Patients who are Black, unmarried or on government insurance described more negatively in EHR, study shows

The language clinicians use in their EHR notes varies by patients' race, marital status and type of insurance, according to a study published Jan. 19 in Health Affairs

Researchers from the ​​University of Chicago analyzed 40,113 EHR notes recorded between January 2019 and October 2020 for 18,459 adult patients. The research team searched for sentences containing a negative descriptor for the patients' behavior, such as "resistant" or "noncompliant."

The study found Black patients were 2.54 times more likely to have one or more negative descriptors in their EHR notes than white patients. It also found patients who are unmarried or enrolled in a government insurance program had higher likelihoods of negative descriptors than patients who were married or enrolled in private or employer-based insurance plans.

The researchers concluded that EHR notes written after the COVID-19 pandemic began had fewer negative descriptors. They said the social pressures ignited during summer 2020, when protests against institutionalized racism were prolific, may have "sensitized providers to racism and increased empathy for the experiences of racially minoritized communities," but added that more research is needed.

The study's authors said their findings raise concerns about racial bias in healthcare and the possible transmission of stigma through the EHR. They said providers may need self-awareness and bias training to change their language.

Read the full study here.

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