Pritzker M3's Study Finds Racial Bias in EHRs

Findings of a study by a Pritzker student published Wednesday showed racial bias in the way doctors described Black patients and white patients in electronic health records.

The study in Health Affairs was the work of third-year Pritzker student Michael Sun and found via an analysis of more than 40,000 electronic health records that Black patients had 2.54 times the odds of white patients of having at least one "negative patient descriptor" in the history and physical notes. The study drew the attention of STAT, which published a story about it on Wednesday. Sun is also set to appear on a Health Affairs podcast soon to discuss the study, on which he worked with Dr. Tomasz Oliwa, Dr. Monica E. Peek, and Dr. Elizabeth L. Tung. 

The study examined a trove of medical records of more than 18,000 patients receiving care in Chicago between January 2019 and October 2020, looking for instances of a "negative descriptor" of patient behavior. Potentially stigmatizing words like "agitated," "noncompliant," and "challenging" were more than two and half times more likely to appear in the records of Black patients than white patients, leading the researchers to conclude "our findings raise concerns about racial bias and possible transmission of stigma in the medical record." The study also found the records of patients with Medicaid had higher odds of containing a negative descriptor than patients with private or employer-based insurance.

Sun told STAT the findings of the study, unfortunately, did not come as a surprise. They are consistent, STAT pointed out, with a recent survey that found more than 10 percent of Black patients reported experiencing discrimination or unfair treatment in a health care setting within the last year. One of the primary concerns with such a trend is "transmission of stigma," wherein a new care provider reads the negative descriptor in a patient's medical history and allows it to impact their approach to treating the patient.

Of note, the study also found separately that records written after the start of the COVID-19 pandemic were associated with decreased odds of containing a negative descriptor. The researchers had expected the opposite, believing the stress of a pandemic could lead to more negative descriptors, but they concluded that the national response to "racialized state violence" such as the police murder of George Floyd and racial disparities in COVID-19 outcomes "may have sensitized providers to racism and increased empathy for the experiences of racially minoritized communities."