Examination of Stigmatizing Language in the Electronic Health Record

Himmelstein, Gracie; Bates, David W.; Zhou, Li

doi:10.1001/jamanetworkopen.2021.44967

Cited by 104 publications

(66 citation statements)

References 36 publications

(70 reference statements)

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“…Finally, questions remain with respect to how PAEHRs affect the quality of documentation [ 102 ]. In this area, the approach of natural language processing has been increasingly used to quantitatively examine note changes, for example, according to ethnicity and disease chronicity [ 103 ].…”

Section: Discussionmentioning

confidence: 99%

Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review

Hagström¹,

Blease²,

Haage³

et al. 2022

J Med Internet Res

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Background Ongoing efforts worldwide to provide patients with patient-accessible electronic health records (PAEHRs) have led to variability in adolescent and parental access across providers, regions, and countries. There is no compilation of evidence to guide policy decisions in matters such as access age and the extent of parent proxy access. In this paper, we outline our scoping review of different stakeholders’ (including but not limited to end users) views, use, and experiences pertaining to web-based access to electronic health records (EHRs) by children, adolescents, and parents. Objective The aim of this study was to identify, categorize, and summarize knowledge about different stakeholders’ (eg, children and adolescents, parents, health care professionals [HCPs], policy makers, and designers of patient portals or PAEHRs) views, use, and experiences of EHR access for children, adolescents, and parents. Methods A scoping review was conducted according to the Arksey and O’Malley framework. A literature search identified eligible papers that focused on EHR access for children, adolescents, and parents that were published between 2007 and 2021. A number of databases were used to search for literature (PubMed, CINAHL, and PsycINFO). Results The approach resulted in 4817 identified articles and 74 (1.54%) included articles. The papers were predominantly viewpoints based in the United States, and the number of studies on parents was larger than that on adolescents and HCPs combined. First, adolescents and parents without access anticipated low literacy and confidentiality issues; however, adolescents and parents who had accessed their records did not report such concerns. Second, the main issue for HCPs was maintaining adolescent confidentiality. This remained an issue after using PAEHRs for parents, HCPs, and other stakeholders but was not an experienced issue for adolescents. Third, the viewpoints of other stakeholders provided a number of suggestions to mitigate issues. Finally, education is needed for adolescents, parents, and HCPs. Conclusions There is limited research on pediatric PAEHRs, particularly outside the United States, and on adolescents’ experiences with web-based access to their records. These findings could inform the design and implementation of future regulations regarding access to PAEHRs. Further examination is warranted on the experiences of adolescents, parents, and HCPs to improve usability and utility, inform universal principles reducing the current arbitrariness in the child’s age for own and parental access to EHRs among providers worldwide, and ensure that portals are equipped to safely and appropriately manage a wide variety of patient circumstances. International Registered Report Identifier (IRRID) RR2-10.2196/36158

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Section: Discussionmentioning

confidence: 99%

Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review

Hagström¹,

Blease²,

Haage³

et al. 2022

J Med Internet Res

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“…This non-accommodation has been translated into inequities in healthcare practices. For instance, racially dissimilar (e.g., Non-Hispanic White) physicians who are likely experiencing communication through an intergroup (interracial) lens may not recognize situations requiring communication accommodation (e.g., exercising cultural sensitivity during both listening and speaking), which has led to labeling Black-identifying patients as uncooperative [ 44 , 45 ]. Our findings suggest that such implicit biases towards AAE persist to this day and such negative perceptions toward AAE translate into poor evaluation of AAE-speaking HCPs.…”

Section: Discussionmentioning

confidence: 99%

Do they speak like me? Exploring how perceptions of linguistic difference may influence patient perceptions of healthcare providers

Lee

Hutchens

George

et al. 2022

Medical Education Online

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The increased utilization of telehealth has provided patients with the opportunity to interact with racially diverse healthcare providers (HCPs). While evidence of racial stereotypes in healthcare is well documented, less is known about whether linguistic cues increase or decrease racial bias in healthcare interactions. The purpose of this pilot study was to use virtual clinicians (VCs) to examine how varying linguistic features affect patient perceptions of Black-identifying HCPs. Participants ( N = 282) were recruited to participate in an online pilot study using a two-arm posttest-only experimental design. Participants were randomly assigned to interact with a Black VC that used vocal cues associated with either Standard American English (SAE) or African American English (AAE) on the topic of colorectal cancer. After the interaction, participants completed a posttest questionnaire. Resulting data were analyzed using mediation.

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“…A large US based study in three centers found that 11% (n=2411) of patients who accessed their notes felt judged or offended by what they read, which included errors, surprises, forms of labeling, and disrespectful wording. 22 Linguistic analyses of documentation in the US recently found that stigmatizing language was significantly more common in notes written about black patients than notes about white patients, 23 24 and among patients with diagnoses of diabetes, 24 substance abuse disorders, or chronic pain.…”

Section: Risks Of Patients’ Online Access To Their Recordsmentioning

confidence: 99%

Patient empowerment through online access to health records

Hägglund

McMillan

Whittaker

et al. 2022

BMJ

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Examination of Stigmatizing Language in the Electronic Health Record

Abstract: This cross-sectional study analyzes the prevalence of stigmatizing language in the electronic health records at a large academic medical center.

Cited by 104 publications

References 36 publications

Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review

Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review

Do they speak like me? Exploring how perceptions of linguistic difference may influence patient perceptions of healthcare providers

Patient empowerment through online access to health records

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