Study: ED Race/Ethnicity Data Quality Needs Improvement

Despite the importance of race and ethnicity data to support health equity improvement efforts, a new study finds that there remain significant data quality issues in its collection and reporting in EHRs.

The study was published in JAMA Network Open by a team from Harvard University, the University of Michigan and Northwestern University, and based on data from a registry maintained by the Michigan Emergency Department Improvement Collaborative (MEDIC). It looked at data from more than half a million people who had two or more emergency visits at 42 hospitals from late 2018 to late 2021.

The research found that 1.7 percent of adults and 7 percent of children who sought emergency care at least twice at the same Michigan hospital or health system had a different race or ethnicity marked in their patient records on different visits.

Nearly 26 percent of adult patients who were registered as being Black and of non-Hispanic origin at their first visit, and 39 percent of those who were registered as being part of a catch-all category of Other race and ethnicity at their first visit, had a different race or ethnicity recorded at their second emergency visit to the same hospital or health system.

Among children, those recorded as being white, multiracial or other on their first visit had another race or ethnicity recorded during their second emergency visit, with 32 percent, 18 percent and 23 percent experiencing this difference respectively. 

The researchers say that these findings suggest that hospitals and health systems need to do more to standardize practices for collecting race and ethnicity data in their emergency departments. What gets marked in a patient’s record in the ED might not get re-examined as they receive care during a hospitalization or at post-emergency visits. In some cases, the ED visit may be the only kind of care disadvantaged people receive. 

Keith Kocher, M.D., M.P.H., who leads MEDIC and is senior author of the study, said in a statement that it suggests that “the current race and ethnicity data in electronic health record systems has important limitations, especially when influencing administrative decisions, clinical processes, research, or for countless other purposes.”

In an accompanying editorial, a team of experts on healthcare disparities research note that “high-quality data are needed to appropriately measure and address pervasive racial and ethnic health disparities with data-driven policies that advance health equity.”

MEDIC is funded by Blue Cross Blue Shield of Michigan.