The promise of the problem-oriented medical record (POMR)

By making the EHR more problem-oriented, healthcare providers can synthesize patient data, highlight key insights, and support more effective decision-making.
problem oriented medical record

What if there was a way to increase your electronic medical record’s (EHR’s) potential to improve patient care, boost healthcare efficiency, and reduce staff burnout?

In a recent webinar, healthcare experts Jim Thompson, MD, ABEM, ABIM, Amber Sieja, MD, and Amanda Heidemann, MD, FAAFP, discussed how a problem-oriented medical record (POMR) could do just that.

Certainly, the problem list can serve as a central hub for patient information, providing a comprehensive view of a patient’s health status. Still, our panelists are very much aware that adopting problem-based charting can be challenging. From the need for practical user training and the resistance to change, to the time constraints and complexity of patient cases, their discussion provides valuable insights on overcoming the barriers to implementation and adoption.

To watch the full on-demand webinar, In praise of the problem-oriented medical record (POMR), click below.

For excerpts and clips from the discussion, continue reading below.

Use of the medical problem list

Thompson, a physician informaticist at IMO, believes that the medical problem list in EHRs should be managed and presented in a way that clinicians can process easily.

He suggests that the problem list often becomes cluttered, acting like an ‘attic’ of patient information. To address this, he advocates for a dynamic display that organizes and presents a comprehensive clinical picture of the patient. Thompson also acknowledges that the use of the medical problem list may vary between doctors, so the display and management should be adaptable to individual needs.

Getting a buy-in

Heidemann, CMIO of KeyCare, Inc., and Sieja, Senior Medical Director of Informatics at UCHealth, advocate for the adoption and effective use of problem-based charting in EHRs.

Sieja suggests tying problem-based charting to financial incentives – emphasizing the importance of accurate problem lists for patient care and insurance needs.

One specific example she provides is the use of Hierarchical Condition Category (HCC) codes. These codes represent how complex a patient’s condition is, which in turn affects reimbursement rates from insurance companies. By maintaining an up-to-date problem list and using problem-based charting, providers can ensure that they accurately capture these codes and optimize financial return.

Budget struggles

Optimizing the EHR is a continuous conversation in healthcare. Sieja believes that hospitals and health systems must recognize this need, given its potential impact on staff turnover and clinician burnout. She suggests that organizations regularly survey their staff about the effectiveness of their EHR systems and use that information to drive improvements.

Interaction with payers

The clinical processes behind billing are complex and can create poor communication between healthcare providers and health plans, such as insurance companies. To help bridge that gap, Thompson and Sieja propose using problem-based charting, which would enable specific notes related to a particular health issue to be sent to the insurance company. This approach could streamline the process of prior authorizations, improve efficiency, and enhance communication between healthcare providers and insurers.

To learn more about the challenges clinicians face when adopting a POMR and how to overcome them, listen to the full discussion below.

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