The Index as a New Concept towards an Integrated Framework for the Electronic Patient Record

Abstract

Summary Objective: To overcome some classical limitations of the POMR (Problem-Oriented Medical Record), including the management of divergent opinions between health professionals, in order to construct a common patient record across multiple disciplines in hospital settings and professional networks. Methods: Using a complex clinical case, we improved a POMR model previously used by GPs in order to translate it into a hospital setting. The enhanced model has been assessed through use in various ongoing clinical cases and through extended discussion with professional end-users (physicians, nurses, general practitioners, and social workers). Results: The Index concept (flexible structural link) is proposed as a major improvement in the construction of a POMR in a shared care environment. Conclusions: The Index introduces interesting new perspectives. Following its implementation in the Belgian pilot site in the CORINES project, further studies remain to be carried out in order to develop a cost/benefit assessment.

Selected Impressions on the Beginning of the Electronic Medical Record and Patient Information

“…In looking, as an example, at recent publicationsinthis journal, we can see how intensivelymedical text processing andthe electronic patientr ecord have become part of medical informaticsr esearch andp ractise. Approximately40yearsafterWolfgang Giere's firstp ublications, we can now read publicationsonfunctionality andarchitecture [34][35][36][37][38][39][40][41][42][43][44][45], on organizationali ssues [46][47][48][49], on evaluation [50][51][52][53][54], andontechnicalissues [55,56] of medical texts andpatient records.The electronic patientr ecord hasbecome an importantcomponent for cooperative,sharedcare [57][58][59][60]. It becamea relevant part of educational programs [ 61] ande venatopic of ethicald iscussion [62,63].…”

Modeling Problem-oriented Clinical Notes

“…Salmon et al listed some limitations of the POMR, but also suggested some areas in which it may be extended [11]. De Clercq suggested a flexible link between data and problems to extend the POMR architecture [12]. The Institute of Medicine report recommends that an EHR should contain a problem list from which clinicians can easily obtain a concise view of all of a patient's medical problems [13].…”