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Bias In Medical Records Can Affect Patient Care

Posted on June 4, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

In the past, doctors wrote whatever they wanted in their notes, including sarcastic and derogatory comments about the patient, assuming that the comments were no big deal. And largely, they were right, as in prior times, few patients would have asked for those records.

Today, however, such records are becoming increasingly public, particularly through the efforts of the Open Notes project. Not only that, when an EMR connects the health system, such notes may be viewed by many types of professionals, ranging from hospital-based doctors to outpatient physicians, residents to outpatient specialists and more.

But how important is this? Doctors need to reduce tension with a bit of gallows humor, don’t they? Is it worth making the effort to discourage such comments and criticism in the notes? A recent study of physicians in training suggests that it is.

The study, which appears in the Journal of General Internal Medicine, was designed to measure whether patient records serve as a means of transmitting bias from one clinician to another. Specifically, the study was intended to assess whether stigmatizing language written in a patient medical record had an effect on students’ clinical decision-making and attitudes toward the patient.

To tease out this information, the researchers created chart notes, one of which used stigmatizing language in the other neutral language to describe hypothetical patient, a 28-year-old man with sickle-cell disease.

Researchers then surveyed medical students and residents in internal and emergency medicine programs at an urban academic medical center to see how their subjects related to the vignette.

The conclusions drawn by this study should concern everyone in the healthcare business. Researchers found that when the medical students and residents were exposed to stigmatizing language in the notes, the exposure was associated with more negative attitudes toward the patient. Even more concerning, the note using stigmatizing language was associated with less aggressive management of the patient’s pain level.

Addressing this problem is not just an ethical issue, as important as that is on its own. If stigma and bias affect how medical students and residents care for patients, it undermines larger goals of the health system, particularly the need to manage populations effectively, promote patient-centered care and reduce healthcare disparities, it’s a clinical and operational issue as well.

No one is suggesting that it’s possible to squeeze all bias out of the healthcare process. However, it seems reasonable to limit how much of this bias makes it into the chart and influences other providers.

HIMSS Social Media Ambassador Debate: FHIR and Patient Focus

Posted on June 8, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at HIMSS, I had a chance to do a “debate” with my good friend, partner and fellow HIMSS Social Media Ambassador, Shahid Shah. This was facilitated by Healthcare IT News, and the debate was moderated by Beth Jones Sanborn, Managing Editor of Healthcare Finance. Shahid and I had a good debate on the topics of healthcare interoperability and FHIR. Plus, we talked about the need for healthcare IT companies to focus on the patient and whether they deserve the bad rap they get or not. Enjoy the video debate below:
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Data Blocking and other Loch Ness Monsters at #HIMSS16

Posted on March 2, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

A torrent of tweets was unleashed on Day 2 of #HIMSS16. According to Symplur, almost 30,000 tweets were sent with the #HIMSS16 hashtag yesterday.

One tweet was particularly memorable:

The quote comes from John Halamka, CIO of Beth Israel Deaconess Medical Center, who was discussing the controversial act of information blocking – where vendors proactively block the sharing of information health information. John Lynn posted a fantastic summary of information blocking here.

That tweet stuck with me and for the rest of Day 2 at #HIMSS16 I was on the lookout for Loch Ness Monsters – things that get discussed, but are almost never seen.

Loch Ness Monster #2 – Interoperability

A close cousin to information blocking – interoperability has been a popular topic again this year at HIMSS. Many vendors are touting new APIs and tools that help make data exchange easier. The HHS even unveiled plans for several initiatives to pave the way for easier information sharing. However, like in previous years, there is a lot of talk, but very little action when it comes to interoperability.

There is frankly very little financial incentive for vendors and institutions to be open with their data. So until the economics change, interoperability will remain a Loch Ness Monster.

Loch Ness Monster #3 – Gender parity

The #HealthITChicks tweetup led by Jennifer Dennard of HISTalk highlighted the issue of gender inequality in healthcare IT. Dennard and a panel of three respected women leaders discussed the progress-made and the progress-yet-to-be made in terms of women being fully accepted as equals in the industry.

The panel pointed to the results of the annual HIMSS Leadership Survey which were revealed in a morning briefing. A key finding of the survey was gender-based pay inequality – “Evidence from the Compensation Survey, for example, suggest female health IT workers are being marginalized in this sector of the economy. Analyzed several different ways, women consistently earn less than their male counterparts. The findings also suggest females are under-represented in IT-related executive and senior management roles in the health sector.”

So apparently we talk a lot about women being equal, but the it’s simply not something that’s seen.

Loch Ness Monster #4 – Patients

HIMSS is by far the largest healthcare IT conference in North America. It attracts attendees from across the spectrum of healthcare. However, there is one stakeholder that is nearly absent – patients. Every vendor talks about including patients in the design of their products and how they consider themselves to be “patient centered” yet there are only a handful of patient advocates and e-Patients at the conference.

Progress has been made in the past few years in terms of patient scholarships, but more can be done to ensure that the voice of the patient is actually seen/heard at the annual HIMSS conference. It’s time for vendors and health institutions to step up.

Loch Ness Monster #5 – Stable WiFi

In the lunch lines, restroom lines and in the aisles of the Exhibit Hall, #HIMSS16 attendees were all asking each other if they knew of a good place to get a stable WiFi signal. To be fair, WiFi coverage this year has been much better than in years past, but there still plenty of people talking about “If you go over there by the window and just under the escalator you’ll get a strong signal”. On two occasions I want to the exact spot recommended by a fellow attendee – only to be disappointed with a single bar of signal strength. My hotspot has rarely seen this much activity in a single day.

What things have you HEARD at #HIMSS16 but have not actually SEEN?

What Do Patients Need From EMRs?

Posted on November 14, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

As we’ve noted countless times in this space, EMRs aren’t going to get any better unless vendors and doctors communicate freely. But what about catering to the needs of patients.  But given that by Stage 3 of Meaningful Use, EMR data will need to be accessible to and available for comments by patients and caregivers, it’s time patient needs were taken into account.

In that spirit, here’s my list of a few EMR features that might benefit patients and their caregivers. Bear in mind that this is me speaking as a patient and family caregiver, but perhaps that’s a good thing.

Patient data needs

*  Multiple views of the data:  Doctors are used to standardized reports, but patients and their families will still be learning the game.  Patients should be able to do pull data by history, by current status, by lists of drugs, allergies and other key factors affecting current care, as well as by a simple overview similar to patient discharge papers.  It should be possble to pull down these reports into Word, PDF, Excel and other popular formats for re-use.

* Access to contextual data:  Being able to fit data into a larger context is very helpful. As a caregiver, I’d want to know if the pulse ox number my asthmatic son was low relative to other asthma patients, particularly pediatric asthma patients. I’d also want to compare his current number to numbers from the past, preferably in easy-to-read chart form.

* Links to medical information: If I’m reading a report on my care, and I run into medical terminology I don’t recognize, I should be able to pull up a pop-up window and search for the definition of that term. I should also have access to full-length reports on my condition — from validated sources such as WebMD — to give me a broad understanding of my care.

* Ability to comment on data and notes:   While I realize this could become very time-consuming for doctors, it might be worth the trouble to give patients the ability to comment on elements of the data or notes. (A Microsoft Word-style comment function would probably be sufficient.)  To contain the time doctors need to spend, comment functions could be constrained to medical notes and other areas where impressions could be clarified or corrected — rather than the entire EMR data set.

*  Portal:  Portals, of course, are on the way regardless. But I wanted to underscore, as the caregiver to two chronically-ill family members, that accessing data through an organized interface will be a welcome method for skimming key indicators and raising the questions I need to ask doctors.

* Mobile access:  Another obvious one. Patients are as likely to access data on the road as physicians are. Patients need an adequate mobile app which offers a reasonable amount of access to key EMR data on a real-time basis.

Readers, what other types of data access do you think patients and caregivers need to participate effectively in care?