100th Anniversary of the Modern Medical Record

As I wrote about in my previous post, world-wide efforts are underway to replace the paper-based medical record with electronic medical records (EHRs). For information on the US effort, you can visit the White House website to get some background information of the US effort, as well as the US Department of Health & Human Services (HHS) website to see current status information.

Something that has gone surprisingly unnoticed is that this month marks the hundredth anniversary of the modern paper medical record. This innovation, which we all take for granted, can trace its origins to Dr. Henry Plummer, a partner at the Mayo Clinic, in the year 1907. Plummer recognized that each patientâ''s medical history needed to be recorded, stored and retrieved in a different manner than was the current practice if the quality of patient care were to improve.

For example, when a patient first visited the clinic, a Mayo doctor would write up his medical notes in the currently active patient ledger book. On a patientâ''s later visit, the treating physician would need to unearth the correct ledger book where the patientâ''s first visit notes were entered, next find where in the ledger book the notes were written, and then append new information underneath the first entry. If there wasnâ''t sufficient room, the doctor wrote his notes in the margins of the page. Adding to the problem was that different medical departments had their own ledger books to record their interactions with the patient. Naturally, creating and especially retrieving a medical record was an awkward process that kept a doctor from having a complete understanding of a patientâ''s medical history.

Plummer, along with his assistant Mabel Root, developed and then began implementation on 1 July 1907 a â''patient dossierâ'' system to address these issues. Now, instead of a ledger, each Mayo doctor would record all aspects of a Mayo patientâ''s visit in a single, comprehensive file that was forever linked to the patient through a unique registration number. Whenever a patient left the clinic, the patientâ''s file was stored in a central file repository until the patient returned when it would be retrieved, possibly years later. This provided a means for maintaining continuity of patient care.

To increase efficiently further, Plummer, who I call properly the first true Chief Information Officer (CIO) as well as IS&T architect, devised an â''information networkâ'' consisting of conveyors and pneumatic tubes to more quickly retrieve patient information from the central repository. The mechanical network transported patient and other administrative information throughout the Mayo Clinicâ''s various offices and medical departments. Plummer later devised a medical search indexing method so that the information contained within a patientâ''s file, with permission, could be used to assist in advancing diagnostic research.

The benefits of his system were so evident that it did not take long for Plummerâ''s medical records systemâ''s approach to become a world-wide standard. His innovations worked very well in large hospital settings and small doctorâ''s offices alike, and provided family doctors almost a complete longitudinal record of a patientâ''s medical history for the next forty years.

So the next time you are at a doctorâ''s office, think about Dr. Plummer, and give him a nod of thanks.

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