The Role of Decision Support Systems in Attenuating Racial Biases in Healthcare Delivery

Abstract

Although significant research has examined how technology can intensify racial and other outgroup biases, limited work has investigated the role information systems can play in abating them. Racial biases are particularly worrisome in healthcare, where underrepresented minorities suffer disparities in access to care, quality of care, and clinical outcomes. In this paper, we examine the role clinical decision support systems play in attenuating systematic biases among black patients, relative to white patients, in rates of amputation and revascularization stemming from diabetes mellitus. Using a panel of inpatient data from three states, and a difference in difference approach, results suggest that the adoption of the clinical decision support systems significantly shrinks disparities in the amputation rate across white and black patients; with no evidence that the increased revascularization is simply delaying eventual amputations. Further, evidence indicates that this effect is driven by changes in treatment care protocols, rather than altering within physician decision-making. These findings highlight the role information systems and digitized patient care can play in promoting unbiased decision making by structuring and standardizing care procedures.

Keywords: Healthcare Bias, Racial Bias, Electronic Health Records, Clinical Decision Support Systems, Amputation, Protocols