Bulletin: Race/Ethnicity: Issue with Updating Patient Details

Introduction

During the PA Emergency Department Data Collection work that is being done as part of the “PA Data Enhancements Project” (P22.007), we encountered a specific behavior within our product regarding how the Race/Ethnicity fields were populated for some patients. After investigating how this data was handled, we realized that if patients having a prior visit in EpiCenter return to a facility, our system did not update the standardized Race/Ethnicity values even if there was a change after processing the raw Race/Ethnicity value since they were already populated from the original visit. This caused our system to report a lower percentage on Race/Ethnicity than we are actually receiving. It is important to note that all of this data is securely captured in our database, it is just not reflected properly in EpiCenter in some instances. We are working to fix this issue.

This issue occurred because most facilities historically did not send any meaningful information in these fields, so our system was originally designed not to repopulate these fields when there were new visits for repeat patients. Thankfully, Race/Ethnicity data reporting has improved immensely over the past few years and is now largely standardized and accurate. We plan to implement a long-term solution to this issue in the next EpiCenter release. In the interim, a short-term solution is outlined below.

Interim Solution

We have adjusted our data completeness report to account for any updated Race/Ethnicity mapping. We can calculate completeness for just the subset of patients who are new to the facility or have a new patient identifier. This report will be used to track progress in the current PA Emergency Department Data Collection work.

Long-Term Solution

Our long-term solution will be included in the upcoming EpiCenter release. The solution is threefold:

1. A tool is developed to retroactively re-apply those administratively configured mapping rules so that a raw Race/Ethnicity value can be correctly converted to their corresponding standardized Race/Ethnicity value.
2. When processing HL7 messages in real time, if a patient initiates a new visit to seek healthcare, her/his most recent demographic information (including the raw Race/Ethnicity value and the standardized Race/Ethnicity value) will be used to create a new Patient Record for her/his current visit.
3. When processing HL7 messages in real time, if a patient reports new demographic information during the same visit, her/his most recent Race/Ethnicity value will be used to update her/his current Patient Record if Race/Ethnicity value was previously absent.