Disability documentation in the EHR can improve care quality

By Kat Jercich ofr Healthcare IT News

A recent article in Health Affairs called the electronic health record an “underrated medium” for improving care and pushed for the standardization of structures for documenting disabilities.

“In medical school, we spend a lot of time learning how to take a patient’s medical history. We practice asking specifically worded questions in a structured way to develop ‘muscle memory’ and allow us to focus on the nuanced content of our conversations,” wrote Trisha Kaundinya, the cofounder of the Disability Advocacy Coalition in Medicine, in the piece.

“But many of us do not learn how to ask patients about disability, whether it affects their daily lives, and what accommodations they need to optimize communication and quality of life,” Kaundinya continued.

WHY IT MATTERS

As Kaundinya notes, a lack of provider training about how to approach patients with disabilities may compromise quality of care.

With that in mind, she proposes a range of strategies, including implementing EHR standardizations to record disability and accommodations.

“EHRs should be required to contain structure to document a patient’s type of disability, history of disability, accommodations required in the healthcare setting, autonomy in activities of daily living, and preferred language surrounding disability,” she wrote.

The information, she said, should come from patients themselves.

“There should also be a capacity to document changes in these metrics over time,” she said.

“Standardized EHR structure, in addition to facilitating documentation, ensures that we consistently address and accommodate the full spectrum of disabilities that patients may have, including disabilities that are invisible,” she continued.

It is also vital, she said, for any additions to be communicated to patient care teams, noting that federal policies – such as including disability in meaningful use criteria for EHRs – tying standardized completion to hospital incentives would likely improve data input.

At the same time, Kaundinya acknowledges that a standardized EHR section on disability can potentially reinforce harmful inaccuracies.

“We should appraise the section of disability status in a patient’s EHR as we do all sections of a thorough history – each is a fluid and important element of the patient’s identity that requires prime screen space and time for active patient-clinician discussion in the health record and clinical encounter, respectively,” she said.

Still, she said, documentation availability and standardization could enable discussions about assistive technologies or accommodations for individual patients, facilitate value-based care and create research opportunities centering the disability community.

“Our commitment in medicine to providing equitable and high-quality care to patients with disabilities requires reform in multiple sectors, from educational curricula to bias training to public health,” she wrote.

“Ableism and the explicit prioritization of certain types of bodies and minds over others are roadblocks to progress in these sectors,” she added.

THE LARGER TREND

Advocates and researchers have put increased focus on the role EHRs can play in care, particularly for historically marginalized groups.

For instance, a team of informaticists this past October developed a gender-inclusive Health Level Seven logical model, aimed at making clinical systems more accurate.

“The incorporation of expanded sex and gender data in clinical decision support tools and algorithms should enable clinicians to accurately document clinical findings and provide service offerings based on measurable data,” said the experts.

At the same time, as Kaundinya noted, the EHR can also be a site of bias.

A University of Chicago study from this past month found that Black patients had more than 2.5 times the odds of having at least one negative descriptor in their histories and physical notes when compared with white patients.

“It is … plausible that if a provider with implicit biases were to document a patient encounter with stigmatizing language, the note may influence the perceptions and decisions of other members of the care team, irrespective of the other team members’ biases or lack thereof,” said the research team.

ON THE RECORD

“Amidst necessary and ongoing reform, all members of the health care team who interface with patients with disabilities have the shared experience of referencing their EHRs,” wrote Kaundinya.

“Implementing standard documentation of disability in the EHR can thus centralize our efforts to better our care for patients with disabilities. It will prompt regular clinical conversations with all patients about their disabilities, help us recognize what accommodations patients may need and invest in these, and facilitate research that furthers our understanding of inequities experienced by patients with disabilities and how to address them,” she said.