Concordance between electronic health record-recorded race/ethnicity and parental report in hospitalized children.

BACKGROUND

Electronic health records (EHRs) have become an important repository for patient race and ethnicity. Misclassification could negatively affect efforts to monitor and reduce health disparities and structural discrimination.

OBJECTIVE

We assessed the concordance of parental reports of race/ethnicity for their hospitalized children with EHR-documented demographics. We also aimed to describe parents' preferences on how race/ethnicity should be captured in the hospital's EHR.

DESIGNS, SETTINGS, AND PARTICIPANTS: From December 2021 to May 2022, we conducted a single-center cross-sectional survey of parents of hospitalized children asking to describe their child's race/ethnicity and compared these responses to the race/ethnicity documented in the EHR.

MAIN OUTCOME AND MEASURES

Concordance was analyzed with a kappa statistic (κ). Additionally, we queried respondents about their awareness of and preferences for race/ethnicity documentation.

RESULTS

Of the 275 participants surveyed (79% response rate), there was 69% agreement (κ = 0.56) for race and 80% agreement (κ = 0.63) for ethnicity between parent report and EHR documentation. Sixty-eight parents (21%) felt that the designated categories poorly represent their child's race/ethnicity. Twenty-two (8%) were uncomfortable with their child's race/ethnicity being displayed on the hospital's EHR. Eighty-nine (32%) preferred a more comprehensive list of race/ethnicity categories.

CONCLUSIONS

Nonconcordance between EHR-recorded race/ethnicity and parental report exists in the EHR for our hospitalized patients, which has implications for describing patient populations and for understanding racial and ethnic disparities. Current EHR categories may be limited in their ability to capture the complexity of these constructs. Future efforts should focus on ensuring that demographic information in the EHR is accurately collected and appropriately reflects families' preferences.