Problem-Oriented Electronic Health Records and Patient Clinical Outcomes: a Scoping Review

Background: The problem-oriented medical record (POMR) was designed to address inefficiencies and errors in medical practice caused by disorganized patient data, fragmented care, and increasing complexity in medical knowledge. However, the relationship between this method of information organization and patient outcomes remains poorly understood. Objective: To explore the association between POMR in electronic health records (EHRs) and patient clinical outcomes, identify which problem-oriented elements are present in existing systems, and assess how frequently these elements are used in clinical workflows. Design: A comprehensive search was conducted across six online databases (Scopus, Web of Science, Scielo, PubMed, LILACS, and Embase) with no restrictions to publication date. The search aimed to identify studies evaluating the relationship between POMR and patient clinical outcomes. Studies were screened independently by pairs of reviewers at the title, abstract, and full-text stages. Disagreements were resolved by a third reviewer. Patient outcomes, POMR elements in the EHR, and their usage rate were extracted by peers from included articles and aggregated by a third reviewer. Results: Of 1,609 unique records identified, 38 studies were included, with most of them evaluating the problem list, followed by SOAP notes and episodes of care. Seventeen studies assessed patient outcomes, reporting associations with reduced mortality, shorter hospital stays, fewer admissions, and improved chronic disease management. Thirty studies identified associations between POMR and changes in healthcare provider behaviors—such as prescribing, screening, counseling, and referral practices—that may influence patient outcomes. Most studies were observational or quality improvement initiatives. Only 25 articles (65.8%) described the usage rate of POMR features. Conclusions: Problem-oriented elements in EHRs may contribute to better clinical outcomes and provider practices. However, evidence is limited and heterogeneous. Future research should adopt more rigorous study designs and provide detailed reporting on feature use and system implementation.