• A tree fell in the forest

    July 7th, 2017 : By steve

    A tree fell in the forest. If not heard, did the tree fall? I asked myself this question after learning that Dr. Larry Weed, known as the Father of Medical Records, left this world on June 3rd of this year. I learned this a full 30 days after his death.

    Unaware …. does this mean the tree is standing tall and strong and he’s still with us? In this case, the answer is yes. Yes, because his groundbreaking work lives on today and so many others stand on his shoulders as they innovate improvements in the electronic medical record he pioneered.

    Why did he change the way he did his medical documentation? How did he ultimately influence the process of patient care? Like other physicians of the time, Dr. Weed wrestled with how to accurately apply medical knowledge to a messy world of symptoms and treatments, a world in which making a correct diagnosis is a challenge in the face of subjective communications between doctor and patient in addition to symptoms that morph.

    He recognized, as others did, that a patient’s diagnosis evolves over time. Like they, he also recognized that medical documentation can become voluminous and unwieldy to the point of its being unusable.  Like others, he developed a manual system to track treatments, tests, and observations, subjective and objective, to a probable diagnosis or problem – a problem-oriented medical record. He found that the medical record grew very large with its utilization over time and hit a brick wall of usability. It ultimately became unmanageable. He concluded that a different system of medical documentation was needed.  So he rolled up his sleeves and developed a computerized version of what he was doing manually – a Problem-Oriented Medical Information System – POMIS – using the power of computer programs to overcome the limitation of the manual record and the human brain to recall medical knowledge and to optimally make correct patient decisions.

    He then linked the medical knowledge in his manual system into its electronic counterpart, the POMIS, and used its data to identify probable diagnoses and treatments. He went a step further and identified the pros and cons of each diagnosis and treatment recommendation for the physician to consider. And so was born the electronic health record, an innovative and revolutionary approach at the time to medical documentation, an approach born out of necessity. Not greeted with universal kudos, today it is recognized as a breakthrough in the application of medical knowledge to optimally treat patients.

    His pioneering steps led the way to today’s electronic health record innovations such as software mediated workflows and medical alerts at the point of need, advising and guiding each clinician of the care team in real time. Today, the practice of medicine is becoming ever more the practice of information as Dr. Weed envisioned. His legacy lives on and the tree stands tall and strong!

    Beth Evans