The Medical Record (TMR)

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The Medical Record (TMR), is a comprehensive medical information system developed at Duke University Medical Center by William Stead, M.D. and Edward Hammond, Ph.D.

The original goal of the TMR was to replace the paper chart with a computer-based record that would serve the needs of a practicing physician. Development started in 1969 and by 1974 the TMR system could process 1,000 patients a week.

By January of 1981 TMR allowed large practices to do scheduling, accounting and medical records. In April of 1983 TMR was used at the Kenneth Norris Cancer Research center, with the expectation that it maintain computerized record and support information needs of ambulatory and clinical care. (Stead and Hammond 1983)

Over its existence, TMR has been implemented in over 40 different sites. It has been implemented in 14 different medical specialties. It has operated in outpatient settings, inpatient settings, intensive care settings, and combinations of these settings. The smallest application was a solo practitioner, and the largest site supported more than 350 providers. The maximum number of patients supported by TMR in one system was approximately 750,000. The Medical Record provides an integrated clinical and accounting functionality. At its peak, it was operational in 15 different sites. At present, TMR is operational in four sites. It is still a character-based system, uses DEC's VMS operating system, and runs on the Alpha computer (Hammond, 2001).

Some of the early functions of the TMR system were to record any data that could be found in a traditional ambulatory record or inpatient chart. It could also maintain a complete list of diagnoses, procedures, and time-oriented records containing subjective and physical findings, laboratory data, and therapeutic interventions. As the system evolved, more features were added such as administrative management functions.

The TMR was created for ambulatory care, and has grown to include inpatient care, including the Labor and Delivery Unit and Surgical Intensive Care Unit at Duke. A recent project connected inpatient and outpatient computer-based patient records for the Bone Marrow Transplant Unit. Medical informatics trainees work in the TMR Laboratory, giving them hands-on experience.

In 2003, the American College of Medical Informatics (ACMI) presented the Morris F. Collen Award to Edward Hammond. The ACMI is an honorary society established to recognize those who have made sustained contributions to the field. The Collen award is its highest award, for lifetime achievement and contributions to the discipline of medical informatics.


Stead, WW, Hammond, EW. TMR - The Medical Record Spanning the Spectrum of Patient Care.

Hammond, W. Ed How the Past Teaches the Future: ACMI Distinguished Lecuture

William W. Stead and William E. Hammond. Functions Required to Allow TMR to Support the Information Requirements of a Hospital. Proc Annu Symp Comput Appl Med Care. 1983 October 26; 106–109. [1]

William W. Stead, MD. "Presentation of the Morris F. Collen Award to William Edward Hammond II, PhD." J Med Inform Assoc. 2004 May–Jun; 11(3): 221–224. [2]