Behavioral health experts say EHR 'frequent flier' icon is unacceptable

EHR patient

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Healthcare technologies should be designed to encourage respectful interactions between physicians and patients, not to further potentially harmful biases, according to a viewpoint in the Journal of the American Medical Association.

The article, by authors from the University of Pennsylvania psychiatry department and Thomas Scattergood Behavioral Health Foundation in Philadelphia, refers to an electronic health record system that allows clinicians to attach an airplane icon to a patient’s medical record indicating he or she is a “frequent flyer.”

These patients often have mental health problems and medical conditions, such as cardiovascular disease or diabetes, as well as non-medical problems concerning lack of housing and food insecurity.

In many cases, these patients’ psychiatric conditions overshadow their medical issues--research has shown they’re less likely to receive needed medical treatment for chronic illnesses--and it could prompt disrespectful behavior from staff. 

Seeing such an icon also might bias the clinician’s judgment about how to treat this patient, the authors add.

At the same time, the patient’s history of high healthcare utilization should be available, they say. These patients require a deeper understanding of their history, and such an icon might discourage that and instead elicit negative assumptions about the person.

All systems reflect those who build them, they say, but they need to be built and tested with patients, physicians, social scientists and others who understand the ramifications of the words and pictures used to avoid reinforcing unproductive biases.