Checking the EMR

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drjchill

Checking the EMR

Post by drjchill » Wed Jul 08, 2015 1:21 pm

Do my fellow examiners “acquire” consent to check a driver's electronic medical record (EMR) when doing a FMCSA exam? I was curious how one acquires “test results” (sleep studies, cardiac testing, HgA1c results etc). If I recall correctly Dr. Hartenbaum suggested in a lecture that we should be checking EMR's if available.



Robert Swotinsky MD
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Re: Checking the EMR

Post by Robert Swotinsky MD » Thu Jul 09, 2015 2:28 pm

When doing a DOT physical, the medical examiner is acting under authority of the FMCSA. That authority does not allow for access to a patient's personal health records without the patient's consent. If the medical examiner believes a sleep study, hemoglobin A1c, or other information necessary to complete the assessment, the medical examiner needs the examinee's consent to get that information. If the examinee does not consent, the medical examiner will likely be unable to find the examinee qualified.

drjchill

Re: Checking the EMR

Post by drjchill » Mon Jul 13, 2015 8:21 am

That is what I thought. Thanks.

lstudt
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Re: Checking the EMR

Post by lstudt » Mon May 24, 2021 2:07 pm

We are having a debate in our department about this very topic. Some in our dept want each driver to sign a release before there DOT exam so we can review their chart. If they do not sign, they are considering not performing the exam due to suspicion of an underlying condition. I don't think this is correct. The physician leading the charge says that Dr. Hartenbaum says we should canvas records to make sure they are telling the truth. I don't disagree that we want to be safe but the line needs to be drawn somewhere. We are providers, not the police.

If we have them sign a release to what we can see, would we need to see records from past providers too?

Any thoughts much appreciated.

Thank you.

Robert Swotinsky MD
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Re: Checking the EMR

Post by Robert Swotinsky MD » Tue May 25, 2021 1:06 pm

"We are having a debate in our department about this very topic. Some in our dept want each driver to sign a release before there DOT exam so we can review their chart. If they do not sign, they are considering not performing the exam due to suspicion of an underlying condition."
I'm unaware of data to support a presumption that not signing over the records is evidence of an underlying condition. There are likely both medical and nonmedical reasons why someone would not sign over their personal health record to the DOT medical examiner. The medical examiner may suspect the driver is trying to conceal a medically disqualifying condition. But, the medical examiner may be wrong. "Suspicion" is not a disqualifying condition from driving a truck.

Also, there's nothing in the regulations or guidelines to support this practice, nor is it a standard (common) practice. If an examiner disqualifies someone based on the examinee's refusal to sign over their personal records, it's not clear that the examiner would prevail in asserting (for example) that it's up to the medical examiner and this is how he/she does things.

On the other hand, by all means, get records if there is a specific concern triggering this request. And, if you see something unrelated but important while reviewing those records, you''ll have to deal with it because you can't "unsee" it.

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