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Determinants of a successful problem list to support the implementation of the problem-oriented medical record
Sereh M J Simons1, Felix H J M Cillessen2, Jan A Hazelzet3
1Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. s.m.j.simons@gmail.com.
Insights
Implementing a problem-oriented medical record (POMR) requires a sociotechnical approach, considering both the system and organizational factors for successful integration. All identified determinants are crucial for effective POMR use.
Area of Science:
- Health Informatics
- Medical Record Management
- Clinical Documentation
Background:
- The problem-oriented medical record (POMR) organizes patient information by medical problem, introduced by Dr. Lawrence Weed.
- Historically, paper-based POMRs lacked advanced features, but modern Electronic Health Records (EHRs) enable enhanced functionality.
- POMRs in EHRs support clinical decision support, registries, order management, and population health initiatives.
Purpose of the Study:
- To identify key determinants for the successful implementation of problem-oriented medical records (POMRs).
- To analyze factors influencing the integration of POMRs within healthcare systems.
Main Methods:
- A systematic literature search was conducted on May 12, 2014, and June 1, 2015.
- Statements regarding POMR implementation were categorized to extract generic determinants.
- 38 articles were included in the analysis.
Main Results:
- Twelve generic determinants for POMR implementation were identified.
- Determinants include: clinical practice/reasoning, problem list completeness/accuracy, data structure/content, efficiency, functionality, interoperability, multidisciplinary approach, patient information overview, quality of care, system support, staff training, and usability.
- These determinants fall into two main categories: the system and the organization using it.
Conclusions:
- Successful POMR implementation necessitates a sociotechnical approach, integrating both the system and the user organization.
- Both system and organizational factors are equally critical for successful POMR adoption.
- The relative importance of each determinant varies depending on the specific healthcare organization.
Background:
A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing with the multiplicity of patient problems. The problem list as a precondition is the centerpiece of the problem-oriented medical record (POMR) also called problem-oriented record (POR). Prior to the digital era, paper records presented a flat list of medical problems to the healthcare professional without the features that are possible with current technology. In modern EHRs a POMR based on a structured problem list can be used for clinical decision support, registries, order management, population health, and potentially other innovative functionality in the future, thereby providing a new incentive to the implementation and use of the POMR.
Methods:
On both 12 May 2014 and 1 June 2015 a systematic literature search was conducted. From the retrieved articles statements regarding the POMR and related to successful or non-successful implementation, were categorized. Generic determinants were extracted from these statements.
Results:
In this research 38 articles were included. The literature analysis led to 12 generic determinants: clinical practice/reasoning, complete and accurate problem list, data structure/content, efficiency, functionality, interoperability, multi-disciplinary, overview of patient information, quality of care, system support, training of staff, and usability.
Conclusions:
Two main subjects can be distinguished in the determinants: the system that the problem list and POMR is integrated in and the organization using that system. The combination of the two requires a sociotechnical approach and both are equally important for successful implementation of a POMR. All the determinants have to be taken into account, but the weight given to each of the determinants depends on the organizationusing the problem list or POMR.
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