ABSTRACT
In the late 1960s, Lawrence Weed successfully advocated for fundamental change in the approach to medical record organization and documentation. [1] In his landmark publication, Dr. Weed identified the challenge physicians face in providing single-minded attention to complex patients with multiple existing and developing problems. His proposed solution would orient data around each patient problem, creating a complete “problem list” displayed prominently in each chart. This Problem-oriented Medical Record (POMR) would be updated at each subsequent care episode. While problem lists have become commonplace in ambulatory practice, there is substantial variation in physician adherence to the use and completeness of information entry. As stated in Dr. Weed's original publication, “Among physicians there is a remarkable spectrum of behavior from the compul-
sively elaborate to the sketchy and haphazard.” [1] Today, practice variation is still considered a significant contributor to inadequacies in health care quality. [2-5]
The premise of the POMR is that an accurately defi ned problem list will directly result in more thorough and effi cient patient care. Despite this assertion, there has been little validation that this approach translates into improved patient outcomes. Simborg et al. evaluated [2] consecutive visits in 6 ambulatory clinics to determine the problems identifi ed in the fi rst visit and the follow-up care for these problems provided in the second visit. [6] It was found that problems listed in the front of the chart were more likely to be addressed at the subsequent visit, particularly if there was a longer interval between visits. Recognizing that practice variation continues to exist decades after Dr. Weed's original publication and that expensive physician resources are required to maintain an accurate problem list, we sought to further quantify the impact of this process on patient outcomes.
