How the Electronic Health Record Can Reveal Unconscious Racism

F. Perry Wilson, MD MSCE
4 min readOct 11, 2023

Every click you make, it is watching you…

When I close my eyes and imagine what it is I do for a living, I see a computer screen.

I mean, yes, I’m primarily a clinical researcher so much of what I do is looking at statistical software, or, more recently, writing grant applications. But even when I think of my clinical duties, I see that computer screen.

Source: My EHR (Epic)

The reason? The electronic health record — the hot beating heart of medical care in the modern era. Our most powerful tool and our greatest enemy.

The EHR records everything — not just the vital signs and lab values of our patients. Not just our notes and billing codes. Everything — every interaction we have is tracked and can be analyzed. The EHR is basically Sting in “Every Breath You Take”. Every click you make it is watching you.

Researchers are leveraging that panopticon to give insight into something we don’t talk about frequently, the issue of racial bias in medicine. Is our true nature revealed by our interactions with the electronic health record?

We’re talking about this study appearing in JAMA Network Open.

Researchers leveraged huge amounts of EHR data from two big academic medical centers — Vanderbilt University Medical Center and Northwestern University Medical Center. All told, there is data from nearly 250,000 hospitalizations here.

The researchers created a metric for EHR engagement. Basically, they summed the total amount of clicks and other EHR interactions that occurred during the hospitalization and divided by the length of stay in days to create a sort of average “engagement per day” metric. This number was categorized into four groups — think low engagement, medium engagement, high, and very high engagement.



F. Perry Wilson, MD MSCE

Medicine, science, statistics. Associate Professor of Medicine and Public Health at Yale. New book “How Medicine Works and When it Doesn’t” available now.