World 3 Medicine

This site is a public repository for documents and discussion about the Problem-Oriented Medical Record (POMR),  the integrally related concept of knowedge coupling, and implications of both for clinical practice and health policy.

• The POMR is a standard of care for organizing data in medical records.  The POMR's components include the familiar problem lists and "SOAP notes." The POMR standard organizes and categorizes medical record contents.  By doing so, the POMR enables the medical record to serve as a clinical guidance and communication tool, thereby facilitating scientific rigor in medical decision making.  But the POMR standard does not govern the informational inputs to decision making and medical record contents.  For that, a separate decision support tool is needed.
• "Knowledge coupling" means a tool-driven process to implement standards of care for inputs to medical decision making and medical records. Problem-specific standards are built into electronic decision support tools (Knowledge Couplers).  Because these standards and tools are external to the human mind, they protect against the vulnerabilities of human cognition.  Specifically, the tools couple patient-specific data with general medical knowledge in a step-by-step process. Beginning with a single data point (the patient's complaint or other presenting problem), a  Coupler uses medical knowledge to identify diagnostic or therapeutic options for that problem. Then the Coupler identifies initial patient data needed to assess which of those options are worth considering for the particular patient. Once the data are collected and entered in the Coupler (as findings from the patient history, physical exam and basic lab tests) , the resulting output is an individualized list of options with evidence for and against each one, plus further guidance on assessing the evidence and determining follow-up actions.

For detailed discussion, see the book Medicine in Denial (Amazon CreateSpace, 2011).  A searchable, downloadable PDF of the book's full text is available here.  See p. 109 of Medicine in Denial for explanation of the term "World 3," which comes from the philosophy of Karl Popper.