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 Medjournal_title
Journal of general internal medicineauthors
Sulmasy LS,López AM,Horwitch CA,, American College of Physicians Ethics, Professionalism and Human Rights Committee.doi
10.1007/s11606-017-4030-1subject
Has Abstractpub_date
2017-08-01 00:00:00pages
935-939issue
8eissn
0884-8734issn
1525-1497pii
10.1007/s11606-017-4030-1journal_volume
32pub_type
杂志文章,评审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
更新日期:2006-03-01 00:00:00
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
更新日期:2020-10-19 00:00:00
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
更新日期:2020-03-01 00:00:00
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
更新日期:2005-05-01 00:00:00
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
更新日期:2020-07-01 00:00:00
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
更新日期:2019-10-01 00:00:00
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
更新日期:2014-08-01 00:00:00
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
更新日期:2017-06-01 00:00:00
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
更新日期:2012-03-01 00:00:00
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
更新日期:2020-12-01 00:00:00
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
更新日期:2007-04-01 00:00:00
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
更新日期:2017-07-01 00:00:00
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
更新日期:1998-01-01 00:00:00
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
更新日期:2002-01-01 00:00:00
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
更新日期:2003-11-01 00:00:00
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
更新日期:2015-04-01 00:00:00
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
更新日期:2020-12-01 00:00:00
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
更新日期:2020-11-01 00:00:00
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
更新日期:1989-01-01 00:00:00
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
更新日期:2020-12-01 00:00:00
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
更新日期:2007-12-01 00:00:00
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
更新日期:2007-02-01 00:00:00
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
更新日期:2008-03-01 00:00:00
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
更新日期:2008-02-01 00:00:00
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
更新日期:2005-12-01 00:00:00
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
更新日期:2009-07-01 00:00:00
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
更新日期:2020-03-01 00:00:00
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
更新日期:2000-11-01 00:00:00
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
更新日期:2007-06-01 00:00:00
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
更新日期:1998-03-01 00:00:00