-care data.…”

mentioning

confidence: 99%

Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures

Cao

Farmer

Carry

et al. 2017

JBJS OA

View full text Add to dashboard Cite

Background:Optimization of the electronic medical record (EMR) is essential to support the clinician and to improve the quality and efficiency of patient care. The present report describes the development and implementation of a standardized template that is embedded in the EMR and is focused on a comprehensive physical examination during the evaluation of pediatric supracondylar humeral fractures. We compared the completeness of physical examinations as well as the timing of detection and documentation of neurovascular injuries before and after implementation of the template. We hypothesized that the use of a template would increase the completeness of examinations and would lead to earlier documentation of neurovascular injuries.Methods:A multidisciplinary quality-improvement task force was created to address neurovascular documentation practices for patients who underwent operative treatment of supracondylar humeral fractures. Following a series of formative and process evaluations, a standardized EMR template was implemented. Neurovascular examination documentation practices that were in use before (pre-template group, n = 224) and after (template group, n = 300) the implementation of the template were compared. Logistic regression analyses of the 2 groups were used to compare the likelihood of a complete neurovascular examination and the timing of neurovascular injury identification.Results:There was significant improvement in the documentation of the vascular (odds ratio [OR], 70.7; 95% confidence interval [CI], 39.5 to 126.6; p < 0.0001), motor (OR, 17.6; 95% CI, 9.5 to 32.7; p < 0.0001), and sensory (OR, 23.9; 95% CI, 12.9 to 44.4; p < 0.0001) examinations in the template group. Neurological injuries were more likely to be identified preoperatively in the template group compared with the pre-template group (OR, 6.8; 95% CI, 1.7 to 27.1; p = 0.0067).Conclusions:The incorporation of a standardized template in the EMR improved the completeness and timing of documentation of neurological injury. Standardized EMR templates developed by a clinically driven multidisciplinary task force have the potential to improve the quality of clinical documentation and to ease communication among providers.Level of Evidence:Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

mentioning

confidence: 99%

Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures

Cao

Farmer

Carry

et al. 2017

JBJS OA

View full text Add to dashboard Cite

show abstract

“…Improvements in current EHR systems and coding terminologies to “code” diagnostic uncertainty in the medical record as “structured data” may also be explored . While current EHR systems allow documentation of diagnostic uncertainty in physician notes, they are not yet “problem‐oriented medical records” as envisioned by Dr. Larry Weed, and provide insufficient cognitive support to physicians . Further research focusing on improvements in documentation of diagnostic uncertainty within EHR systems is warranted.…”

Section: Discussionmentioning

confidence: 99%

Electronic health record reviews to measure diagnostic uncertainty in primary care

Bhise

Rajan

Sittig

et al. 2018

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…18,19 The fact that most health services researchers remain largely unaware of Dr Weed's important contributions to medicine-specifically in relation to the creation of problem-oriented standards for medical records and combinatorial knowledge coupling-is troublesome in light of the ongoing problems facing contemporary evidence-based medicine. 3,20…”

Section: An Overlooked Alternative Paradigm For Evidence-based Medicinementioning

confidence: 99%

An Alternative Paradigm for Evidence-Based Medicine: Revisiting Lawrence Weed, MD’s Systems Approach

Shukor

2017

TPJ

View full text Add to dashboard Cite

Lawrence Weed, MD, is renowned for being the father of the Problem-Oriented Medical Record (POMR), the medical care standard for collecting, managing, and contextualizing patient data in medical records. What have been consistently overlooked are his teachings on knowledge coupling, which refers to matching patient data with associated medical knowledge. Together, the POMR standard and knowledge coupling are meant to form the basis of a systems approach that enables individualized evidence-based decision making within the context of multimorbidity and patient complexity.The POMR and knowledge coupling tools operationalize a problem-oriented model that reflects a sophisticated general systems theoretical approach to knowledge. This paradigm transcends reductionist approaches to knowledge by depicting how the meaning of specific entities (eg, disease constructs) and their associated probabilities can only be understood within their respective spatiotemporal and biopsychosocial relational contexts. Rigorous POMRs therefore require knowledge inputs from a network of interconnections among specific entities, which Dr Weed enabled through development of the Knowledge Net standard. The Knowledge Net's relational structure determines the applicability of knowledge within specific patient contexts. To enable the linkage of unique combinations of data in individual patient POMRs with existing medical knowledge structured in Knowledge Nets, Dr Weed developed the Knowledge Coupling standard.Dr Weed's standards for record keeping and knowledge coupling form the basis of a combinatorial approach to evidence-based medicine that fulfills Stange's call for a science of connectedness. Ensuing individualized processes of care become the dynamo powering a learning health care system that enables a co-construction of health premised on empowerment and intelligent human decision making, rather than promoting the artificial intelligence of tools. If the value of Engel's biopsychosocial model indeed relates to "guiding the parsimonious application of medical knowledge to the needs of each patient," Dr Weed's approach warrants serious consideration.

show abstract

Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record

Cited by 41 publications

References 13 publications

Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures

Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures

Electronic health record reviews to measure diagnostic uncertainty in primary care

An Alternative Paradigm for Evidence-Based Medicine: Revisiting Lawrence Weed, MD’s Systems Approach

Contact Info

Product

Resources

About