Data Element
Submitted By: Robert McClure, MD / HL7 International
Data Element Information
Data Element Description Description: Text attribute that provides the name that should be used when addressing or referencing the patient.
Usage Notes: This information is usually provided by the patient. Depending on the standard applicable to an implementation, this might be encoded within a Person/Patient Name field with an appropriate name type qualifier but is independent of any other name type or name component. This may be a nickname or formal name. This data element may change over time, such as when a patient desires a change in name to align with expressed gender. This means the data element should support a validity period and a comment attribute to allow text that can be used to capture context for use of the name.
Rationale for Separate Consideration This is a specific type of name that needs to be considered as a unique data element distinct from other patient name types, e.g: First name, last name, previous name.
Use Case Description(s)
Use Case Description These use cases are supported by the work defined within the Gender Harmony HL7 informative publication: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=564 and also by a JAMIA article describing the project and it’s need: https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocab196/6382238?guestAccessKey=016faba4-edcc-4cbd-b5bc-27d3452d2ce1.
Name to use: Clearly specifying the name to be used when interacting with the patient is foundational to a supportive and meaningful relationship. Additionally it provides a data element that can be used to mark a clear transition noting that the patient has changed the name to align with a desired persona. This is distinct from a legal name or other types of names. The Name To Use can also rapidly reflect proper naming even when other names, such as the legal name may not change as easily or quickly.
Pronouns: Pronouns are effectively similar to the name to use in clarifying proper reference verbage for the patient and can be used to engage in supportive interactions. Proper pronoun use cannot be inferred from a patient name because some patients use gender-neutral names or may desire use of pronouns that do not typically align with social norms. Health system pronoun documentation should be supported independent of other related sex and gender elements, including Recorded Sex or Gender (which is recommended to document changes to legal documents including birth certificates, jurisdictional identification cards (e.g., drivers licenses etc.).
Estimate the breadth of applicability of the use case(s) for this data element Both Name to Use and Pronouns are widely implemented in systems and should be considered Level 2
Link to use case project page http://hl7.me/GHP
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) LOINC Personal pronouns – Reported 90778-2
LOINC does not have a specific observable that aligns directly with “Name to use”

Recommendation for USCDI v3 Alignment with HL7 and LOINC
he/him/his/his/himself H (LA29518-0)
she/her/her/hers/herself S (LA29519-8)
they/them/their/theirs/themself T (LA29520-6)
Something else, please specify: nullFlavor OTH
Unknown nullFlavor UNK
Other options are permissible, such as neopronouns (ze/hir, ey/em, etc.) and options such as “use only my name” or “any pronouns”, in addition to the above minimum set. For further recommendations related to pronouns, see Kronk et al (2021).
https://loinc.org/90778-2/
Additional Specifications HL7 Informative Document: Gender Harmony - Modeling Sex and Gender Representation, Release 1
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=564
The intent is to have changes to support the implementation of the Gender Harmonly Logical Model in FHIR R5. In addtion there will be a Gender Harmony specific FHIR IG in September 2022 ballot that provides additional guidance across HL7 products including V2 and C-CDA.
For Name To Use, FHIR already supports this element through the use of HumanName datatype. HumanName.use = “Usual”.
Current Use In limited use in production environments
Supporting Artifacts Utilized in Epic EHR although in Epic-specific way. Found in modifications to support the need by the EHR in use at Fenway Health systems in Boston, MA.
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) none
Restrictions on Use (e.g. licensing, user fees) none
Privacy and Security Concerns Some systems may determine there are privacy implications of this data but the intent is to make this openly available given it is intented to support direct interactions with the patient.
Estimate of Overall Burden Implementing additional fields to collect this information is the only potential burden.
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following 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
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by Kristic333 on

Cornell Health Comments on Draft USCDI v5

"Name to Use" is an important field to collect and use. Using the name a patient wishes to be called can be an important factor in building trust and delivering patient centered care. Calling patients by the name they use helps to establish a safe and non-judgmental space where the patient can be open and honest about their health needs. 

Failure to use the name the patient uses can be perceived as discriminatory, thereby damaging the therapeutic relationship. Many patients, particularly in the LGBTQ+ community, delay or avoid seeking care due to fear of or actual experience of discrimination.  

 

Submitted by pwilson@ncpdp.org on

NCPDP Comments on USCDI draft v5

NCPDP supports the use of the data element Preferred Name which can be interchanged with the data element Name to Use in the NCPDP SCRIPT Standard v2017071.

Submitted by dcarlson on

Is "name to use" is considered a "casual" usage?

If this is what i think it is, something to be used by office workers as a "casual" interactions with the person on how to address them namewise... is the implication that the first/middle/last name data elements are some sort of "legal" name fields?  If so, is that deliniated in the definitions of first/middle/last name, or should they be?

 

 

Submitted by Steven.Lane on

Provider support for Name to Use

When a patient has shared with a provider or other caregiver their preferred Name to Use and this data has been captured in a health IT system, we owe it to the individual to share this information along with other core demographic data.  Routine exchange of this data, when it is available, will contribute to effective patient engagement, patient trust, efficient workflows, and may also improve patient privacy.  

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