Details
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Change Request
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Resolution: Persuasive with Modification
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Medium
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US Core (FHIR)
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4.1.0 [deprecated]
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Cross-Group Projects
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US Core Race Extension
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Social Determinants of Health (SDOH) [deprecated]
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10.137.1
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Brett Marquard/Rob McClure: 8-1-3
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Enhancement
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Compatible, substantive
Description
FHIR-35694 removed "Other" from the US Core (OMB race categories value set|http://build.fhir.org/ig/HL7/US-Core/ValueSet-omb-race-category.html). The rationale is that HL7 v3 Null Flavor "Other" does not indicate the right information. However, there exists a VSAC value set that contains all of the OMB codes (using the same codes from the larger CDC Race and Ethnicity value set) PLUS another code from the CDC Race and Ethnicity value set - 2131-1 "Other Race". This additional code does express the meaning and it allows an individual to also choose a more specific race which, based on the hierarchy, rolls up to one of the 5 OMB categories. This option also appears in the US Census form - see figure 2 at: https://www.census.gov/newsroom/blogs/random-samplings/2021/08/improvements-to-2020-census-race-hispanic-origin-question-designs.html. Thus, the addition of "Other Race" should be specific and allowable. Further, remove the HL7 v3 null flavor codes, ASKU and UNK as they are specifically null flavor, and instead substitute with 3 codes from the DataAbsentReason value set (http://terminology.hl7.org/CodeSystem/data-absent-reason): Asked-declined, Not-asked, and Asked-unknown. These codes are more specific and fit better with clinical and financial data than the current "null flavor" content.
So 2 Options:
*Option 1 *- (preferred solution): Modify ValueSet: OMB Race Categories (http://build.fhir.org/ig/HL7/US-Core/ValueSet-omb-race-category.html) to:
- 1002-5 American Indian or Alaska Native (VSAC value set 2.16.840.1.114222.4.11.836 “Race”) – - CHANGE
- 2028-9 Asian (VSAC value set 2.16.840.1.114222.4.11.836 “Race”) – CHANGE
- 2054-5 Black or African American (VSAC value set 2.16.840.1.114222.4.11.836 “Race”) – CHANGE
- 2076-8 Native Hawaiian or Other Pacific Islander (VSAC value set 2.16.840.1.114222.4.11.836 “Race”) – CHANGE
- Race)
- 2106-3 White (VSAC value set 2.16.840.1.114222.4.11.836 “Race”) – CHANGE
- 2131-1 Other Race (VSAC value set 2.16.840.1.114222.4.11.836 “Race”) - ADDITION
- Asked-declined (level 2 in http://terminology.hl7.org/CodeSystem/data-absent-reason - CHANGE
- Not-asked (level 2 in http://terminology.hl7.org/CodeSystem/data-absent-reason - CHANGE
- Asked-unknown (level 2 in http://terminology.hl7.org/CodeSystem/data-absent-reason - CHANGE
- REMOVE - ASKU asked but unknown (http://terminology.hl7.org/CodeSystem/v3-NullFlavor) – CHANGE
- REMOVE - OTH other (http://terminology.hl7.org/CodeSystem/v3-NullFlavor) ALREADY DONE
- REMOVE - UNK unknown (http://terminology.hl7.org/CodeSystem/v3-NullFlavor) – CHANGE
OR
*Option 2 *(allows persistence of direct reference to PHIN-VADS). Modify ValueSet: OMB Race Categories (http://build.fhir.org/ig/HL7/US-Core/ValueSet-omb-race-category.html) to:
- 1002-5 American Indian or Alaska Native (from PHIN-VADS 2.16.840.1.113883.6.238) – NO CHANGE
- 2028-9 Asian (from PHIN-VADS 2.16.840.1.113883.6.238) – NO CHANGE
- 2054-5 Black or African American (from PHIN-VADS 2.16.840.1.113883.6.238) – NO CHANGE
- 2076-8 Native Hawaiian or Other Pacific Islander (from PHIN-VADS
- 2.16.840.1.113883.6.238) – NO CHANGE
- 2106-3 White (from PHIN-VADS 2.16.840.1.113883.6.238) – NO CHANGE
- 2131-1 Other Race (from PHIN-VADS 2.16.840.1.113883.6.238) – CHANGE
- Asked-declined (level 2 in http://terminology.hl7.org/CodeSystem/data-absent-reason – CHANGE
- Not-asked (level 2 in http://terminology.hl7.org/CodeSystem/data-absent-reason – CHANGE
- Asked-unknown (level 2 in http://terminology.hl7.org/CodeSystem/data-absent-reason – CHANGE
- REMOVE - ASKU asked but unknown (http://terminology.hl7.org/CodeSystem/v3-NullFlavor) – CHANGE
- REMOVE - OTH other (http://terminology.hl7.org/CodeSystem/v3-NullFlavor) ALREADY DONE
- REMOVE - UNK unknown (http://terminology.hl7.org/CodeSystem/v3-NullFlavor) – CHANGE