Improving Race, Ethnicity, & New American Data Quality to Advance Health Equity

1. IMPROVING RACE, ETHNICITY, AND NEW
AMERICAN DATA QUALITY
TO ADVANCE HEALTH EQUITY

2. C O N F I D E N T I A L
TRAINING OBJECTIVES
1. Understand the importance of data collection.
2. Learn foundational terminology and new American background.
3. Understand current and future state.
4. Know why and how to ask, and how to document in Epic.
5. Become familiar with addressing patient/caregiver concerns.

3. WHY WE COLLECT RACE, ETHNICITY AND NEW
AMERICAN RESETTLEMENT INFORMATION

4. C O N F I D E N T I A L
WHY | WE ASK BECAUSE WE CARE
Accurate, self-reported race, ethnicity, and
New American status allows us to:
Identify differences in
individual care
Examine disparities
within populations
Provide needed
resources to patients

5. C O N F I D E N T I A L
WHY | INTERSECTIONALITY WITH SOGI
SOGI (Sexual Orientation and Gender Identity) Work at U
Health
Chosen Name and Preferred Pronoun data collection timed with RAE data
collection
Human Rights Campaign Healthcare Equality Index
Achievement
The HEI evaluates and scores health care facilities on foundational policies
and training in LGBTQ+ patient-centered care, LGBTQ+ patient services and
support, employee benefits and policies, and patient and community
engagement
New Americans and SOGI
Some New Americans have been forced to flee their country due to their
sexual orientation or gender identity.

6. C O N F I D E N T I A L
WHY | POLICY AND BEHAVIOR STANDARDS
• The University of Utah (“University”) is committed
to providing and fostering an environment that is
safe and free from prohibited Discrimination
• The University of Utah does not discriminate
against individuals on the basis of race, ethnicity,
color, religion, national origin, age, disability, sex,
sexual orientation, gender, gender identity,
gender expression, pregnancy, pregnancy-related
conditions, genetic information, or protected
veteran status (“protected class”)……
NON-DISCRIMINATION POLICY PROMISE STANDARDS
• I am kind to others and value individual
differences including culture, age, religion, and
gender.
• I offer assistance to those who may need help or
find someone who can.
• I always act in the best interest of patients,
students, employees, leaders, and our
organization.

7. GETTING STARTED

8. C O N F I D E N T I A L
VOCAB PRIMER
an individual who is new to the United States and was previously forced to flee their home country
as a refugee. Once they are established in the United States, we no longer refer to them as a
refugee, but rather, New Americans.
NEW
AMERICAN
race and ethnicity describe a group with shared characteristics or culture.
RACE &
ETHINCITY
COMBINED
a structural construct that describes a group of people that share certain distinct physical attributes
such as skin color or facial features.
RACE
a structural construct that defines a group of people who share cultural expression, background,
and identification.
ETHINCITY

9. C O N F I D E N T I A L
NEW AMERICANS RESETTLEMENT PROCESS
1 in 88 people on earth have been forced to flee their home country
Approx. 1% will get to leave a camp and relocate to a new country.
Interviews
Background
checks
Medical
screenings
Cultural
orientation
Flight to
United
States
Refugee process
New American
Arrive in
United
States
Navigate
education
Navigate
medical
care
English
lessons
Find a job …

10. C O N F I D E N T I A L
18
17
13
12
4%
4%
3%
3%
3% 3%
Arrivals to Utah by Top Nationalities
Nov 2012 to present
Afghanistan
Dem Republic of the Congo
Iraq
Somalia
So Sudan
Bhutan
Myanmar (Burma)
Karenni
Ukraine
Cuba
NEW AMERICANS IN UTAH
Due to the process of resettlement and integration into new surroundings, there
are treatment guidelines and care coordination protocols that we must align with to
provide culturally sensitive and safe care.
The language we use is powerful.
They're are over 65,000 new
Americans in Utah.
University of Utah Health is the
primary care home to many of these
newcomers.

11. CURRENT AND FUTURE STATE

12. C O N F I D E N T I A L
CURRENT AND FUTURE STATE
Race
and
Ethnicity
2 questions to collect race and ethnicity 1 combined question to collect race and ethnicity
6 race options
77 race and ethnicity options
2 ethnicity options
New
American
New American FYI flag
New American registration question
New American data collection form
Confirmation warning to fill out form when New American
is ‘yes”
New indicator on the front end and clinical storyboard
Clinical storyboard hover will show New American data
Smartphrase that pulls data from the form to clinical note
FUTURE STATE
CURRENT STATE

13. C O N F I D E N T I A L
CURRENT STATE: RACE & ETHNICITY AND NEW AMERICAN
Race & Ethnicity New American

14. C O N F I D E N T I A L
FUTURE STATE
American Indian/Alaska Native
Diné (Navajo)
Newe (Goshute)
Newe (Shoshone)
Nuche (Ute Tribe)
Nuwuvi (Paiute)
So-So-Goi (Shoshone)
Other American Indian/Alaska Native
Asian
Asian American
Asian Indian
Bhutanese
Burmese
Cambodian
Chinese
Filipino/a
India Indian
Japanese
Karen
Kareni
Korean
Laotian
Mongolian
South East Asian
Thai
Tibetan
Vietnamese
Other Asian
Black
African
African American
Caribbean/West Indian
Congolese
Ethiopian
Jamaican
Kenyan
Nigerian
Somali
South Sudanese
Sudanese
Other Black
Hispanic/Latino/a/x
Argentinean
Caribbean/West Indian
Colombian
Cuban
Guatemalan
Mexican American
Mexican, Chicano/a
Peruvian
Puerto Rican
Salvadoran
Spanish/Spaniard
Venezuelan
Other Hispanic/Latino/a/x
Pacific Islander
Chamorro
Fijian
Guamanian
Micronesian/Marshallese/Palauan
(COFA communities)
Native Hawaiian
Samoan
Tongan
Other Pacific Islander
White
Afghan
Bosnian
Eastern European
Iraqi
Middle Eastern/North African
Russian
Scandinavian/Nordic
Slavic.3
Syrian
Ukrainian
Western European
White American
White Australian/New Zealander
Other White
Race & Ethnicity

15. C O N F I D E N T I A L
New American
FUTURE STATE
A
B
C
B
New American category in
demographics
New American Resettlement
form to collect additional details
Warning if “yes” is selected in the
new American category
A
B
C

16. C O N F I D E N T I A L
New American
FUTURE STATE
Smartphrase to pull New American
Resettlement Information details into
note
New American indicator on the
clinical storyboard with a hover-
over to show the resettlement
information form details
New American indicator on the Front
end storyboard with a hover-over
to show the resettlement information
form details
A
B
C
A B
C

17. C O N F I D E N T I A L
NEW RAE DATA COLLECTION REQUIREMENTS
• New patients will be asked to enter demographic data using updated race and ethnicity information via MyChart/PRS/Care
Navigation (Roll out and always)
• Patients will be asked to confirm every 6 months as part the of existing patient verification process
• If patient selects “choose not to disclose,” patient will be prompted to confirm once/year
• Return patients will be prompted to update race and ethnicity if listed previously “other” or “unknown” (@ Roll out, or every six
months moving forward)
Race & Ethnicity
New American
• New American resettlement information will be recorded in an updated form with definitive fields.
• Similar to previous FYI flag; the information only needs to be collected once and can be updated as needed.
• New American field in Demographics, prompts user to enter in additional details in the New American Resettlement
Information Form
• A soft warning will occur if specific form fields are incomplete.

18. C O N F I D E N T I A L
Race & Ethnicity
MYCHART DATA COLLECTION
Patients can enter and update their
race and ethnicity in MyChart.
If a patient declines to answer
during registration, you can offer to
have them self-disclose in MyChart.
New American
Patients can not enter and update
new American details in MyChart.

19. HOW AND WHEN TO ASK

20. C O N F I D E N T I A L
RACE & ETHNICITY PILOT | RESULTS
333 31
4
12
380 total patients
Single RAE
Multiple RAE
Accurate Identication
Not Listed
Choose Not to
Disclouse
Focused on the list and asking the
question in a one-question format
(did not test Epic functionality)
Conducted September 6th –
September 30th
Pilot Locations
 Redwood Health Center
 Madsen Geriatrics
 Guest Communications (Call
center)
 Madsen Internal Medicine
 Cardiovascular Center

21. RACE & ETHNICITY PILOT | FINDINGS
What to expect
• Fewer patients pushed back than expected;
many patients were surprised and happy
• Staff had less discomfort after trying it
How to prepare
• Be prepared with suggested verbiage
• Having the physical list helps with in-person
registration
• Tone and confidence helps when asking
• Understand the why before you start
“I loved it! There is so much more
research that can be down with the
more specific information that we
are gathering with this.”
- Pilot participant at Redwood Primary Care
“Everyone I spoke to was happy
that they were able to give both
race and ethnicity.”
- Pilot participant in Guest Communications
“I really love this, because as being
Hispanic and also looking very
European; it reflects where I come
from and who I am, in a sense.”
- Pilot participant in Guest Communications

22. C O N F I D E N T I A L
Race & Ethnicity
HOW TO ASK
Using the new combined race and ethnicity format, ask the patient about their race and ethnicity. You can use
the following scripting examples below:
“To make sure all patients get the best care
possible, we would like you to tell us about
your race and ethnicity your answers are
confidential.
May I ask you for your race and
ethnicity?“
"I understand. I'll record that you don't wish to
share. You can enter this information on your
own in MyChart if you wish”
“How would you describe your race
and ethnicity?”
“What race and ethnicity do you
identify with?”
OR
Yes
No

23. C O N F I D E N T I A L
Race & Ethnicity
EPIC DATA ENTRY
Record the answer or
answers in the new
combined formatted
field.

24. C O N F I D E N T I A L
Race & Ethnicity
EPIC DATA ENTRY
The patient may choose one or multiple
choices.
Clicking the magnifying glass will open up
the new expanded list of 77 RAE choices.
You can also type in a specific RAE choice
for easier navigation.
If the patient chooses not to share their
information, you may use the option of
“choose not to disclose.”

25. C O N F I D E N T I A L
New American
RESETTLEMENT INFORMATION DATA COLLECTION | FINDINGS
We’ve collected this information on a smaller scale since March of 2018.
FYI Flag Resettlement Information Form
Individual Care Gaps
Individual Care Gaps and
System Level Care Gaps
Improving equity on a bigger scale

26. C O N F I D E N T I A L
New American
HOW TO ASK
Patient discloses to staff
that they are a new
American
“Do you have a
caseworker or agency
that helps you with your
care?”
Agency discloses to staff
that they are supporting
a new American
“Are you affiliated with a
resettlement agency?”
Patient is accompanied
by a caseworker/agency
volunteer
“Can I please collect
information about the
caseworker or agency
that helps you with your
care?”
WHEN
TO
ASK
HOW
TO
ASK
Listen for: AGENCY | CASEWORKER | REFUGEE | CLIENT | IRC | CCS | AAU | UHHR | WoW

27. C O N F I D E N T I A L
New American
EPIC DATA ENTRY
During registration or check-in, if the patient
or caseworker discloses to you that the
patient is a new American, please collect
additional information.
This information should be documented in
Demographics
New American Resettlement
Information form
A
B
A
B

28. LET’S PRACTICE

29. C O N F I D E N T I A L
ADDRESSING PATIENT/CAREGIVER CONCERNS
You may encounter patients who feel uncomfortable providing their racial and
ethnic information.
• It is important to be sympathetic to their perspective.
• Remind patients that their answers are confidential.
• Do not push them to answer if they are uncomfortable.

30. C O N F I D E N T I A L
ADDRESSING PATIENT/CAREGIVER CONCERNS
Patient situation Staff response What to record
Seeking opinion from
staff
Remember that you are not trained to make assumptions.
What you can say: "I'm trained not to make assumptions. It's really
up to you as self-identification is the most accurate way to collect
this data.”
Whatever option the patient ultimately
selects
Confused Remind them there is not a wrong answer.
What you can say: “Where is your family from”
"It's really up to you. Race is often thought of as physical attributes,
where ethnicity is connected to cultural backgrounds.”
Record the most fitting option for the
situation. * Their specific race and ethnicity *
Choose not to disclose * Unable to obtain
(Patient not available or details not known) *
Accurate identification not listed
Upset Be understanding and validate their feeling.
What you can say: “It is perfectly alright if you do not want to answer
the question. However, this information does help our hospital
provide better care. Regardless of whether you answer these
questions, we will provide you care.”
Choose not to disclose
Concerned Inform the patient that knowing this information can help reduce
health risks and disparities and improve quality of care
What you can say: “Although we are all individual people, our racial
and ethnic backgrounds may place us at differing risks for some
diseases. We can work to reduce these risks by making sure that
everyone gets high quality health care.”
Record the most fitting option for the
situation. * Their specific race and ethnicity *
Choose not to disclose * Unable to obtain
(Patient not available or details not known) *
Accurate identification not listed

31. LET’S PRACTICE | WHEN THE PATIENT WANTS YOUR OPINION
Can’t you tell by looking
at me?
I was born in Nigeria, but I’ve
really lived here all my life.
What should I say?
What do you think I am?
I could be wrong, so it’s
better to let you tell me.
That is really up to you. You
can use any term you like. It
is fine to say that you are
Nigerian. You can also
choose to select more than
one.
I can review the options
with you, it is best that you
select this information for
yourself.
Show or tell the patient some of the options and remind them it is their choice. You don’t make assumptions.

32. LET’S PRACTICE | WHEN THE PATIENT IS CONFUSED
Who will you give this
information to?
I don’t know what race and
ethnicity are.
Why are you asking this?
This information will be
stored in your medical
record. The staff providing
your care will be able to see
this information. We do not
share any medical records
without getting the patients
permission.
Race and ethnicity describe
a group of shared
characteristics or culture. .
Race is often thought of as
physical attributes, where
ethnicity is connected to
cultural backgrounds.
We collect this information
to help our care teams
understand more about
your racial and ethnic
background. Knowing this,
can help us get a better
idea of health risks and can
influence your health care
plans.
Knowing this information can help reduce health risks and disparities and improve the quality of care.

33. LET’S PRACTICE | WHEN THE PATIENT IS UPSET
Why do you care? We’re all
human beings?
That is none of your business.
Are you trying to find out if
I’m a US citizen?
We ask to make sure we
provide the best equitable
care possible.
Studies have shown that a
patient's race and ethnicity
aids in the best treatment
plan.
No problem, I can put down
that you don’t want to
answer.
No, definitely not. Patient
confidentiality is protected
by law, and we do not share
this information with
anyone.
Do not push them to answer if they are uncomfortable. Offer the patient the option to self disclose through MyChart.

34. LET’S PRACTICE | WHEN THE PATIENT IS A NEW AMERICAN
I am a new American.
I’m calling to schedule an
appointment for a new American.
I understand you’re a newcomer.
Welcome! Do you have an agency or
caseworker that helps you with your
care?
Thank you for letting me know
that this patient is a newcomer.
Can I please collect a little more
information so we can coordinate
their care with you and provide
them with additional resources if
they need any help?
Turn the information needed to be collected into a conversation. This is an opportunity to learn about the patient
and make a connection.

35. WRAP UP
Remember:
• We ask because we care.
• Responding to each other with
kindness is essential. In times when
people of color or otherwise
underrepresented might feel
increased racial or minority trauma,
consider an extra pause.
• Be confident when asking this
question. Your tone matters.
• Be prepared to answer why we ask.
• Lean on your team when you
encounter unique experience.
Thank you for asking,
your list now has my
personal identity to
report.
I feel seen in your list.
I now understand why
this information is
important for my health.
Thank you for explaining
why you ask.
I don’t have to select
other!

36. Our ability to reach unity in
diversity will be the beauty and the
test of our civilization.
- Mahatma Gandhi

37. Thank you