Shukor Ali Rafik
Doctoral Candidate in Social Medicine at the Academisch Medisch Centrum in Amsterdam, The Netherlands.
Perm J. 2017;21:16-147. doi: 10.7812/TPP/16-147.
Lawrence Weed, MD, is renowned for being the father of the Problem-Oriented Medical Record (POMR), the medical care standard for collecting, managing, and contextualizing patient data in medical records. What have been consistently overlooked are his teachings on knowledge coupling, which refers to matching patient data with associated medical knowledge. Together, the POMR standard and knowledge coupling are meant to form the basis of a systems approach that enables individualized evidence-based decision making within the context of multimorbidity and patient complexity.The POMR and knowledge coupling tools operationalize a problem-oriented model that reflects a sophisticated general systems theoretical approach to knowledge. This paradigm transcends reductionist approaches to knowledge by depicting how the meaning of specific entities (eg, disease constructs) and their associated probabilities can only be understood within their respective spatiotemporal and biopsychosocial relational contexts. Rigorous POMRs therefore require knowledge inputs from a network of interconnections among specific entities, which Dr Weed enabled through development of the Knowledge Net standard. The Knowledge Net's relational structure determines the applicability of knowledge within specific patient contexts. To enable the linkage of unique combinations of data in individual patient POMRs with existing medical knowledge structured in Knowledge Nets, Dr Weed developed the Knowledge Coupling standard.Dr Weed's standards for record keeping and knowledge coupling form the basis of a combinatorial approach to evidence-based medicine that fulfills Stange's call for a science of connectedness. Ensuing individualized processes of care become the dynamo powering a learning health care system that enables a co-construction of health premised on empowerment and intelligent human decision making, rather than promoting the artificial intelligence of tools. If the value of Engel's biopsychosocial model indeed relates to "guiding the parsimonious application of medical knowledge to the needs of each patient," Dr Weed's approach warrants serious consideration.
劳伦斯·威德医学博士被誉为问题导向医疗记录（POMR）之父，POMR是医疗记录中收集、管理患者数据并将其置于具体情境的医疗护理标准。然而，他关于知识耦合的教导却一直被忽视，知识耦合是指将患者数据与相关医学知识相匹配。POMR标准和知识耦合共同构成了一种系统方法的基础，该方法能够在多重疾病和患者复杂性的背景下实现基于个体证据的决策。POMR和知识耦合工具实施了一种问题导向模型，该模型反映了一种复杂的知识通用系统理论方法。这种范式超越了对知识的还原论方法，它描述了特定实体（如疾病结构）的意义及其相关概率只有在其各自的时空和生物心理社会关系背景中才能被理解。因此，严谨的POMR需要来自特定实体之间相互联系网络的知识输入，威德博士通过开发知识网络标准实现了这一点。知识网络的关系结构决定了知识在特定患者情境中的适用性。为了使个体患者POMR中独特的数据组合与知识网络中结构化的现有医学知识相联系，威德博士开发了知识耦合标准。
威德博士的记录保存和知识耦合标准构成了循证医学组合方法的基础，满足了施坦格对关联性科学的呼吁。随之而来的个性化护理过程成为推动学习型医疗系统的动力，该系统能够在赋权和明智的人类决策基础上共同构建健康，而不是推广工具的人工智能。如果恩格尔的生物心理社会模型的价值确实与“指导将医学知识简约地应用于每个患者的需求”相关，那么威德博士的方法值得认真考虑。
