1907: The First Plummer Project #ThrowbackThursday

These pages are from a medical ledger used by Henry Plummer, M.D., before the integrated medical record was adopted at Mayo Clinic.

The successful launch of Epic at the Mayo Clinic Health System sites in Wisconsin in 2017 recalls another milestone 110 years ago. On July 19, 1907, patient No. 1 registered in the new system designed by Henry Plummer, M.D., in collaboration with Mabel Root and other colleagues. The patient hailed from Canada—an early example of Mayo Clinic’s international reach.

Mabel Root

Prior to the dossier or unit record that Dr. Plummer developed, the conventional approach was for each physician to maintain a ledger in which patient information was recorded according to the individual doctor’s preference. As the practice grew, it became increasingly difficult to access prior information.

Dr. Plummer spent more than a year studying record-keeping systems at other medical centers. He also reached out to business and industry to learn their methods. Processing this information, he developed a one-of-a-kind system.

"It is precisely because of the principles developed and promoted by Dr. Plummer that our Epic implementation is named the Plummer Project," says Steve Peters, M.D., Co-Chair of the Plummer Project. These principles have stood the test of time from Dr. Plummer’s era of disseminating patient information on paper files transported via pneumatic tubes to the electronic environment of today:

  • Excellent care requires excellent documentation to benefit the individual patient and advance medical science. Indeed, excellent documentation facilitates patient care of the highest quality.
  • The record does not belong to any individual practitioner. It is held in trust by the organization as a whole.
  • Each patient is registered upon arrival and assigned a serial number.
  • All information about the patient’s care is placed in a central repository to which data can be continuously added in the course of ongoing episodes of care.
  • Information is recorded and meticulously maintained according to standardized methods.
  • The history is readily available to any member of the practice group who participates in the patient’s care.
  • Records are cross-indexed according to criteria such as disease, medical treatment, surgical technique, results, and pathological findings. Each record contributes to a database of information that can be used in case studies to benefit many other patients.
Henry Plummer, M.D.

Dr. Plummer was committed to fine-tuning every aspect of the medical record. Mayo Clinic identified a grade of paper that would not turn brittle or yellow. And in that era of using fountain pens, rather than keystrokes, to document patient information, the staff publication Mayovox announced: "All persons who write in the medical records are asked to use the ink supplied by the Clinic in order to insure permanency of the records. . . . The point to remember is that Clinic records are priceless—priceless because [they are] irreplaceable. A note on a patient’s condition today may be the diagnostic key to a solution of that same patient’s medical problem a quarter-century from now." For the same reason, today’s Epic implementation includes standard typographical fonts to ensure legibility and prevent misunderstanding of information.

This spirit of innovation, rigor, and standardization—all in service to the patient—is the legacy of Dr. Plummer, the "diversified genius" of Mayo Clinic’s founding generation and the reason why the Epic project is named for him. It’s not surprising that William J. Mayo, M.D., said hiring Dr. Plummer was "the best day’s work" he ever did.

“It’s both a privilege and awesome responsibility to be engaged in the namesake project that digitizes Dr. Plummer’s vision,” says Kevin Paige, Chair of Practice Operations—Electronic Health Record Oversight.

To learn more, watch the Heritage Film "Forever Looking Forward: The Remarkable Life of Dr. Henry S. Plummer."

Alyssa Frank

Alyssa Frank is a Marketing Segment Manager at Mayo Clinic Laboratories. She leads marketing strategies for product management and specialty testing. Alyssa has worked at Mayo Clinic since 2015.