If you work in healthcare or are studying to be a doctor, nurse, or medical assistant, you know one thing for sure: keeping good records is very important. But not all records are the same. For many years, hospitals and clinics used a system called the Source-Oriented Medical Record (SOMR). Then, a smarter way came along. It is called the Problem-Oriented Medical Record (POMR). In this blog we will explain everything about POMR and show you how and why this system helps patients get better care. By the end, you will know the parts of POMR, the good sides, the bad sides, and how it is different from the older SOMR system.
What Is the Problem-Oriented Medical Record (POMR)?
The Problem-Oriented Medical Record is a way of writing down patient information. The main idea is simple: you organize all the notes around the patient’s problems. A “problem” can be any medical issue. It can be a disease like diabetes, a symptom like headache, or even a social issue like not having a home.
In POMR, every piece of information connects to a specific problem. This is different from old-style records where you just wrote everything in one big list. POMR forces the healthcare team to think clearly. They must ask: “What problem does this information belong to?”
For example, if a patient has high blood pressure and also feels sad, those are two separate problems. In POMR, you write notes for problem #1 (high blood pressure) and separate notes for problem #2 (sadness). This keeps things clean and easy to follow.
A Quick History: Where Did POMR Come From?
A doctor named Lawrence Weed invented the POMR system in the 1960s. Dr. Weed was a professor at the University of Vermont. He noticed that many medical records were messy. Different doctors wrote in different places. Important information got lost. No one had a clear plan for the patient.
Dr. Weed believed that good medical care starts with clear thinking. He said: “You cannot treat what you do not understand.” So he created POMR to help doctors and nurses organize their thoughts. Today, many hospitals and clinics use a version of POMR. It is also the basis for modern electronic health records (EHRs).
The Four Main Components of POMR
POMR has four fixed parts. Every patient record using POMR must have these four things. Think of them like four drawers in a filing cabinet. Each drawer holds a different kind of information.
The Database
The database is all the basic information you collect about the patient. This includes their medical history, physical exam results, lab tests, and any other starting facts. You gather this information during the first visit or first few visits.
For example, a database for a new patient might say: “55-year-old man, has smoked for 30 years, blood pressure 150/90, weight 200 pounds, cholesterol high.” The database does not yet say what the problems are. It just holds raw facts.
The database is like a snapshot of the patient at the beginning. Later, when you find problems, you will go back to the database to get supporting facts. Without a good database, you cannot build a good POMR.
The Problem List
The problem list is the heart of POMR. It is a numbered list of every problem the patient has. Each problem gets its own number. The list stays at the front of the medical record so anyone can see it quickly.
Problems can be active or inactive. Active problems need current treatment. Inactive problems are things that have been solved or are no longer a big issue. For example, a broken leg that healed is inactive. High blood pressure that needs daily pills is active.
A problem list for a patient might look like this:
- Type 2 diabetes (active)
- High blood pressure (active)
- Seasonal allergies (active)
- Broken wrist from 2019 (inactive)
The problem list grows over time. If a patient develops a new issue, you add it to the list. If a problem goes away, you mark it inactive but keep it for history.
The Initial Plan
For each problem on the list, you write an initial plan. The plan says what you are going to do about that problem. The plan has three parts: diagnostic (tests to find out more), therapeutic (treatments to fix it), and educational (what you teach the patient).
Let us use problem #1: Type 2 diabetes. The initial plan might say:
- Diagnostic: Check blood sugar every morning. Order A1C blood test.
- Therapeutic: Start metformin 500 mg twice a day. Advise low-sugar diet.
- Educational: Teach patient how to use a glucose meter. Explain signs of low blood sugar.
The initial plan is like a roadmap. It tells everyone on the healthcare team what to do next. Without a plan, you just have a list of problems with no action.
The Progress Notes (SOAP Format)
Progress notes are what you write during follow-up visits. In POMR, progress notes use a special format called SOAP. SOAP stands for Subjective, Objective, Assessment, and Plan. Each note is tied to one problem number.
Here is what each letter means:
- S (Subjective): What the patient tells you. “I feel tired. My head hurts.”
- O (Objective): What you measure or see. Blood pressure 140/90. Temperature 98.6. Wound looks red.
- A (Assessment): Your professional judgment. “Diabetes is getting worse. Need to change medicine.”
- P (Plan): What you will do next. “Increase metformin to 1000 mg. Check blood sugar log in two weeks.”
You write a separate SOAP note for each problem. This way, you can track how each problem changes over time. If a problem gets better, the notes show that. If it gets worse, you see that too.
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POMR Example
Let us follow a real patient named Mrs. Jones. She is 60 years old. She comes to a clinic for the first time. Here is how the POMR would look.
Database:
Mrs. Jones, 60 years old. History of smoking (quit 5 years ago). Blood pressure 160/95. Weight 180 pounds. Cholesterol 240. No known drug allergies.
Problem List (after first visit):
- High blood pressure (active)
- High cholesterol (active)
- Chronic knee pain (active)
Initial Plan for Problem #1 (High blood pressure):
- Diagnostic: Check blood pressure at home twice daily. Order kidney function blood test.
- Therapeutic: Start lisinopril 10 mg daily. Reduce salt intake.
- Educational: Explain how high blood pressure damages heart and kidneys. Show how to take medicine correctly.
Progress Note (SOAP) for Problem #1 – Two weeks later:
- S: “I feel fine. No headaches. I take my pill every morning.”
- O: Home blood pressure log shows 135/85 on average. Kidney test normal.
- A: Blood pressure improving but not yet ideal.
- P: Increase lisinopril to 20 mg daily. Return in one month.
See how clear this is? Anyone reading the chart knows exactly what is happening with Mrs. Jones’s blood pressure. They do not have to search through pages of random notes.
Advantages of POMR (The Good Sides)
POMR has many benefits for patients, doctors, and nurses. Here are the most important ones.
Better Organization: POMR forces you to keep information in order. Each problem has its own home. You never mix up diabetes notes with heart problem notes. This saves time. A nurse can quickly find the plan for a patient’s high blood pressure without reading about their allergies.
Clearer Thinking: When you write a SOAP note for each problem, you must think step by step. First, what did the patient say? Second, what did I see or measure? Third, what does this mean? Fourth, what will I do? This logical flow reduces mistakes. Doctors are less likely to forget important steps.
Better Teamwork: In a hospital, many people care for the same patient: doctors, nurses, physical therapists, social workers. POMR lets everyone write notes under the same problem numbers. A physical therapist can add a note to problem #3 (knee pain). A social worker can add a note to problem #4 (needs help at home). Everyone stays on the same page.
Easy to Track Progress Over Time: Because every note is tied to a specific problem, you can look back and see how that problem has changed. You can ask: “Did the blood pressure get better after we started the new medicine?” The answer is right there in the SOAP notes. This makes treatment smarter.
Supports Medical Education: Medical students and new residents learn to think like doctors by using POMR. It teaches them to identify problems, make plans, and write clear notes. Many medical schools use POMR as a teaching tool.
Disadvantages of POMR (The Bad Sides)
No system is perfect. POMR also has some downsides. You should know them before deciding to use POMR in your clinic or hospital.
Takes More Time to Write: Writing separate SOAP notes for each problem takes longer than writing one big paragraph. If a patient has five problems, you write five notes. Busy doctors often feel rushed. They might complain that POMR adds extra paperwork. In a fast-paced emergency room, POMR can feel too slow.
Can Be Repetitive: Sometimes the same information belongs to more than one problem. For example, a patient’s weight loss might help both diabetes and high blood pressure. In POMR, you might have to write the same fact twice. This repetition can be frustrating. Some information gets copied and pasted too many times.
Problem List Can Get Very Long: Elderly patients or patients with many chronic diseases can have 20 or 30 problems on their list. A long list is hard to manage. Important problems might get buried under less important ones. Keeping the list updated takes work. If no one cleans the list, old, inactive problems stay there forever.
Requires Training and Discipline: POMR only works if everyone uses it the same way. If one doctor writes SOAP notes and another writes free text, the system breaks down. Training all staff takes time and money. Some older doctors who are used to the old system may resist changing.
Not Ideal for Very Simple Visits: For a quick visit like a sore throat that goes away in one day, POMR can feel like overkill. You do not need a full problem list and SOAP note for a minor cold. Many clinics use a simpler system for acute, minor problems and save POMR for chronic or complex patients.
POMR vs. Source-Oriented Medical Record (SOMR)
To truly understand POMR, you must compare it to the older system: SOMR. SOMR stands for Source-Oriented Medical Record. Let us break down the differences.
What Is SOMR?
In SOMR, you organize information by who wrote it or where it came from. All nurses’ notes go in one section. All lab results go in another section. All doctor’s notes go in a third section. Each “source” (person or department) has its own folder or tab.
Imagine a paper chart with five tabs: Lab, Nursing, Pharmacy, Doctor, X-ray. To understand a patient’s diabetes, you have to look in every tab. The doctor’s note might mention blood sugar. The lab tab has the A1C results. The nursing tab has the patient’s report of feeling dizzy. You must jump back and forth.
Key Differences Between POMR and SOMR
| Feature | POMR | SOMR |
|---|---|---|
| Organization | By problem number | By source (who wrote it) |
| Problem list | Yes, at the front | No |
| Progress notes | SOAP format, per problem | Free text, mixed together |
| Finding information | Easy – go to problem number | Hard – search many sections |
| Teamwork | Excellent – everyone writes to same problem | Poor – each source works in silo |
| Time to write | Longer | Shorter |
| Time to read | Shorter | Longer |
| Teaching value | High | Low |
An Example of the Difference
Let us say a patient with heart failure comes to the hospital. In SOMR, the doctor writes in the doctor’s section: “Patient short of breath.” The nurse writes in the nursing section: “Patient’s legs are swollen.” The lab puts results in the lab section: “B-type natriuretic peptide (BNP) is high.” To see the full picture, you must flip between three different places.
In POMR, all of that information goes under one problem: “Problem #1: Heart failure.” The doctor’s note, the nurse’s finding, and the lab result all live together. You see everything in one place. That is the power of POMR.
Which One Is Better?
For complex, long-term care, POMR is much better. It reduces errors, improves communication, and helps track progress. For very simple, one-time visits, SOMR might be faster. Most modern hospitals use a hybrid. They use POMR principles for chronic diseases and a simpler system for acute issues. But the trend is moving toward POMR because electronic health records make it easier to link notes to problems.
How to Start Using POMR in Your Practice
If you want to switch to POMR, here are simple steps to follow.
Step 1: Train Your Team
Hold a one-hour workshop. Teach everyone what POMR is and how to write SOAP notes. Show examples. Let people practice. Make sure doctors, nurses, medical assistants, and even front desk staff understand the problem list.
Step 2: Create a Master Problem List for Each Patient
Start with new patients. During the first visit, sit down and write the problem list together as a team. For existing patients, take time to review their old charts and create a problem list from scratch. This takes effort but is worth it.
Step 3: Use Templates
Make paper or electronic templates for SOAP notes. The template should have spaces for S, O, A, and P. This guides people to write correctly. Many electronic health record systems already have SOAP note templates. Turn them on.
Step 4: Assign a Problem List Manager
In a busy clinic, one person (like a nurse or medical assistant) should be responsible for keeping the problem list updated. They remove inactive problems, add new ones, and fix errors. Without a manager, the list gets messy.
Step 5: Review and Improve
After one month, ask your team: “What is hard about POMR? What is easy?” Adjust your process based on feedback. Maybe you decide to use short SOAP notes for minor problems. Maybe you create a separate quick-log for colds and rashes. Be flexible.
Common Mistakes to Avoid With POMR
Even good systems fail when people use them wrong. Here are mistakes to watch out for.
Mistake #1: Writing SOAP Notes Without Linking to a Problem Number
If you write a SOAP note but forget to put the problem number on top, the note is lost. Always write: “Problem #2 – Diabetes” before the S-O-A-P.
Mistake #2: Putting Two Problems in One SOAP Note
Never mix problems. If a patient has high blood pressure and also a rash, write two separate notes. Otherwise, you cannot track each problem individually.
Mistake #3: Not Updating the Problem List
A problem list from 2019 is useless in 2024. Review the list at every visit. Mark resolved problems as inactive. Add new problems immediately. A stale list confuses everyone.
Mistake #4: Writing Vague Assessments
In the “A” part of SOAP, do not just write “doing okay.” Write something specific. “Blood pressure improved but still above goal. Medicine working partially.” Vague notes help no one.
The Future of POMR in Electronic Health Records
Today, most electronic health records (EHRs) are built on POMR ideas. When you open a patient’s chart in Epic, Cerner, or other systems, you see a problem list first. You can click on a problem and see all related notes, labs, and orders.
New technology like artificial intelligence (AI) is making POMR even better. AI can suggest new problems based on lab results. AI can remind you to update the problem list. AI can even write draft SOAP notes for you to review. But the core idea – organizing care around problems – stays the same.
In the future, POMR may connect across hospitals. A patient’s problem list from one clinic could be shared with a specialist in another city. This would reduce repeated tests and missed information. That future is coming soon.
Final Thoughts: Why POMR Matters for Good Healthcare
Good medical records save lives. Bad medical records cause mistakes. The Problem-Oriented Medical Record is not just a paperwork system. It is a way of thinking. It forces doctors and nurses to be clear, logical, and patient-focused. When you use POMR, you never lose track of a patient’s problems. You always have a plan. You can see what worked and what did not. Your whole team works together instead of in separate silos.
Yes, POMR takes more time to write. Yes, it requires training. But the benefits are worth it. Patients get better care. Doctors make fewer errors. Nurses spend less time searching for information.
If you are still using old-style SOMR notes, try switching to POMR for one week. Start with just three patients. Write a problem list. Use SOAP format. See how it feels. Most healthcare workers who try POMR never go back.
Your patients deserve a record that puts their problems first. Give them the gift of clear, organized, problem-oriented thinking. Start using POMR today.
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Dr. Connor Yost is an Internal Medicine resident at Creighton University School of Medicine in Arizona and an emerging leader in clinical innovation. He currently serves as Chief Medical Officer at Skriber, where he helps shape AI-powered tools that streamline clinical documentation and support physicians in delivering higher-quality care. Dr. Yost also works as a Strategic Advisor at Doc2Doc, lending his expertise to initiatives that improve financial wellness for physicians and trainees.
His professional interests include medical education, workflow redesign, and the responsible use of AI in healthcare. Dr. Yost is committed to building systems that allow clinicians to spend more time with patients and less on administrative tasks. Outside of medicine, he enjoys photography, entrepreneurship, and family life.
