Assessing Electronic Health Records for Describing Racial and Ethnic Health Disparities: A Research Note

The use of data derived from electronic health records (EHRs) to describe racial and ethnic health disparities is increasingly common, but there are challenges. While the number of patients covered by EHRs can be quite large, such patients may not be representative of a source population. One way to evaluate the extent of this limitation is by linking EHRs to an external source, in this case with the American Community Survey (ACS). Relying on a stratified random sample of about 200,000 patient records from a large, public, integrated health delivery system in North Carolina (2016-2019), we assess linkages to restricted ACS microdata (2001-2017) by race and ethnicity to understand the strengths and weaknesses of EHR-derived data for describing disparities. The results in this research note suggest that Black-White comparisons will benefit from standard adjustments (e.g., weighting procedures) but that misestimation of health disparities may arise for Hispanic patients because of differential coverage rates for this group.