The problem-oriented medical record, developed by Lawrence L. Weed, M.D., involves an interactive computer system and has been operational on two wards at the University Hospital in Burlington, Vermont, a teaching hospital. The Problem-Oriented Medical Information System (PROMIS) consists of terminals that feed into the central memory units; the terminals can be wheeled to the patient's bedside. Displays indicate first the common and then less common diseases that can be attributed to the patient's symptoms. Other displays logically lead the physician to a treatment plan through references from the medical literature and other considerations. The system also maintains problem-oriented progress notes. The system is designed to educate a new physician and other health practitioners who are patient-centered, team-oriented, and who relate to patients as mutual participants. Physicians must be trained and educated differently under this system. Under a restructured medical curriculum, it should be possible to train more people for less expense. The system creates conditions under which medical care can become coordinated in its delivery and potentially less costly both because tests are not done unless absolutely necessary and because the physician is warned not to do something in treating one problem that will complicate another. To the extent that "experts" create guidance tools that other members of the health team can use, costs can be lowered. The present system of provider-centered health care will be restructured to be patient-centered if the PROMIS system is accepted by the medical community. (SW)