Problem-Knowledge Couplers

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Problem-Knowledge Couplers (PKC) is founded by Dr. Lawrence L. Weed, the father of problem-oriented medical record (POMR).


POMR generally includes four parts: Subjective, Objective, Analytical and Planning(SOAP) progress notes. Dr Weed developed SOAP and POMR in the early 1960s, and still continues to work on and advocate it's use. SOAP is commonly used today by all physicians in medical records, but not necessarily as a problem-oriented structure.

PKC right now provides software tools that help both healthcare consumers and providers make well informed medical decisions. Take their Headache Diaggnosis Coupler as an example, it is web-based platform with four steps

  • Step 1 Enter data
  • Step 2 Review Data
  • Step 3 Review guidance
  • Step 4 Finish

The coupler design is based on two premises, that the human mind cannot process large amounts of data, and creating arobust decision making system requires consistant data gathering from many patients and doctors.1 PKC collects data from a variety of patients and providers and can find consistencies with diagnostic hypotheses for both common and uncommon diagnoses. It can provide alternative treatments if necessary, or provide evidence of disease progression.

Problem Knowledge Couplers

are built on the premise that no single clinician can remember all of the numerous possible causes of any symptom and that clinicians tend to focus on the one or few medical problems that fall within their recent experiences rather than the hundreds that may or may not be pertinent to the patient with the problem. The couplers, therefore, take the recall variable out of the equation of diagnostic or management problem solving, and give clinicians a set of possible solutions based on the patient responses to the questions linked to the facts in the knowledge net. From this set of solutions, clinicians are then able to rule out the impossible, review the improbable, and select the most logical solution to the medical problem as determined by the patient and the knowledgebase with little or no reliance on personal biases."2


  2. PKC Introduction to Problem-Knowledge Couplers, PCK Corporation
  3. McGoaan, Julie J., Ph.D., AHIP, Winstead-Fry, Patricia, Ph.D. Problem Knowledge Couplers: reengineering evidenced based medicine through interdisciplinary development,decision support, and research, Bulletin of the Medical Library Association, Oct 1999