During its 2021 session, the Washington State Legislature passed new hospital data reporting requirements (HB 1272) for inpatient and observation records used to populate the CHARS database. RCW 43.70.052(6) and WAC 246-455-025 require all hospitals to collect and submit detailed patient self-identified demographics, including race, ethnicity, language, disabilities, sexual orientation and gender identity. A detailed overview of the new law and its requirements for hospitals is available to members and the public in WSHA’s Bulletin and the DOH ESSHB 1272 CHARS Implementation webpage.
Washington is the first state in the country to require all hospitals to report this level of detailed information for patients. Early implementation focused heavily on modifying EHR systems, mapping new codes to other reporting systems and developing workflows. While much has been accomplished, we seek to continuously improve data collection, patient experience and utility of demographic data reported. Tools and resources will be added to this webpage as they become available.
Patient Education Materials
To promote patient participation, hospitals are encouraged to explain the purpose of collecting detailed demographic information, including the option to decline to respond. Guidance may be needed for parents and guardians responding on behalf of their dependents.
- WA DOH Patient Handouts (English, Amharic, Arabic, Chinese, Japanese, Khmer (Cambodian), Korean, Marshallese, Punjabi, Russian, Samoan, Somali, Spanish, Tagalog)
- Aligning Forces for Quality: We Ask Because We Care Posters/Tent Cards
- LGBTQIA+ Care at Swedish: People Matter Words Matter poster
- LGBTQIA+ Care at Swedish: We Ask Because We Care poster
- LGBTQIA+ Care at Swedish: We Ask Because We Care wallet-sized card
- Fenway Institute: Sexual Orientation and Gender Identity Questions: Information for Patients (available in 13 languages)
Definitions of Demographic Terms
The required categories for sexual orientation and gender identity (SOGI) may be unfamiliar to some patients and staff. To avoid confusion, hospitals are encouraged to make available brief definitions of all SOGI terms. In addition to collecting gender identity, it is best practice to also note a patient’s pronouns and preferred name to avoid misgendering.
- Confluence: SOGI Definitions Panel Card
- LGBTQIA+ Care at Swedish: Sexual Orientation and Gender Identity (SOGI) Glossary
- LGBTQIA+ Glossary of Terms for Health Care Teams (does not include all CHARS SOGI terms)
- Trans Lifeline: Glossary of Terms and Definitions (does not include all CHARS SOGI terms)
- Human Rights Campaign: Glossary of Terms (does not include all CHARS SOGI terms)
Asking patients about their identities can be uncomfortable for staff. To build confidence, hospitals are encouraged to provide training, including opportunities for roleplay, supported by scripting and video. Staff appreciate guidance for de-escalating situations where patients react with anger or disrespect. It is important to remind staff that patients have the option to decline to report their demographic information and may prefer to respond to the questions privately.
- PeaceHealth Culturally Responsive and Gender Affirming Care Toolkit
- National LGBTQIA+ Health Education Center (Fenway Institute):
- SO/GI Data Collection Demonstration Videos
- Collecting Sexual Orientation and Gender Identity Data (AESGM 2023) Webinar
- Collecting Sexual Orientation and Gender Identity (SO/GI) Data In Electronic Health Records (slide deck)
- Cultural Adaptation of Measures and Tools for Sexual Orientation and Gender Identity (SOGI) Data Collection Webinar
- Affirmative Services for Transgender and Gender-Diverse People; Best Practices for Frontline Health Care Staff (Updated Winter 2020)
- Helping Your Organization Collect Sexual Orientation and Gender Identity Data (Fenway & NORC)
- Eight Tips for Building Coalition Support and Moving SOGI Data Collection Forward in Your Organization (Fenway & NORC)
- Human Rights Campaign Healthcare Equality Index (HEI) Resource Guide
- The Center for Excellence in Transgender Health has an online learning module on acknowledging Gender and Sex that includes best practice scenarios for asking questions about sex and gender.
- A web-based training entitled “Catching Everyone in America’s Safety Net: Collecting Data on Sexual Orientation (SO) and Gender Identity (GI) in Health Care Settings” is available on the Medicare Learning Network. You can sign up for a free account to access the training.
- Hospital/Health System Example materials:
- Montefiore Medical Center‘s document teaches front desk staff how to collect gender identity data within their EHR system.
- Cone Health Behavioral Health Hospital trains staff on how to capture patient gender identity information in their registration software and the importance of collecting this data.
- Michigan Medicine has communicated with staff their updated EHR system and the steps to record gender identity data.
- Hospital for Special Surgery training materials trains clinicians and administrators how to enter patient gender identity into their EHR system.
- Collecting and Reporting Patient Demographic Data: Training deck developed for Maryland hospitals improve their collection methods taking into account the difficulties presented when hospital personnel are unfamiliar with the background and culture of the patient.
- RWJF Aligning Forces for Quality (AF4Q) Race, Ethnicity and Language (R/E/L) Training: A presentation intended for use in provider organizations to train clinicians, managers, and front desk or registration staff to: Understand the role of R/E/L data and quality improvement in identifying and reducing disparities in health care; outline key decision points that will need to be considered at the organizational level; review the “nuts and bolts” of how to train staff to collect standardized R/E/L information.
Understanding how to make sharing identity information comfortable, private and convenient for patients is critical to improving the quality and completeness of demographic data collected. Some hospitals have employed feedback surveys to better understand patient preferences and experiences. In addition, collaborating with patient and family advisory councils or community groups is a helpful way to co-design processes that are well accepted.
- Fred Hutch E-Advisors Survey: Screening for Patient Sexual Orientation and Gender Identity
- Fred Hutch Engaging Patients in a SOGI Demographic Screening Survey (slide presentation)
- Confluence: Presentation on SOGI Implementation: A Community-Guided Approach (slide presentation)
Frequently Asked Questions
At what age should demographic information be collected? How is this age determined?
- RCW 43.70.052(6) and the corresponding agency regulation under WAC 246-455-025 are silent on age.
- All patients and guardians may choose to “decline” to respond to demographic fields. If a patient/guardian is provided an opportunity to review the questions and leaves the fields blank, this may be interpreted and coded as “Patient declined to respond.”
- Recommendations from the MultiCare Pediatric Primary Care Clinical Council
- JAMIA article (2022): Pediatric sexual orientation and gender identity data collection in the electronic health record. Also summarized in Fenway Health Blog Post.
Which demographics should be collected at registration, and which (if any) should be incorporated into the clinical encounter?
- A WSHA implementation survey of hospitals (prior to June 8, 2023) found all hospitals are collecting at least some demographic information at registration, more than half also collect it pre-visit or during the e-check in process, and some are collecting demographics during the clinical encounter. A few are collecting demographics at discharge.
- Sexual orientation and disability data is more likely to be collected by clinical staff in the privacy of a clinic room than by registration staff, but there is no consensus among the hospitals (some hospitals collect all demographic data at registration and through the patient portal).
How did you address mapping of new CHARS (72) race codes to pre-existing standard reporting, such as the federal Office of Management and Budget (OMB)?
- DOH created a table showing how detailed CHARS race categories can be aggregated/collapsed into the 1997 OMB minimum standard for purposes of federal reporting. The document is titled: Aggregation Guidelines for Federal Hospitalization Reporting in WA. Hospitals note the limitations of the DOH table, as many “races” are aggregated into “other” (including: Central American, Chicano/a or Chicanx, Cuban, Dominican, Indigenous-Latino/a or Indigenous Latinx, Mestizo, Mexican/Mexican American, Puerto Rican, South African, South American).