MU Stage1 Final Rule - Record Demographics (EP)

SECTION #  Section 170.304(c)—Record Demographics

MU OBJECTIVE Record~\Record demographics: • preferred language • gender • race • ethnicity • date of birth

MU STAGE 1 MEASURE More than 50% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demographics Recorded as structured data

CERTIFICATION CRITERION Final Rule Text: §170.304(c). Record demographics. Enable a user to electronically Record, modify, and retrieve patient demographic data including preferred language, gender, race, ethnicity, and date of birth. Enable race and ethnicity to be Recorded in accordance with the standard specified at 170.207(f).

STANDARDS 170.207(f) http://www.whitehouse.gov/omb/fedreg_1997standards/

TEST CRITERIA # §170.304(c) http://healthcare.nist.gov/docs/170.304.c_RecordDemographicsAmb_v1.1.pdf

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At a minimum, the values in following three sections (Race, Ethnicity, Language) must be supported in some way for certification testing.

Race - American Indian or Alaska Native - Asian - Black or African American - Native Hawaiian or Other Pacific Islander - White

(the above race values are mentioned in the NIST test criteria. Peter Bodtke)

Ethnicity: - Hispanic or Latino - Not Hispanic or Latino

(the above ethnicity values are mentioned in the NIST test criteria. Peter Bodtke)

Language: English Japanese French Italian Portuguese Russian

(the above ethnicity values are mentioned in the NIST test criteria. Peter Bodtke)

[Below Nancy Anthracite has noted the inconsistencies between the NIST test criteria demographic values (referenced with a broken link and described as "OMB Standards for Maintaining, Collecting, and Presenting Federal Data") and data provided as part of the Physician Quality Reporting Initiative program.]

Race and ethnicity required for quality reporting has not been harmonized by with the Meaningful use requirements by the Office of the National Coordinator for Health IT. A query regarding this has been sent to the ONC. In general, there has been general movement in the direction of harmonization but this seems to have escaped scrutiny. However, WV learned in general terms on a PQRI related call that efforts are still underway to harmonize Meaningful Use and PQRI.

For now, what WorldVistA has done is to follow the race and ethnicity standards that are specified by Meaningful Use for PQRI as the same entries are duplicated in the extendsive list for the PQRI reporting. Thus, they will be valid entries for PQRI. The information is stored as a pointer in the Race Information field and in the ethnicity information field in the patient file.

1. VistA does not Record preferred language at this point and it will be desirable to pick some sort of reasonable standard list of languages to standardize against across the community of VistA users. Also, to my mind just preferred language is not enough. With requirements for translators to be provided in certain circumstances, it is not enough to know, for instance, if Spanish is the preferred language without knowing if a translator is need and if the patient will provide a translator, so this sounds simple, but it is not so simple.

WV has decided to use the ISO standard http://www.loc.gov/standards/iso639-2/ascii_8bits.html in the language file 0.85. There are also additional enhancements under discussion which may or may not be added by the time of Meaningful Use testing.

Chris Richardson is doing the preliminary work of adding the standard to the file. The work of making it available to select and Record as the preferred language of the patient is pending. Thoughts on the subject and help doing it are welcome.

2. Race and Ethnicity was defined by the ONC for Meaningful Use, but so was quality reporting and the race and ethnicity required for quality reporting is daunting. I am happy to see that race has been expanded to stop using just various Hispanic peoples and not much else, but Recording 900+ of what I would think is not race and ethnicity but ethnicity one and ethnicity two choices with no guidance how to handle those of mixed "race" seems rather ridiculous but even more disturbing, and invasion of privacy. This has been brought to the attention of the ONC but there has been no response to a query about that. In the meantime, you can see what the requirements for Quality Reporting are in the following two lists of race and ethnicity

Race: American Indian or Alaska Native, American Indian, Abenaki, Algonquian, Apache, Chiricahua, Fort Sill Apache, Jicarilla Apache, Lipan Apache, Mescalero Apache, Oklahoma Apache, Payson Apache, San Carlos Apache, White Mountain Apache, Arapaho, Northern Arapaho, Southern Arapaho, Wind River Arapaho, Arikara, Assiniboine, Assiniboine Sioux, Fort Peck Assiniboine Sioux, Bannock, Blackfeet, Brotherton, Burt Lake Band, Caddo, Oklahoma Cado, Cahuilla, Agua Caliente Cahuilla, Augustine, Cabazon, Los Coyotes, Morongo, Santa Rosa Cahuilla, Torres-Martinez, California Tribes, Cahto, Chimariko, Coast Miwok, Digger, Kawaiisu, Kern River, Mattole, Red Wood, Santa Rosa, Takelma, Wappo, Yana, Yuki, Canadian and Latin American Indian, Canadian Indian, Central American Indian, French American Indian, Mexican American Indian, South American Indian, Spanish American Indian, Catawba, Cayuse, Chehalis, Chemakuan, Hoh, Quileute, Chemehuevi, Cherokee, Cherokee Alabama, Cherokees of Northeast Alabama, Cherokees of Southeast Alabama, Eastern Cherokee, Echota Cherokee, Etowah Cherokee, Northern Cherokee, Tuscola, United Keetowah Band of Cherokee, Western Cherokee, Cherokee Shawnee, Cheyenne, Northern Cheyenne, Southern Cheyenne, Cheyenne-Arapaho, Chickahominy, Eastern Chickahominy, Western Chickahominy, Chickasaw, Chinook, Clatsop, Columbia River Chinook, Kathlamet, Upper Chinook, Wakiakum Chinook, Willapa Chinook, Wishram, Chippewa, Bad River, Bay Mills Chippewa, Bois Forte, Burt Lake Chippewa, Fond du Lac, Grand Portage, Grand Traverse Band of Ottawa-Chippewa, Keweenaw, Lac Courte Oreilles, Lac du Flambeau, Lac Vieux Desert Chippewa, Lake Superior, Leech Lake, Little Shell Chippewa, Mille Lacs, Minnesota Chippewa, Ontonagon, Red Cliff Chippewa, Red Lake Chippewa, Saginaw Chippewa, St. Croix Chippewa, Sault Ste. Marie Chippewa, Sokoagon Chippewa, Turtle Mountain, White Earth, Chippewa Cree, Rocky Boy's Chippewa Cree, Chitimacha, Choctaw, Clifton Choctaw, Jena Choctaw, Mississippi Choctaw, Mowa Band of Choctaw, Oklahoma Choctaw, Chumash, Santa Ynez, Clear Lake, Coeur D'Alene, Coharie, Colorado River, Colville, Comanche, Oklahoma Comanche, Coos, Lower Umpqua, Siuslaw, Coos, Coquilles, Costanoan, Coushatta, Alabama Coushatta, Cowlitz, Cree, Creek, Alabama Creek, Alabama Quassarte, Eastern Creek, Eastern Muscogee, Kialegee, Lower Muscogee, Machis Lower Creek Indian, Poarch Band, Principal Creek Indian Nation, Star Clan of Muscogee Creeks, Thlopthlocco, Tuckabachee, Croatan, Crow, Cupeno, Agua Caliente, Delaware, Eastern Delaware, Lenni-Lenape, Munsee, Oklahoma Delaware, Rampough Mountain, Sand Hill, Diegueno, Campo, Capitan Grande, Cuyapaipe, La Posta, Manzanita, Mesa Grande, San Pasqual, Santa Ysabel, Sycuan, Eastern Tribes, Attacapa, Biloxi, Georgetown, Moor, Nansemond, Natchez, Nausu Waiwash, Nipmuc, Paugussett, Pocomoke Acohonock, Southeastern Indians, Susquehanock, Tunica Biloxi, Waccamaw-Siousan, Wicomico, Esselen, Fort Belknap, Fort Berthold, Fort Mcdowell, Fort Hall, Gabrieleno, Grand Ronde, Gros Ventres, Atsina, Haliwa, Hidatsa, Hoopa, Trinity, Whilkut, Hoopa Extension, Houma, Inaja-Cosmit, Iowa, Iowa of Kansas-Nebraska, Iowa of Oklahoma, Iroquois, Cayuga, Mohawk, Oneida, Onondaga, Seneca, Seneca Nation, Seneca-Cayuga, Tonawanda Seneca, Tuscarora, Wyandotte, Juaneno, Kalispel, Karuk, Kaw, Kickapoo, Oklahoma Kickapoo, Texas Kickapoo, Kiowa, Oklahoma Kiowa, Klallam, Jamestown, Lower Elwha, Port Gamble Klallam, Klamath, Konkow, Kootenai, Lassik, Long Island, Matinecock, Montauk, Poospatuck, Setauket, Luiseno, La Jolla, Pala, Pauma, Pechanga, Soboba, Twenty-Nine Palms, Temecula, Lumbee, Lummi, Maidu, Mountain Maidu, Nishinam, Makah, Maliseet, Mandan, Mattaponi, Menominee, Miami, Illinois Miami, Indiana Miami, Oklahoma Miami, Miccosukee, Micmac, Aroostook, Mission Indians, Miwok, Modoc, Mohegan, Mono, Nanticoke, Narragansett, Navajo, Alamo Navajo, Canoncito Navajo, Ramah Navajo, Nez Perce, Nomalaki, Northwest Tribes, Alsea, Celilo, Columbia, Kalapuya, Molala, Talakamish, Tenino, Tillamook, Wenatchee, Yahooskin, Omaha, Oregon Athabaskan, Osage, Otoe-Missouria, Ottawa, Burt Lake Ottawa, Michigan Ottawa, Oklahoma Ottawa, Paiute, Bishop, Bridgeport, Burns Paiute, Cedarville, Fort Bidwell, Fort Independence, Kaibab, Las Vegas, Lone Pine, Lovelock, Malheur Paiute, Moapa, Northern Paiute, Owens Valley, Pyramid Lake, San Juan Southern Paiute, Southern Paiute, Summit Lake, Utu Utu Gwaitu Paiute, Walker River, Yerington Paiute, Pamunkey, Passamaquoddy, Indian Township, Pleasant Point Passamaquoddy, Pawnee, Oklahoma Pawnee, Penobscot, Peoria, Oklahoma Peoria, Pequot, Marshantucket Pequot, Pima, Gila River Pima-Maricopa, Salt River Pima-Maricopa, Piscataway, Pit River, Pomo, Central Pomo, Dry Creek, Eastern Pomo, Kashia, Northern Pomo, Scotts Valley, Stonyford, Sulphur Bank, Ponca, Nebraska Ponca, Oklahoma Ponca, Potawatomi, Citizen Band Potawatomi, Forest County, Hannahville, Huron Potawatomi, Pokagon Potawatomi, Prairie Band, Wisconsin Potawatomi, Powhatan, Pueblo, Acoma, Arizona Tewa, Cochiti, Hopi, Isleta, Jemez, Keres, Laguna, Nambe, Picuris, Piro, Pojoaque, San Felipe, San Ildefonso, San Juan Pueblo, San Juan De, San Juan, Sandia, Santa Ana, Santa Clara, Santo Domingo, Taos, Tesuque, Tewa, Tigua, Zia, Zuni, Puget Sound Salish, Duwamish, Kikiallus, Lower Skagit, Muckleshoot, Nisqually, Nooksack, Port Madison, Puyallup, Samish, Sauk-Suiattle, Skokomish, Skykomish, Snohomish, Snoqualmie, Squaxin Island, Steilacoom, Stillaguamish, Suquamish, Swinomish, Tulalip, Upper Skagit, Quapaw, Quinault, Rappahannock, Reno-Sparks, Round Valley, Sac and Fox, Iowa Sac and Fox, Missouri Sac and Fox, Oklahoma Sac and Fox, Salinan, Salish, Salish and Kootenai, Schaghticoke, Scott Valley, Seminole, Big Cypress, Brighton, Florida Seminole, Hollywood Seminole, Oklahoma Seminole, Serrano, San Manual, Shasta, Shawnee, Absentee Shawnee, Eastern Shawnee, Shinnecock, Shoalwater Bay, Shoshone, Battle Mountain, Duckwater, Elko, Ely, Goshute, Panamint, Ruby Valley, Skull Valley, South Fork Shoshone, Te-Moak Western Shoshone, Timbi-Sha Shoshone, Washakie, Wind River Shoshone, Yomba, Shoshone Paiute, Duck Valley, Fallon, Fort McDermitt, Siletz, Sioux, Blackfoot Sioux, Brule Sioux, Cheyenne River Sioux, Crow Creek Sioux, Dakota Sioux, Flandreau Santee, Fort Peck, Lake Traverse Sioux, Lower Brule Sioux, Lower Sioux, Mdewakanton Sioux, Miniconjou, Oglala Sioux, Pine Ridge Sioux, Pipestone Sioux, Prairie Island Sioux, Prior Lake Sioux, Rosebud Sioux, Sans Arc Sioux, Santee Sioux, Sisseton-Wahpeton, Sisseton Sioux, Spirit Lake Sioux, Standing Rock Sioux, Teton Sioux, Two Kettle Sioux, Upper Sioux, Wahpekute Sioux, Wahpeton Sioux, Wazhaza Sioux, Yankton Sioux, Yanktonai Sioux, Siuslaw, Spokane, Stewart, Stockbridge, Susanville, Tohono O'Odham, Ak-Chin, Gila Bend, San Xavier, Sells, Tolowa, Tonkawa, Tygh, Umatilla, Umpqua, Cow Creek Umpqua, Ute, Allen Canyon, Uintah Ute, Ute Mountain Ute, Wailaki, Walla-Walla, Wampanoag, Gay Head Wampanoag, Mashpee Wampanoag, Warm Springs, Wascopum, Washoe, Alpine, Carson, Dresslerville, Wichita, Wind River, Winnebago, Ho-chunk, Nebraska Winnebago, Winnemucca, Wintun, Wiyot, Table Bluff, Yakama, Yakama Cowlitz, Yaqui, Barrio Libre, Pascua Yaqui, Yavapai Apache, Yokuts, Chukchansi, Tachi, Tule River, Yuchi, Yuman, Cocopah, Havasupai, Hualapai, Maricopa, Mohave, Quechan, Yavapai, Yurok, Coast Yurok, Alaska Native, Alaska Indian, Alaskan Athabascan, Ahtna, Alatna, Alexander, Allakaket, Alanvik, Anvik, Arctic, Beaver, Birch Creek, Cantwell, Chalkyitsik, Chickaloon, Chistochina, Chitina, Circle, Cook Inlet, Copper Center, Copper River, Dot Lake, Doyon, Eagle, Eklutna, Evansville, Fort Yukon, Gakona, Galena, Grayling, Gulkana, Healy Lake, Holy Cross, Hughes, Huslia, Iliamna, Kaltag, Kluti Kaah, Knik, Koyukuk, Lake Minchumina, Lime, Mcgrath, Manley Hot Springs, Mentasta Lake, Minto, Nenana, Nikolai, Ninilchik, Nondalton, Northway, Nulato, Pedro Bay, Rampart, Ruby, Salamatof, Seldovia, Slana, Shageluk, Stevens, Stony River, Takotna, Tanacross, Tanaina, Tanana, Tanana Chiefs, Tazlina, Telida, Tetlin, Tok, Tyonek, Venetie, Wiseman, Southeast Alaska, Tlingit-Haida, Angoon, Central Council of Tlingit and Haida Tribes, Chilkat, Chilkoot, Craig, Douglas, Haida, Hoonah, Hydaburg, Kake, Kasaan, Kenaitze, Ketchikan, Klawock, Pelican, Petersburg, Saxman, Sitka, Tenakee Springs, Tlingit, Wrangell, Yakutat, Tsimshian, Metlakatla, Eskimo, Greenland Eskimo, Inupiat Eskimo, Ambler, Anaktuvuk, Anaktuvuk Pass, Arctic Slope Inupiat, Arctic Slope Corporation, Atqasuk, Barrow, Bering Straits Inupiat, Brevig Mission, Buckland, Chinik, Council, Deering, Elim, Golovin, Inalik Diomede, Inupiaq, Kaktovik, Kawerak, Kiana, Kivalina, Kobuk, Kotzebue, Koyuk, Kwiguk, Mauneluk Inupiat, Nana Inupiat, Noatak, Nome, Noorvik, Nuiqsut, Point Hope, Point Lay, Selawik, Shaktoolik, Shishmaref, Shungnak, Solomon, Teller, Unalakleet, Wainwright, Wales, White Mountain, White Mountain Inupiat, Mary's Igloo, Siberian Eskimo, Gambell, Savoonga, Siberian Yupik, Yupik Eskimo, Akiachak, Akiak, Alakanuk, Aleknagik, Andreafsky, Aniak, Atmautluak, Bethel, Bill Moore's Slough, Bristol Bay Yupik, Calista Yupik, Chefornak, Chevak, Chuathbaluk, Clark's Point, Crooked Creek, Dillingham, Eek, Ekuk, Ekwok, Emmonak, Goodnews Bay, Hooper Bay, Iqurmuit (Russian Mission), Kalskag, Kasigluk, Kipnuk, Koliganek, Kongiganak, Kotlik, Kwethluk, Kwigillingok, Levelock, Lower Kalskag, Manokotak, Marshall, Mekoryuk, Mountain Village, Naknek, Napaumute, Napakiak, Napaskiak, Newhalen, New Stuyahok, Newtok, Nightmute, Nunapitchukv, Oscarville, Pilot Station, Pitkas Point, Platinum, Portage Creek, Quinhagak, Red Devil, St. Michael, Scammon Bay, Sheldon's Point, Sleetmute, Stebbins, Togiak, Toksook, Tulukskak, Tuntutuliak, Tununak, Twin Hills, Georgetown, St. Mary's, Umkumiate, Aleut, Alutiiq Aleut, Tatitlek, Ugashik, Bristol Bay Aleut, Chignik, Chignik Lake, Egegik, Igiugig, Ivanof Bay, King Salmon, Kokhanok, Perryville, Pilot Point, Port Heiden, Chugach Aleut, Chenega, Chugach Corporation, English Bay, Port Graham, Eyak, Koniag Aleut, Akhiok, Agdaagux, Karluk, Kodiak, Larsen Bay, Old Harbor, Ouzinkie, Port Lions, Sugpiaq, Suqpigaq, Unangan Aleut, Akutan, Aleut Corporation, Aleutian, Aleutian Islander, Atka, Belkofski, Chignik Lagoon, King Cove, False Pass, Nelson Lagoon, Nikolski, Pauloff Harbor, Qagan Toyagungin, Qawalangin, St. George, St. Paul, Sand Point, South Naknek, Unalaska, Unga, Asian, Asian Indian, Bangladeshi, Bhutanese, Burmese, Cambodian, Chinese, Taiwanese, Filipino, Hmong, Indonesian, Japanese, Korean, Laotian, Malaysian, Okinawan, Pakistani, Sri Lankan, Thai, Vietnamese, Iwo Jiman, Maldivian, Nepalese, Singaporean, Madagascar, Black or African American, Black, African American, African, Botswanan, Ethiopian, Liberian, Namibian, Nigerian, Zairean, Bahamian, Barbadian, Dominican, Dominica Islander, Haitian, Jamaican, Tobagoan, Trinidadian, West Indian, Native Hawaiian or Other Pacific Islander, Polynesian, Native Hawaiian, Samoan, Tahitian, Tongan, Tokelauan, Micronesian, Guamanian or Chamorro, Guamanian, Chamorro, Mariana Islander, Marshallese, Palauan, Carolinian, Kosraean, Pohnpeian, Saipanese, Kiribati, Chuukese, Yapese, Melanesian, Fijian, Papua New Guinean, Solomon Islander, New Hebrides, White, European, Armenian, English, French, German, Irish, Italian, Polish, Scottish, Middle Eastern or North African, Assyrian, Egyptian, Iranian, Iraqi, Lebanese, Palestinian, Syrian, Afghanistani, Israeili, Arab, Other Race, Other Pacific Islander

Ethnicity:

Hispanic or Latino, Spaniard, Andalusian, Asturian, Castillian, Catalonian, Belearic Islander, Gallego, Valencian, Canarian, Spanish Basque, Mexican, Mexican American, Mexicano, Chicano, La Raza, Mexican American Indian, Central American, Costa Rican, Guatemalan, Honduran, Nicaraguan, Panamanian, Salvadoran, Central American Indian, Canal Zone, South American, Argentinean, Bolivian, Chilean, Colombian, Ecuadorian, Paraguayan, Peruvian, Uruguayan, Venezuelan, South American Indian, Criollo, Latin American, Puerto Rican, Cuban, Dominican, Not Hispanic or Latino

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