pomr

POMR, or problem-oriented medical record, is a framework for organizing medical records around the patient’s active problems rather than around episodes of care or individual disciplines. Introduced by Dr. Lawrence Weed in the 1960s, it was developed to support clinical reasoning, continuity of care, and comprehensive documentation in teaching and complex patient management. The core idea is to structure the record so that problems drive the clinical content.

A POMR typically comprises four interrelated components: a database, a problem list, a structured treatment plan, and progress notes. The database collects the patient’s history, physical examination findings, and results from investigations. The problem list is a prioritized inventory of active and resolved problems, with each item having a concise statement, onset date, status, and responsible clinician. The treatment plan outlines diagnostic and therapeutic actions, including medications, procedures, referrals, and patient education. Progress notes, often written in SOAP format, are linked to the respective problems to document changes over time.

Advantages include improved organization, easier retrieval of information, and enhanced clinical reasoning and patient safety through a single reference for care. It also supports multidisciplinary communication and accountability. Challenges include the time required to establish and maintain the problem list, integration with modern electronic health records, need for staff training, and potential workflow disruption. While many EHR systems incorporate POMR-inspired structures, full implementation varies by setting.