Data used to categorize individuals for identification, records matching, and other purposes.

Data Element

Additional Information
Tribal Affiliation
Description
Tribe or band with which an individual associates.
Submitted By: Laura Conn
Data Element Information
Use Case Description(s)
Use Case Description Health Equity Strategy
Estimated number of stakeholders capturing, accessing using or exchanging As of 2019, there were an estimated 5.7 million people who were classified as American Indian and Alaska Native (AI/AN) alone or in combination with one or more other races. This racial group comprises 1.7 percent of the total U.S. population.
Link to use case project page https://www.cdc.gov/ecr/index.html
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) HL7 FHIR: US Public Health Tribal Affiliation extension
HL7 CDA: Tribal Affiliation template
HL7 Value Set: TribalEntityUS

https://www.hl7.org/implement/standards/product_brief.cfm?product_id=519 https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436 http://terminology.hl7.org/ValueSet/v3-TribalEntityUS
Additional Specifications HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) based on FHIR R4 HL7 CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report (eICR) HL7 FHIR: US Public Health Tribal Affiliation extension HL7 CDA: Tribal Affiliation template
Current Use Extensively used in production environments
Supporting Artifacts Soon to be published: HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) STU Release 2 Soon to be published: HL7 CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report (eICR) Release 1, STU Release 3.0
https://www.hl7.org/implement/standards/product_brief.cfm?product_id=519 https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436
Number of organizations/individuals with which this data element has been electronically exchanged 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) N/A
Restrictions on Use (e.g. licensing, user fees) N/A
Privacy and Security Concerns N/A
Estimate of Overall Burden These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data.
Other Implementation Challenges N/A
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 4 criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Maturity – Standards/Technical Specifications Level 1/2 - Must be represented by a vocabulary standard or an element of a published technical specification
Maturity - Current Use Level 2 - Used at scale in more than 2 different production environments
Maturity - Current Exchange Level 2 - Demonstrates exchange between 4 or more organizations with different EHR/HIT systems
Breadth of Applicability - # Stakeholders Impacted Level 1 - Used by many, but not most, patients, providers or events requiring its use
Evaluation Comment Tribal affiliation, rather than tribal enrollment, is recommended as only tribes determine and define tribal enrollment. Federal, state, and local entities do not have the ability to verify tribal enrollment, and use of tribal affiliation allows for the collection of what tribe(s) an individual patient identifies with, without impeding on tribal sovereignty in any way.

Comment

Submitted by nedragarrett_CDC on 2022-04-29

CDC's Consolidated Comment

  • CDC supports the ONC decision on adding the Tribal Affiliation data element (Demographics data class) to the USCDI v.3. Adding this data element to EHR provides an additional mechanism for the assessment of health status and organization health equity interventions for tribal populations. In addition it facilitates tribal access to data about their tribal members. Also, we support the CSTE and WA Department of Health comments on a necessity of a dialog with tribes to assure addressing privacy concerns of patients. Furthermore, we recommend the following changes so current and accurate information and references are used.
 
  • Because of absence this data element definition in the USCDI, we recommend the following definition:
The Tribal Affiliation data element provides the patient’ association by name with federally recognized Indian tribes or with federally recognized Alaska native villages/tribes within the state of Alaska.  
  • Please update the Links to use case project page as the following:
  1.  Indian Affairs Bureau, https://www.federalregister.gov/documents/2022/01/28/2022-01789/indian-entities-recognized-by-and-eligible-to-receive-services-from-the-united-states-bureau-of  and
  2.  HL7 http://terminology.hl7.org/ValueSet/v3-TribalEntityUS (INDIAN ENTITIES RECOGNIZED AND ELIGIBLE TO RECEIVE SERVICES FROM THE UNITED STATES BUREAU OF INDIAN AFFAIRS)
 
  • Edit the Applicable Vocabulary Standard(s) as the following:
  1. LOINC 95370-3, Tribal Affiliation (for the question).
  2. The following standards for the answer: Indian Entities Recognized by and Eligible To Receive Services From the United States Bureau of Indian Affairs, 87 FR 4636, 01/28/2022 (https://www.federalregister.gov/documents/2022/01/28/2022-01789/indian-entities-recognized-by-and-eligible-to-receive-services-from-the-united-states-bureau-of) with added HL7 NullFlavor values: NI (no information), OTH (other), UNK (unknown), ASKU (asked but unknown).
 
  • Please add to the Supporting Artifacts the following:
  1. HL7 http://terminology.hl7.org/ValueSet/v3-TribalEntityUS (INDIAN ENTITIES RECOGNIZED AND ELIGIBLE TO RECEIVE SERVICES FROM THE UNITED STATES BUREAU OF INDIAN AFFAIRS)
    Comment from CSTE:
  • Tribal affiliation (draft V3); The collection, usage, management, disclosure, and safeguarding of Tribal data is a governance activity that ONC should develop in collaboration with the Tribe(s) whose members are included in the data. The ONC should commit to meaningful consultation with tribal leaders of individual sovereign tribal nations to ensure they have an opportunity to provide timely input before using Tribal data, including Tribal affiliation or any other Tribal identifying information. The U.S. Constitution recognizes that Tribal nations are sovereign governments. As such, they have powers of self-government, upheld, repeatedly, by the U.S. Supreme Court. Tribal governments have the legal authority to administer the collection, ownership, application, and interpretation of their own data, even if it is collected by federal, state, or local governments. Tribal data means public or private facts, statistics or items of information on or about a Tribe or its people subject to tribal rights of ownership and control. This includes, but is not limited to, Tribe of membership, Tribe of affiliation, and identification of tribal facilities, entities, and enterprises. Tribal data means (1) data that is specific to an individual Tribe; or (2) data that is specific to more than one Tribe but does not identify individual Tribe(s).
  Comment from ASTHO (WA DOH):  
  • The collection, usage, management, disclosure, and safeguarding of Tribal data is a governance activity that ONC should develop in collaboration with the Tribe(s) whose members are included in the data. The ONC should commit to meaningful consultation with tribal leaders of individual sovereign tribal nations to ensure they have an opportunity to provide timely input before using Tribal data, including Tribal affiliation or any other Tribal identifying information. The U.S. Constitution recognizes that Tribal nations are sovereign governments. As such, they have powers of self-government, upheld, repeatedly, by the U.S. Supreme Court. Tribal governments have the legal authority to administer the collection, ownership, application, and interpretation of their own data, even if it is collected by federal, state, or local governments. Tribal data means public or private facts, statistics or items of information on or about a Tribe or its people subject to tribal rights of ownership and control. This includes, but is not limited to, Tribe of membership, Tribe of affiliation, and identification of tribal facilities, entities, and enterprises. Tribal data means (1) data that is specific to an individual Tribe; or (2) data that is specific to more than one Tribe but does not identify individual Tribe(s).
     

Submitted by RUy on 2022-04-29

NACHC believes tribal…

  • NACHC believes tribal affiliation is foundational component of patient identity and required for patient-centered care.
  • We strongly support the use of the code systems and codes described by the Tribal Entity code systems to ensure robust and patient-centered support for patients with tribal affiliation in the US healthcare system.
Please see attached NACHC letter, documenting this comment and other feedback for v3 accepted draft data elements.

2022-04-30 NACHC USCDIv3 Letter of Support_8.pdf

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