This column addresses a specific meaningful use requirement each month, looking at how it connects to health care quality priorities and previewing possible updates to the measure in future stages of meaningful use. 

Background:  

Data on disparities of care, especially in areas with a very diverse population and/or specific population health indicators, are critical for the government in its effort to address those disparities and improve the health care system for all Americans. The specific race and ethnicity codes should follow the current federal standards published by the Office of Management and Budget (OMB). Although the rule requires that all the listed demographic elements be captured for each unique patient, it is certainly within the patient's right to decline to answer or not know the information. Such refusal or lack of knowledge need only to be captured as structured data. Preferred language captures a patient preference only; there is no requirement for the provider to actually communicate to the patient in that preferred language.

Stage 2 Proposals:

A bump in the measure threshold is expected: 80% of patients have demographics recorded and can use them to produce stratified quality reports. Stage 3 is expected to expand this by developing new standards for granular demographics as recommended in a 2009 Institute of Medicine report.

Question from the MU Burning Issues Workgroup:

In an effort to reduce health disparities, may an EP/clinic add races in addition to the OMB-defined race categories (American Indian or Alaskan Native, Asian, Black or African American, Native Hawaiian or Other Pacific, and White) for tracking patient populations specific to their geographic location?

Answer:

Yes - however, those additional races, origins or groups must be mapped back to the Office of Management and Budget race options. For example, if an EP adds Korean as an option for race, those patients would have to be included in the calculations for Asian for reporting purposes. This poses unique workflow and reporting challenges that are beyond the scope of the Burning Issues Workgroup and may not be pertinent specifically to the EHR Incentive program.  Additionally, it should be noted that if a patient declines to provide their ethnicity or race, this may be included as a response.

This answer was vetted by CMS' Travis Broome (Special Assistant for Quality Improvement and Survey and Certification Operations) on November 4, 2011.

Reference:
"Therefore if a patient declines to provide the information or if capturing a patient's ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an entry for purposes of meeting the measure." (Medicare and Medicaid EHR Incentive Program Final Rule p. 44341)