Standardized Disability EHR Documentation Could Boost Health Equity

Standardized EHR documentation of disability status could help drive health equity, according to an article published in HealthAffairs.

In February 2014, the Department of Health and Human Services (HHS) proposed a rule that required EHRs to include the capability to document disability status. The report also proposed seven questions for clinicians to ask patients surrounding disability and sought input on these.

A 2020 study that interviewed patients with disabilities identified that almost all patients preferred for data about their disability to be in the EHR and available to all their care teams.

However, in 2022, there remains significant variability in clinical documentation of disability and accommodations.

Disability data is often absent in EHRs. Other times, the information may be buried in charts or documented in a way that care teams cannot easily reference.

The article called for federal stakeholders to mandate the standardized completion of this information and tie completion to hospital incentives to improve the input of disability data in the EHR. For instance, ONC could include disability in meaningful use criteria for certified EHRs, the author pointed out.

However, a standardized EHR section on disability could perpetuate inaccuracies and assumptions that harm patients if there are not opportunities for patients to engage with it.

“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,” the article noted.

Querying patients on disability in the EHR during clinic visits is just one way to collect this data, the author pointed out. A study found that telephone outreach regarding disability status and accommodations to new patients in an academic medical center via trained staff increased documentation rates by more than 40 percent.

Reliable patient-reported data on patients with disabilities could also create research opportunities to drive health equity, the author emphasized.

“Access to representative information about patients with different disabilities and their comorbidities, social determinants of health, and outcomes would enable health services researchers to combat health disparities in this minority population, which continues to be excluded in research,” they added.

Standardized EHR documentation related to disability and accommodations could also help healthcare organizations support value-based care for persons with disabilities by developing and tailoring quality metrics for this population.

The article noted that after standardizing the incorporation of the disability status of patients into EHRs, it is critical for healthcare stakeholders to communicate these additions to all members of patient care teams.

“Changes in system capabilities will not meaningfully improve disability documentation if healthcare professionals, staff, and trainees are not educated on appropriately documenting information based on their clinical encounters,” the author wrote.