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Takling the problem-oriented medical records approach (POMR)

March 8, 2016

POMR.jpgFirst described in 1968 by Dr. Lawrence Weed, MD, the medical record-keeping system dubbed “Problem Oriented Medical Records”, or POMR, offers advantages to both provider and patients, not the least of which is a more patient-focused approach. However, many physicians object to its use as being too cumbersome, data synthesis restrictions, lengthy progress notes, etc.  However the system’s proponents insist that when used properly, POMR does just the opposite and results in concise, complete and accurate record keeping, especially with reporting and managing chronic care conditions.

POMR defined:

POMR arose from the recognized need for better management of chronic illness involving multiple encounters and interventions, increasing the need for tracking care over time while providing individualized medical solutions for each unique patient.

POMR consists of the following components:

1. A defined information data base

2. A complete problem list, further broken down into:

  • Filter problems by status: current (either improving or worsening), dormant (no change) or resolved
  • Grouped in chronological order, either by encounter date or entry date.
  • As originally conceived, the system only allowed for one problem to be considered at a time. As many providers can attest, however, one visit can engender reporting of multiple problems.

3. A plan of action for every listed problem broken down into the following:

  • Basis
  • Status
  • Disability
  • Goal
  • Following the course
  • Additional investigation
  • Awareness of possible complications

4. Notes on the progress documenting follow-up, feedback from patient and others and adjustments to the plan over time.

  Limitations of the POMR system:

 Some possible limitations that cause POMR to be under-utilized include:

  • The perception by providers is that the system, while usually quickly understood and learned in the first stages, is too complex overall to maintain once entries have begun.
  • Multiple problems may be discussed by patients during a single visit (‘encounter’.) Some providers may feel overwhelmed by “data overload” as a result.
  • Information may belong under multiple ‘problem’ headings such as blood pressure measurements showing under the headings of “ischemic heart disease” and “hypertension.”
  • There is often a need to link across entry boundaries, i.e.: when one ‘problem’ is caused by or closely linked to another, such as “pneumonia (secondary problem) following prolonged bed confinement due to the operation for a broken hip (primary problem.)
  • Working within the scope and limitations of the provider’s own EHR system, including software and hardware reporting capabilities, as well as within governmental and other reporting constraints.

Suggestions for improved POMR implementation

Lawrence Weed, MD and his son Lincoln Weed in their book Medicine in Denial, suggest that health care providers make the effort to adopt this patient-centered approach by setting aside the “culture of medicine” that allow providers’ habits to dictate patient care.  In addition, a paper by members of the Primary Health Care Specialist Group of the British Computer Society recommended using software designed to make intelligent decisions about data that can be easily noted and amended.  A system could look for specific notes within a listed problem, for example, and create a new episode when such entries are input by the provider.

More providers are teaming up with professional medical billing and claims management services to ensure that billable information is accurate and fully compliant while protecting patient privacy as per HIPAA requirements.  M-Scribe Technologies, a leader in the medical services industry since 2003, offers experienced and dedicated claims and compliance personnel combined with state-of-the-art technology to provide fast and accurate processing of claims with increased revenues for client practices.  Email or call M-Scribe 888-727-4234 for more information about how your practice can save money and time so you can do what you do best: care for your patients.


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