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

Data Element
Rurality
Description

Individual's self-identification as living in a rural area. Rurality is recognized in public health science as a significant indicator of adverse rates of morbidity and morality; this is sometimes called the 'rural health penalty'. Rurality is a complex phenomenon that researchers treat fluidly, with changing definition: https://www.sciencedirect.com/science/article/abs/pii/S0743016721000437 This failure of research to confirm a settled defintion should not constrain from asking the individual's self-identification, anymore than the failure of research to confirm a settled definition of sex or gender should constrain from asking the individual's self-identification of sex or gender.
Submitted By: edward strickler / member and past chair, ethics, american public health association
Data Element Information
Data Element Description Individual's self-identification as living in a rural area. Rurality is recognized in public health science as a significant indicator of adverse rates of morbidity and morality; this is sometimes called the 'rural health penalty'. Rurality is a complex phenomenon that researchers treat fluidly, with changing definition: https://www.sciencedirect.com/science/article/abs/pii/S0743016721000437 This failure of research to confirm a settled defintion should not constrain from asking the individual's self-identification, anymore than the failure of research to confirm a settled definition of sex or gender should constrain from asking the individual's self-identification of sex or gender.
Use Case Description(s)
Use Case Description Rurality is recognized in public health science as a significant indicator of adverse rates of morbidity and morality; this is sometimes called the 'rural health penalty'. Rurality is a complex phenomenon that researchers treat fluidly, with changing definition: https://www.sciencedirect.com/science/article/abs/pii/S0743016721000437 & https://www.census.gov/content/dam/Census/library/publications/2016/acs/acsgeo-1.pdf
But failure of research and federal bureaucracy to confirm a settled defintion should not constrain from asking the individual's self-identification, anymore than the failure of research to confirm a settled definition of sex or gender should constrain from asking the individual's self-identification of sex or gender.
Estimate the breadth of applicability of the use case(s) for this data element Estimated to be from 14-19% of the US population ... "Compared to urban areas, rural communities face higher poverty rates, lower educational attainment, lack of transportation, a higher proportion of elderly individuals, and lack of access to health services ... Owing to these factors, rural communities face elevated rates of morbidity and mortality and greater percentages of excess deaths from the five leading causes of death including cancer and cardiovascular disease" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043306/ There is a significant ethical and moral burden on health IT to capture data regarding rurality. The ethical and moral burden requires affirmative attention to rurality.
ONC Priority
  • Mitigate health and health care inequities and disparities
  • Address the needs of underserved communities
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) N/A
Additional Specifications N/A
Current Use Not currently captured, stored, or accessed
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) unknown but self-identification should not be a restriction and should not be a burden on providers anymore than asking for self-identification of sex and/or gender
Restrictions on Use (e.g. licensing, user fees) none known
Privacy and Security Concerns self-identification with 'rurality' does not appear to broach any known nondiscrimination or privacy protection laws, regulations or policies
Estimate of Overall Burden no burden, any more than self-identification of sex and/or gender is a burden
Other Implementation Challenges none known; self-identification with 'rurality' or not should not be any more challenging that requesting self-identification of sex and/or gender
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 0 - Data element is not represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 0 - Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 1 - Use cases apply to several care settings or specialties.

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Fig 4 The "File Upload" section permits users to attach supporting documentation that supplements their written comments.

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Fig 6 The review screen allows users to verify comment content and make any necessary modifications before final submission.

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