Differences in Health Professionals’ Engagement With Electronic Health Records Based on Inpatient Race and Ethnicity

Abstract

ImportanceUS health professionals devote a large amount of effort to engaging with patients’ electronic health records (EHRs) to deliver care. It is unknown whether patients with different racial and ethnic backgrounds receive equal EHR engagement.ObjectiveTo investigate whether there are differences in the level of health professionals’ EHR engagement for hospitalized patients according to race or ethnicity during inpatient care.Design, Setting, and ParticipantsThis cross-sectional study analyzed EHR access log data from 2 major medical institutions, Vanderbilt University Medical Center (VUMC) and Northwestern Medicine (NW Medicine), over a 3-year period from January 1, 2018, to December 31, 2020. The study included all adult patients (aged ≥18 years) who were discharged alive after hospitalization for at least 24 hours. The data were analyzed between August 15, 2022, and March 15, 2023.ExposuresThe actions of health professionals in each patient’s EHR were based on EHR access log data. Covariates included patients’ demographic information, socioeconomic characteristics, and comorbidities.Main Outcomes and MeasuresThe primary outcome was the quantity of EHR engagement, as defined by the average number of EHR actions performed by health professionals within a patient’s EHR per hour during the patient’s hospital stay. Proportional odds logistic regression was applied based on outcome quartiles.ResultsA total of 243 416 adult patients were included from VUMC (mean [SD] age, 51.7 [19.2] years; 54.9% female and 45.1% male; 14.8% Black, 4.9% Hispanic, 77.7% White, and 2.6% other races and ethnicities) and NW Medicine (mean [SD] age, 52.8 [20.6] years; 65.2% female and 34.8% male; 11.7% Black, 12.1% Hispanic, 69.2% White, and 7.0% other races and ethnicities). When combining Black, Hispanic, or other race and ethnicity patients into 1 group, these patients were significantly less likely to receive a higher amount of EHR engagement compared with White patients (adjusted odds ratios, 0.86 [95% CI, 0.83-0.88; P < .001] for VUMC and 0.90 [95% CI, 0.88-0.92; P < .001] for NW Medicine). However, a reduction in this difference was observed from 2018 to 2020.Conclusions and RelevanceIn this cross-sectional study of inpatient EHR engagement, the findings highlight differences in how health professionals distribute their efforts to patients’ EHRs, as well as a method to measure these differences. Further investigations are needed to determine whether and how EHR engagement differences are correlated with health care outcomes.

Returning personalized, genetic health test results to individuals of African descent or ancestry in precision medicine research

“… 24 In addition, even when genetic conditions are identified in patients of African descent, they may be at risk of receiving care that is inferior to the care received by patients of European descent because of systemic biases that presently exist in health care settings. 10 , 25 , 26 Materials that proactively address these complications should be disseminated through NIH-supported communication routes to help members of the African-American community fully understand the intent and processes for the return of results. The All of Us program may benefit African Americans by engaging in the development of community-driven solutions that address challenges.…”

“… 7-9 In addition, genetic testing typically provides less utility for individuals of African descent/ancestry, providing molecular explanations for disease less often, perhaps partially due to health system factors that may include, but not be limited to, low clinician electronic health record engagement for historically marginalized groups and thus lesser amounts of phenotype data that are required to accurately interpret the genetic basis of disease among such groups. 10 Moreover, as data on the influence of pharmacogenetic variants in individuals of African descent/ancestry emerge, it is unclear whether pharmacogenetic research reports provided to such individuals are consistent across genetic research programs to help address health disparities.…”

Enhanced Patient Portal Engagement Associated with Improved Weight Loss Outcomes in Post-Bariatric Surgery Patients

“…We extracted patient portal engagement history from MHAV event logs, which record every action taken by system users through provided interfaces. [19][20][21][22][23][24] These included unique patient identifiers, event timestamps, and event types. For each patient, we focused on the timeframe starting from day 5 post-surgerytypically regarded as the commencement of the post-discharge phase-up to 12 months postoperative.…”

A Window Into Inpatient Health Care Delivery Through Secure Message Logs—Tracing the Latest Breadcrumbs of the Electronic Health Record

“…The study by Small et al adds to a growing body of literature that leverages data from EHRs to understand patterns of clinician interactions with the EHR in outpatient and inpatient settings, as well as how that time is associated with outcomes for patients . While prior work has highlighted clinicians interactions with a diversity of EHR functions, the study by Small et al focused specifically on communication among team members.…”

“…There are known differential health care outcomes for racially and ethnically minoritized patients, such as eg Black or Hispanic patients, cared for in the hospital setting . The mechanisms for these differences are not well understood, and a study by Yan et al previously described that minoritized racial and ethnic groups at 2 academic medical centers were less likely to have high levels of engagement with their EHRs than White patients. In contrast, hospitalized patients of female physicians have been shown to have better outcomes, with the mechanisms for these differences also inadequately characterized .…”