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May 12, 1989

The Computer-Stored Medical Record

JAMA. 1989;261(18):2636. doi:10.1001/jama.1989.03420180060020

To the Editor. —  The article by McDonald and Tierney1 concerning computer-stored medical records has a significant omission. Nowhere is mentioned the philosophical and technological landmark effort of Dr Lawrence Weed with the computerized problem-oriented medical information system (PROMIS). Under the leadership of Dr Weed at the University of Vermont from 1969 through 1981, PROMIS demonstrated the prototype integrated computer-stored medical record.2,3 It was funded primarily by the federal government, to the tune of more than $10 million.The PROMIS system was developed from the perspective of the patient, focusing on medical care delivery problems in coordination, logic, memory, and feedback, problems that still remain basically unsolved today. The entire medical record was on-line, most of it as coded text entered through branched logic pathways, using a defined, unified medical vocabulary. The system provided guidance to users both in the form of the pathways and with online information