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CME / ABIM MOC

Ethics, Electronic Health Record Integrity and the Patient-Physician Relationship

  • Authors: Case History by John B. Bundrick, MD; Case Commentary by Daniel T. Kim, MPH, MA, and Thomas A. Bledsoe, MD, FACP
  • CME / ABIM MOC Released: 2/16/2021; Reviewed and Renewed: 2/11/2022
  • Valid for credit through: 2/11/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

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:

  • Describe ethical issues concerning the conflict that sometimes arises between patient advocacy and the need for medical record integrity, according to an ACP ethics case study and commentary
  • Describe ethical issues involved in ensuring that EHRs facilitate patient care, according to an ACP ethics case study and commentary
  • Identify practical steps to help address ethical issues concerning the conflict that sometimes arises between the need for accurate records and the physician-patient relationship, according to an ACP ethics case study and commentary


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author, Case History

  • John B. Bundrick, MD

    Associate Professor
    Mayo Clinic College of Medicine
    Rochester, Minnesota

    Disclosures

    Disclosure: John B. Bundrick, MD, has disclosed no relevant financial relationships.

Authors, Case Commentary

  • Daniel T. Kim, MPH, MA

    PhD Candidate
    University of Chicago
    Chicago, Illinois
    (Former) Senior Associate
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Daniel T. Kim, MPH, MA, has disclosed no relevant financial relationships

  • Thomas A. Bledsoe, MD, FACP

    Clinical Associate Professor of Medicine Alpert Medical School of Brown University
    Brown Medicine
    Brown Physicians, Inc.
    East Providence, Rhode Island

    Disclosures

    Disclosure: Thomas A. Bledsoe, MD, FACP, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor

  • Lois Snyder Sulmasy, JD

    Director
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

CME Reviewer

  • Amy Bernard, MS, BSN, RN-BC, CHCP

    Director
    Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.


The authors would like to thank Paula Katz, staff at the ACP Center for Ethics and Professionalism, for editorial assistance.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

 

    For Physicians

  • The case and commentary were developed by the American College of Physicians.

    Medscape, LLC designates this enduring material for a maximum of 0.25 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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CME / ABIM MOC

Ethics, Electronic Health Record Integrity and the Patient-Physician Relationship

Authors: Case History by John B. Bundrick, MD; Case Commentary by Daniel T. Kim, MPH, MA, and Thomas A. Bledsoe, MD, FACPFaculty and Disclosures

CME / ABIM MOC Released: 2/16/2021; Reviewed and Renewed: 2/11/2022

Valid for credit through: 2/11/2023

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Case History

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?

Table of Contents

  1. Case History
  2. Commentary
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