A problem-oriented, knowledge-based patient record system.

The concept of a problem-oriented patient record was presented in the late 1960s but has yet to gain wide acceptance. In this paper we suggest a distinction between the idea of problem orientation and the implementation of the idea. We argue that the problem-oriented patient record offers an intuitive and useful way to work with patient information. We show that the concept of problem-oriented patient records facilitates better care of patients by supporting continuity of care, removing redundant and confusing information, and enabling easy overview of and access to its content. We further propose a two-layer framework that has knowledge of its content and use and is able to better utilize information in the record by presenting relevant information to the user at a time when needed. Conceptually, this is done by adding a layer of knowledge to the patient record system: 1) Knowledge about physicians' way of thinking and working, 2) Their corresponding information use and need during patient care, and 3) Tools to determine information relevance in a given situation; such a knowledge-based system is able to reason with its content and use.