Ethical Implications of the Electronic Health Record: In the Service of the Patient.

Abstract:

:Electronic health records (EHRs) provide benefits for patients, physicians, and clinical teams, but also raise ethical questions. Navigating how to provide care in the digital age requires an assessment of the impact of the EHR on patient care and the patient-physician relationship. EHRs should facilitate patient care and, as an essential component of that care, support the patient-physician relationship. Billing, regulatory, research, documentation, and administrative functions determined by the operational requirements of health care systems, payers, and others have resulted in EHRs that are better able to satisfy such external functions than to ensure that patient care needs are met. The profession has a responsibility to identify and address this mismatch. This position paper by the American College of Physicians (ACP) Ethics, Professionalism and Human Rights Committee does not address EHR design, user variability, meaningful use, or coding requirements and other government and payer mandates per se; these issues are discussed in detail in ACP's Clinical Documentation policy. This paper focuses on EHRs and the patient-physician relationship and patient care; patient autonomy, privacy and confidentiality; and professionalism, clinical reasoning and training. It explores emerging ethical challenges and concerns for and raised by physicians across the professional lifespan, whose ongoing input is crucial to the development and use of information technology that truly serves patients.

journal_name

J Gen Intern Med

authors

Sulmasy LS,López AM,Horwitch CA,, American College of Physicians Ethics, Professionalism and Human Rights Committee.

doi

10.1007/s11606-017-4030-1

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

935-939

issue

8

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-017-4030-1

journal_volume

32

pub_type

杂志文章,评审
  • Frequency of mastalgia among women veterans. Association with psychiatric conditions and unexplained pain syndromes.

    abstract:OBJECTIVE:To determine the prevalence and frequency of mastalgia and its association with psychiatric conditions and unexplained pain syndromes. DESIGN, SETTING, AND PARTICIPANTS:Cross-sectional mailed survey completed by 1,219 female veterans enrolled at the VA Puget Sound Health Care System in 1998. MEASUREMENTS:Br...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2006.00378.x

    authors: Johnson KM,Bradley KA,Bush K,Gardella C,Dobie DJ,Laya MB

    更新日期:2006-03-01 00:00:00

  • Machine Learning to Develop and Internally Validate a Predictive Model for Post-operative Delirium in a Prospective, Observational Clinical Cohort Study of Older Surgical Patients.

    abstract:BACKGROUND:Our objective was to assess the performance of machine learning methods to predict post-operative delirium using a prospective clinical cohort. METHODS:We analyzed data from an observational cohort study of 560 older adults (≥ 70 years) without dementia undergoing major elective non-cardiac surgery. Post-op...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06238-7

    authors: Racine AM,Tommet D,D'Aquila ML,Fong TG,Gou Y,Tabloski PA,Metzger ED,Hshieh TT,Schmitt EM,Vasunilashorn SM,Kunze L,Vlassakov K,Abdeen A,Lange J,Earp B,Dickerson BC,Marcantonio ER,Steingrimsson J,Travison TG,Inouye SK

    更新日期:2020-10-19 00:00:00

  • Admission Laboratory Values Accurately Predict In-hospital Mortality: a Retrospective Cohort Study.

    abstract:BACKGROUND:The greater the severity of illness of a patient, the more likely the patient will have a poor hospital outcome. However, hospital-wide severity of illness scores that are simple, widely available, and not diagnosis-specific are still needed. Laboratory tests could potentially be used as an alternative to es...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05282-2

    authors: Blanco N,Leekha S,Magder L,Jackson SS,Tamma PD,Lemkin D,Harris AD

    更新日期:2020-03-01 00:00:00

  • Depression and suicidal behaviors in Medicare primary care patients under age 65.

    abstract:OBJECTIVE:To examine suicidal behavior and depression prevalence among a group of Medicare patients under age 65 with functional impairment and recent significant health care services use. DESIGN:An observational study of baseline characteristics of participants in a randomized controlled trial. SETTING:A Medicare de...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1525-1497.2005.40244.x

    authors: Friedman B,Conwell Y,Delavan RR,Wamsley BR,Eggert GM

    更新日期:2005-05-01 00:00:00

  • Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial.

    abstract:PURPOSE:Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controll...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-05769-3

    authors: Jerant A,Duberstein P,Kravitz RL,Stone DM,Cipri C,Franks P

    更新日期:2020-07-01 00:00:00

  • Understanding Long-Term Cancer Survivors' Preferences for Ongoing Medical Care.

    abstract:BACKGROUND:Due to risk for treatment-related late effects and concerns about cancer recurrence, long-term cancer survivors have unique medical needs. Survivors' preferences for care may influence adherence and care utilization. OBJECTIVE:To describe survivors' preferences for care and factors associated with preferred...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05189-y

    authors: Smith TG,Strollo S,Hu X,Earle CC,Leach CR,Nekhlyudov L

    更新日期:2019-10-01 00:00:00

  • Sexual minority status and violence among HIV infected and at-risk women.

    abstract:IMPORTANCE:Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence. OBJECTIVE:To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV. D...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-014-2832-y

    authors: Pyra M,Weber K,Wilson TE,Cohen J,Murchison L,Goparaju L,Cohen MH

    更新日期:2014-08-01 00:00:00

  • Breast Density Notification Legislation and Breast Cancer Stage at Diagnosis: Early Evidence from the SEER Registry.

    abstract:BACKGROUND:Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. OBJECTIVE:To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DESIGN:Using a difference-in...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3904-y

    authors: Richman I,Asch SM,Bendavid E,Bhattacharya J,Owens DK

    更新日期:2017-06-01 00:00:00

  • Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system.

    abstract:BACKGROUND:Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. OBJECTIVE:To measure patient perceptions about the prevalence...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-011-1760-3

    authors: Grande D,Shea JA,Armstrong K

    更新日期:2012-03-01 00:00:00

  • Association Between Opioid Dose Reduction Against Patients' Wishes and Change in Pain Severity.

    abstract:BACKGROUND:There is inadequate evidence of long-term benefit from opioid medications for chronic pain and substantial evidence of potential harms. For patients, dose reduction may be beneficial when implemented voluntarily and supported by a multidisciplinary team but experts have advised against involuntary opioid red...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06294-z

    authors: Frank JW,Carey E,Nolan C,Hale A,Nugent S,Krebs EE

    更新日期:2020-12-01 00:00:00

  • Risk of cardiovascular events and death--does insurance matter?

    abstract:BACKGROUND:Many Americans lack health insurance. Despite good evidence that lack of insurance compromises access to care, few prospective studies examine its relationship to health outcomes. OBJECTIVE:To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0127-2

    authors: Fowler-Brown A,Corbie-Smith G,Garrett J,Lurie N

    更新日期:2007-04-01 00:00:00

  • Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates.

    abstract:BACKGROUND:Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it. OBJECTIVE:To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates. DESIGN:Observational study....

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-017-4046-6

    authors: Patel MS,Volpp KG,Small DS,Wynne C,Zhu J,Yang L,Honeywell S Jr,Day SC

    更新日期:2017-07-01 00:00:00

  • Clinic HIV-focused features and prevention of Pneumocystis carinii pneumonia.

    abstract:OBJECTIVE:To examine the association of clinic HIV-focused features and advanced HIV care experience with Pneumocystis carinii pneumonia (PCP) prophylaxis and development of PCP as the initial AIDS diagnosis. DESIGN:Nonconcurrent prospective study. SETTING:New York State Medicaid Program. PARTICIPANTS:Medicaid enrol...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1046/j.1525-1497.1998.00003.x

    authors: Turner BJ,Markson L,Cocroft J,Cosler L,Hauck WW

    更新日期:1998-01-01 00:00:00

  • How well do clinicians estimate patients' adherence to combination antiretroviral therapy?

    abstract:OBJECTIVE:Adherence to combination antiretroviral therapy is critical for clinical and virologic success in HIV-infected patients. To combat poor adherence, clinicians must identify nonadherent patients so they can implement interventions. However, little is known about the accuracy of these assessments. We sought to d...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.2002.09004.x

    authors: Miller LG,Liu H,Hays RD,Golin CE,Beck CK,Asch SM,Ma Y,Kaplan AH,Wenger NS

    更新日期:2002-01-01 00:00:00

  • Incidence of venous thromboembolic events among nursing home residents.

    abstract::Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.2003.21133.x

    authors: Gomes JP,Shaheen WH,Truong SV,Brown EF,Beasley BW,Gajewski BJ

    更新日期:2003-11-01 00:00:00

  • Physician burnout: coaching a way out.

    abstract::Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture tha...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-014-3144-y

    authors: Gazelle G,Liebschutz JM,Riess H

    更新日期:2015-04-01 00:00:00

  • Association Between Patients' Self-Reported Gaps in Care Coordination and Preventable Adverse Outcomes: a Cross-Sectional Survey.

    abstract:BACKGROUND:Whether patients' reports of gaps in care coordination reflect clinically significant problems is unclear. OBJECTIVE:To determine any association between patient-reported gaps in care coordination and patient-reported preventable adverse outcomes. DESIGN AND PARTICIPANTS:We administered a cross-sectional s...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06047-y

    authors: Kern LM,Reshetnyak E,Colantonio LD,Muntner PM,Rhodes JD,Casalino LP,Rajan M,Pesko M,Pinheiro LC,Safford MM

    更新日期:2020-12-01 00:00:00

  • Primary Care Practitioners' Barriers to and Experience of COVID-19 Epidemic Control in China: a Qualitative Study.

    abstract:BACKGROUND:The coronavirus disease 2019 (COVID-19) emerged in December 2019 and posed numerous challenges to China's health system. Almost 4 million primary care practitioners (PCPs) participated in controlling the outbreak. However, PCPs' barriers to and experience of the epidemic control remain unknown and are essent...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06107-3

    authors: Xu Z,Ye Y,Wang Y,Qian Y,Pan J,Lu Y,Fang L

    更新日期:2020-11-01 00:00:00

  • AIDS prevention in primary care clinics: testing the market.

    abstract::To assess attitudes toward educational programs about AIDS, 540 patients and 36 of their medical providers in primary care clinics were systematically sampled to ascertain what age groups should be exposed to a pamphlet entitled "Am I at Risk for AIDS?", as well as what was acceptable content for posters and pamphlets...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02596487

    authors: Mathews WC,Linn LS

    更新日期:1989-01-01 00:00:00

  • Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial.

    abstract:BACKGROUND:Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resou...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06007-6

    authors: Matthias MS,Bair MJ,Ofner S,Heisler M,Kukla M,McGuire AB,Adams J,Kempf C,Pierce E,Menen T,McCalley S,Johnson NL,Daggy J

    更新日期:2020-12-01 00:00:00

  • Chronic illness with complexity: implications for performance measurement of optimal glycemic control.

    abstract:OBJECTIVE:To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. PARTICIPANTS:Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fis...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0310-5

    authors: Meduru P,Helmer D,Rajan M,Tseng CL,Pogach L,Sambamoorthi U

    更新日期:2007-12-01 00:00:00

  • Deficiencies in the quality of diabetes care: comparing specialist with generalist care misses the point.

    abstract::The quality of diabetes care delivered to patients falls below the expectations of practice guidelines and clinical trial evidence. Studies in many jurisdictions with varying health care systems have shown that recommended processes of care occur less often than they should; hence, outcomes of care are inadequate. Man...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-006-0027-x

    authors: Shah BR,Hux JE,Laupacis A,Zinman B,Zwarenstein M

    更新日期:2007-02-01 00:00:00

  • Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial.

    abstract:BACKGROUND:Despite advances in pharmacologic therapy and invasive management strategies for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), these patients still suffer substantial morbidity and mortality. OBJECTIVE:The objective of this study was to analyze independent predictors of 1-year ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1007/s11606-007-0498-4

    authors: Mahaffey KW,Yang Q,Pieper KS,Antman EM,White HD,Goodman SG,Cohen M,Kleiman NS,Langer A,Aylward PE,Col JJ,Reist C,Ferguson JJ,Califf RM,SYNERGY Trial Investigators.

    更新日期:2008-03-01 00:00:00

  • The accuracy of clinician perceptions of "usual" blood pressure control.

    abstract:BACKGROUND:The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE:To describe one potential mechanism for clinical inertia, seen through the lens of clini...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-007-0464-1

    authors: Rose AJ,Shimada SL,Rothendler JA,Reisman JI,Glassman PA,Berlowitz DR,Kressin NR

    更新日期:2008-02-01 00:00:00

  • Psychosocial risk factors for adverse outcomes in patients with nonvalvular atrial fibrillation receiving warfarin.

    abstract:OBJECTIVE:Our goal was to establish whether psychosocial risk factors for nonadherence, previously identified as negative predictors of warfarin prescribing, are predictors of adverse events for patients with nonvalvular atrial fibrillation receiving warfarin. DESIGN:Retrospective cohort analysis. SETTING:Ohio Medica...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2005.0242.x

    authors: Schauer DP,Moomaw CJ,Wess M,Webb T,Eckman MH

    更新日期:2005-12-01 00:00:00

  • Developing physician-leaders: a call to action.

    abstract:BACKGROUND:The many challenges in health care today create a special need for great leadership. However, traditional criteria for physicians' advancement to leadership positions often regard academic and/or clinical accomplishments rather than the distinctive competencies needed to lead. Furthermore, physicians' traini...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-009-1007-8

    authors: Stoller JK

    更新日期:2009-07-01 00:00:00

  • Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study.

    abstract:BACKGROUND:Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. OBJECTIVE:To measure the association between physician-hosp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05312-z

    authors: Ho V,Metcalfe L,Vu L,Short M,Morrow R

    更新日期:2020-03-01 00:00:00

  • Measuring compliance with preventive care guidelines: standardized patients, clinical vignettes, and the medical record.

    abstract:OBJECTIVE:To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence. DESIGN:Scoring criteria based on national guidelines were developed for 7 separate items of preventive care. The preventive care provided by randomly selected physicians was measured p...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1046/j.1525-1497.2000.91007.x

    authors: Dresselhaus TR,Peabody JW,Lee M,Wang MM,Luck J

    更新日期:2000-11-01 00:00:00

  • Effects of paying physicians based on their relative performance for quality.

    abstract:BACKGROUND:Studies examining the effectiveness of pay-for-performance programs to improve quality of care primarily have been confined to bonus-type arrangements that reward providers for performance above a predetermined threshold. No studies to date have evaluated programs placing providers at financial risk for perf...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0185-5

    authors: Young GJ,Meterko M,Beckman H,Baker E,White B,Sautter KM,Greene R,Curtin K,Bokhour BG,Berlowitz D,Burgess JF Jr

    更新日期:2007-06-01 00:00:00

  • A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts.

    abstract:OBJECTIVE:To compare physicians' and their patients' attitudes toward pharmaceutical gifts. DESIGN:Survey of physicians and their patients. SETTING:Two tertiary-care medical centers, one military and one civilian. PARTICIPANTS:Two hundred sixty-eight of 392 consecutively surveyed physicians, 100 of 103 randomly sele...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1998.00048.x

    authors: Gibbons RV,Landry FJ,Blouch DL,Jones DL,Williams FK,Lucey CR,Kroenke K

    更新日期:1998-03-01 00:00:00