Becker's Hospital Review

59 CIO / HEALTH IT 'Stigmatizing' language in EHRs may negatively affect patient care for years By Jessica Kim Cohen I ncluding nonessential, "stigmatizing" notes in a patient's health record may lead them to receive inadequate care in the future, according to a study out of Balti- more-based Johns Hopkins University School of Medicine and published in the Journal of General Internal Medicine. For the study, the researchers developed a series of chart notes, half of which employed "neutral language," and half of which em- ployed "stigmatizing" language. e research- ers enrolled 413 medical students and internal and emergency medicine residents to review these notes and suggest next steps, in an effort to assess whether stigmatizing language affect- ed providers' attitudes toward patients. All of the notes contained identical medical information about the same hypothetical pa- tient — a 28-year-old African American man with sickle cell disease. In the "neutral" and "stigmatizing" vignettes, the patient visits a hospital's emergency department with a va- so-occlusive crisis, a painful condition com- mon among patients with sickle cell disease. In one example, the researchers provided se- lect study participants with the observation, "He has about 8-10 pain crises a year, for which he typically requires opioid pain medi- cation in the ED." Other participants received a note with "nonessential" language that im- plied various value judgments, according to the researchers, such as, "He is narcotic de- pendent and in our ED frequently." e researchers found notes with stigmatizing language not only led participants to have a more negative attitude toward the hypothetical patient, but also affected their treatment plans. Physicians-in-training who read the stigma- tizing chart notes were more likely to treat the patient's pain less aggressively, even if they rec- ognized the language as stigmatizing. "is record may be the only source of in- formation a new clinician has about some patients," Mary Catherine Beach, MD, senior author and a professor in the department of medicine at the Johns Hopkins University School of Medicine, said in a May 9 state- ment. "We have to question the assumption that the medical record always represents an objective space." e researchers argued clinician bias that seeps into a patient's chart notes may affect subsequent medical care for years, contribut- ing to long-term healthcare disparities. "is is an important and overlooked path- way by which bias can be propagated from one clinician to another," the study authors concluded. "Attention to the language used in medical records may help to promote pa- tient-centered care and to reduce healthcare disparities for stigmatized populations." n 1 in 3 healthcare organizations have suffered a cyberattack, 1 in 10 paid ransom: 6 things to know By Julie Spitzer T he vast majority (77 percent) of healthcare IT pro- fessionals are very concerned about a cyberattack striking their organization, according to a recent sur- vey commissioned by Imperva, a cybersecurity firm. The survey asked 102 health IT leaders at the 2018 Health- care Information and Management Systems Society Con- ference in March about their fears, concerns and plans for cybersecurity. Here are six survey insights: 1. Thirty-eight percent of respondents said their organiza- tions suffered a cyberattack in the past year. 2. Nearly one in 10 organizations have paid a ransom or extortion fee after a cyberattack in the past year. 3. Just 32 percent of respondents feel their organization's ability to handle a cyberattack is "adequate," and 33 per- cent said it is "above average." Six percent admitted the organization's cybersecurity plan "needs an overhaul." 4. Respondents are most concerned about ransomware (32 percent), insider threats (25 percent) and compro- mised applications (19 percent). 5. Most respondents (73 percent) indicated their organiza- tion employs a senior information security leader or chief information security officer, and 14 percent said their orga- nization is planning to hire one in the next 12 months. 6. Here is what respondents said makes detecting threats so difficult: • A lack of tools to monitor employee and other insid- ers' activities (27 percent) • A lack of staff to analyze permissions data on employ- ee access (25 percent) • More company assets stored on the network or cloud (24 percent) • More employees, contractors, business partners have access to our network (24 percent) n

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