Tuesday, December 5, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
This article is intended for physicians, healthcare system administrators, electronic health record (EHR) vendors, and other professionals involved in use of EHRs.
The goal of this activity is to describe ethical issues concerning the conflict that sometimes arises between the need for EHR integrity and the patient-physician relationship, according to an American College of Physicians (ACP) ethics case study and commentary.
Upon completion of this activity, participants will:
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The case and commentary were developed by the American College of Physicians.
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AMA PRA Category 1 Credit(s)™
. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
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and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
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CME / ABIM MOC Released: 2/16/2021; Reviewed and Renewed: 2/6/2023
Valid for credit through: 2/6/2024, 11:59 PM EST
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Dr Robins is an internist at HS Health Systems, which has recently implemented a new electronic health record (EHR) system. Mr Collins, 66, was her final patient today, and he has just left. Dr Robins is now trying to complete orders and close her notes on the visit so that she can go home.
During the visit, the patient had noted increased fatigue, for which history and examination disclosed no obvious cause. He also had noted the more frequent occurrence of restless legs over the past few months. Dr Robins observed that his hemoglobin and mean corpuscular volume were just at the lower limits of the normal range and had strongly considered a diagnosis of iron deficiency. The patient had to leave to catch a bus, so she planned to order a serum ferritin to be performed the following week. As the patient did not meet the qualifications for a diagnosis of anemia or microcytosis, she tried associating both "fatigue" and "restless legs syndrome" to the serum ferritin in the EHR. Each time, she received a pop-up message on the screen that gave her a choice of printing out an Advance Beneficiary Notice or selecting from a list of covered diagnoses. Aware of Mr Collins' limited finances, she searched the list and found that "anemia" was the only diagnosis that would be a covered indication for the test. She associated this diagnosis and ordered the ferritin.
A few days later, the patient required a dental procedure, and his dentist’s office requested that he provide a copy of his recent medical records. Dr Robins' office provided him with an "After-Visit Summary," including the diagnosis of anemia. When he gave the summary to his dentist on the day of the procedure, that diagnosis resulted in a cancellation of the procedure for further evaluation. Mr Collins was confused because Dr Robins had not mentioned that he was anemic.
Although her decision was in some ways helpful to the patient because it paid for a useful test that he may have otherwise decided to decline, what are the implications for his care, the patient-physician relationship, and the integrity and clarity of the medical record?
