Racial Disparity in Clinical Alert Overrides

The existence of systemic racism in US health care is widely recognized, but the role that informatics plays has received little attention. Clinical guidelines, which can incorporate implicit racial bias or be adhered to in racially disparate ways, are often the basis for clinical alerting systems. It is also possible that clinicians might be discriminatory in their response to alerts (for example, by deciding whether to agree or override the alert). We sought to study whether alert logic in our hospital uses patient race as part of its criteria and if alert override rates show any racial disparities. We obtained data on 5,120,114 alert events at the University of Alabama at Birmingham (UAB) Hospital and examined override the rates and reasons with respect to patient race. We found override rates of 82.27% and 81.30% for Black or African American patients and White patients, respectively. Some differences by alert were statistically significant but generally small. Override patterns varied by clinician but reasons given were generally not disparate, suggesting that if racist behavior is present, it is not widely systemic. However, the great variability in individual clinician behavior suggests that deeper analysis is warranted to determine whether disparities are indeed racist in nature.