Documenting disability in the EHR can improve quality of care

A recent article in Health Affairs called the electronic health record an “undervalued aid” to improving care and pushed for the standardization of disability documentation structures.

“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, co-founder of the Disability Advocacy Coalition in Medicine, in the room.

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


As Kaundinya notes, the lack of provider training on how to approach patients with disabilities can compromise the quality of care.

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

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

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

“There should also be an ability to document changes in these parameters over time,” she said.

“The standardized structure of the EHR, in addition to facilitating documentation, ensures that we systematically address and accommodate the full range of disabilities that patients may have, including invisible disabilities,” she continued.

It’s also critical, she said, that any additions be communicated to patient care teams, noting that federal policies — such as including disability in criteria for meaningful use of EHRs — tie the Standardized completion to hospital incentives would likely improve data capture.

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

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

Yet, she said, the availability and standardization of literature could enable discussions of assistive technologies or accommodations for individual patients, facilitate value-based care, and create opportunities for research centered on the disability community.

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

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


Advocates and researchers have placed greater emphasis on the role that EHRs can play in care, especially for historically marginalized groups.

For example, a team of computer scientists last October developed an inclusive Health Level 7 logic model, aimed at making clinical systems more accurate.

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

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

A University of Chicago study last month found that black patients were more than 2.5 times more likely to have at least one negative descriptor in their history and physical notes compared to white patients.

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


“In the midst of needed and ongoing reform, all members of the healthcare team who interact with patients with disabilities have the shared experience of referencing their EHRs,” Kaundinya wrote.

“Implementing standard disability documentation in the EHR can thus centralize our efforts to improve our care of patients with disabilities – it will spark regular clinical conversations with all patients about their disability, help us recognize accommodations that patients may need and to invest in them, and to facilitate research that deepens our understanding of the inequalities experienced by patients with disabilities and how to address them,” she said.

Kat Jercich is editor of Healthcare IT News.
Twitter: @kjercich
E-mail: [email protected]
Healthcare IT News is a HIMSS Media publication.

About Antoine L. Cassell

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