Clinicians’ EHR Descriptions Reveal Racial Bias

African American patients had 2.54 times the adjusted odds of having one or more negative descriptors in their Electronic Health Record compared to White patients, according to a recent study by Health Affairs.

The study examines medical providers’ use of negative patient descriptors in EHRs and investigates whether the use of these terms varied by patient race and ethnicity due to little information on how bias and racism may be communicated by health providers in the EHR.

In the study, patients with government insurance and those unmarried were found to have higher adjusted odds of negative descriptors compared with patients who had private or employer-based insurance and patients who were married.

In addition, notes written after the beginning of the COVID-19 pandemic were associated with decreased odds of having a negative descriptor in the EHR.

To obtain findings, the Health Affairs authors reviewed EHRs from one urban academic medical center for January 1, 2019–October 1, 2020. According to their knowledge, there is no other study to date that uses a quantitative approach to specifically examine differences in providers’ use of negative patient descriptors by race or ethnicity in the context of real-world medical notes.

“Our findings suggest disproportionate use of negative patient descriptors for Black patients compared with their White counterparts, which raises concerns about racial bias and possible transmission of stigma in the medical record,” authors of the study share. “Such bias has the potential to stigmatize Black patients and possibly compromise their care, raising concerns about systemic racism in healthcare.”

However, a tool that can benefit patients and avoid bias further on is adopting healthcare imaging within EHRs.

In a previous interview with Managed Healthcare Executive, Art Papier, practicing dermatologist, professor of dermatology at University of Rochester and CEO of VisualDx, a platform collecting thousands of images for EHRs, said these images have helped healthcare providers in avoiding racial bias that, "unfortunately, many clinicians unconsiously make poor decisions on."

Images in EHRs allow physicians to see a wide range of diseases and a wide range of skin types.

For example, the way a common disease may look in a lighter skin color can be very different than a darker skin color.

In the same interview with MHE, Nada Elbuluk, dermatologist in Los Angeles and Director of Clinical Impact for VisualDx, said if a clinician hasn't been trained to see that particular disease in darker skin type, they may miss diagnose it or under treat. She added this can lead to many consequences downstream from not having that appropriate training.

In terms of overcoming cognitive bias, there's two ways to think, Papier said - one is fast, which is through pattern recognition, and the other is slow through analytical thinking.

Nada added there is a significant patient engagement component of imaging and EHRs. This component has positive downstream consequences for improving relationships between the patient and physician.

"It can translate into increased patient compliance and trust between the physician and provider, which ultimately leads to improved healthcare outcomes, which is really the ultimate goal that we all want in medicine," she said. "So it seems like maybe a small feature, but it actually is really powerful."