Out-patient Medical Record (OMR)

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The Out-patient Medical Record (OMR) was developed by informaticians working at the Beth Israel Hospital in Boston, MA. In February 1989, approximately 20% of Beth Israel Hospital's clinicians moved to a location physically disconnected from the main hospital. From this remote location it was not possible to transport the patient's paper medical record from the hospital.

To facilitate communication between the clinicians at this location and those at the hospital, they installed computer terminals in every clinician's office in this new setting and developed computer applications that allowed clinicians to enter, edit, and display patients' problems, medications, health promotion and disease prevention screening sheets, flow sheets, and progress notes that were problem oriented and displayed updates under the suitable active problem within the problem list. In addition, clinicians could rely on an automated set of influenza shot reminders associated with every patient older than 65 years or suffering from a chronic disease(1).

Three months after introducing the system to the rest of the clinics at he hospital in July 1990, a study noted a discrepancy in the number of patients with updated medication and problem lists between the clinics at the hospital and the outside clinics. Almost three fourths of the patients taken care for at the hospital clinics were without any problem lists or medication lists. Unlike the distant clinics, where 70% of the patients had updated problem and medication lists (1). Moreover, even though it took more time to type the notes than to write them, clinicians typed twice as much words as they wrote in every note. Using problem lists generated by the system, providers were prompted to review, edit, and update clinical records. This shows that clinicians considered the notes that they wrote on the out-patient medical record more valuable and effective.

As of 1991, 20 staff physicians, 5 fellows, 64 residents, and 11 nurse practitioners have entered 15,121 active problems and 1996 inactive problems for 3524 patients. Furthermore, plans have been set to add modules for referral letters, rapid physical exam findings entry, and more.



References

1. Safran C, Rury C, Rind DM, Taylor WC. Outpatient medical records for a teaching hospital: beginning the physician-computer dialogue.

2. Cintron A, Phillips R, Hamel MB. The effect of a web-based, patient-directed intervention on knowledge, discussion, and completion of a health care proxy. [1]