Patient Race and Ethnicity

Sample HL7 V2

• PID-10 Race - follows same rules as FHIR for OMB-5

• PID-22 Ethnic Group - follows same rules as FHIR for OMB-2

Sample HL7 CDA

In C-CDA, Race and Ethnicity are encoded in the patientRole/patient element using:

• <raceCode> and <ethnicGroupCode>

• Codes from the same CDCREC code system as used by FHIR

CDA RecordTarget/Patient class model showing raceCode and ethnicGroupCode attributes drawn from the CDCREC code system, alongside PatientRole and LanguageCommunication structures.

Sample HL7 FHIR

To be compliant with HL7 standards (C-CDA and US Core FHIR) and the ONC/ASTP U.S. Core Data for Interoperability (USCDI) requirements, the correct values for Race and Ethnicity are based on code systems and value sets specified by:

• HL7 Version 3

• USCDI v3 (or latest adopted version)

• Office of Management and Budget (OMB) Directive 15

Race

The OMB 1997 standard categories for race are required, and should come from the CDC Race & Ethnicity – CDCREC code system (urn:oid:2.16.840.1.113883.6.238).

OMB minimum required race categories:

Code	Display
1002-5	American Indian or Alaska Native
2028-9	Asian
2054-5	Black or African American
2076-8	Native Hawaiian or Other Pacific Islander
2106-3	White

You may also include more granular race details (e.g., "Filipino," "Japanese") as extensions or detailed codes under the main OMB categories, using the same code system.

FHIR and C-CDA CodeSystem Mapping

FHIR Code	Urn:oid	FHR Display	C-CDA Code Note: C-CDA uses this ValueSet but then the template permits the use of NullFlavors	Urn:oid	C-CDA Display
1002-5	2.16.840.1.113883.6.238	American Indian or Alaska Native	1002-5	2.16.840.1.113883.6.238	American Indian or Alaska Native
2028-9	2.16.840.1.113883.6.238	Asian	2028-9	2.16.840.1.113883.6.238	Asian
2054-5	2.16.840.1.113883.6.238	Black or African American	2054-5	2.16.840.1.113883.6.238	Black or African American
2076-8	2.16.840.1.113883.6.238	Native Hawaiian or Other Pacific Islander	2076-8	2.16.840.1.113883.6.238	Native Hawaiian or Other Pacific Islander
2106-3	2.16.840.1.113883.6.238	White	2106-3	2.16.840.1.113883.6.238	White
ASKU	2.16.840.1.113883.5.1008	Asked but unknown	ASKU	2.16.840.1.113883.5.1008	Asked but unknown
UNK	2.16.840.1.113883.5.1008	Unknown	UNK	2.16.840.1.113883.5.1008	Unknown
Asked- declined	2.16.840.1.113883.4.642.4.1048	Asked but declined	Asked-declined	2.16.840.1.113883.4.642.4.1048	Asked but declined

Ethnicity

Ethnicity values are also taken from the CDC Race & Ethnicity – CDCREC code system, matching OMB standards.

OMB minimum required ethnicity categories:

Code	Display
2135-2	Hispanic or Latino
2186-5	Not-Hispanic or Latino

Like race, you may include more granular ethnicity codes under these categories, though only the above two are required for minimum interoperability. The option of “Not Hispanic or Latino” has no subcategories.

Additional nullflavor options are also supported outlined below:

FHIR Code	Urn:oid	FHIR Display	C-CDA Code Note: C-CDA uses this ValueSet but then the template permits the use of NullFlavors	Urn:oid	C-CDA Display
ASKU	2.16.840.1.113883.5.1008	Asked but unknown	ASKU	2.16.840.1.113883.5.1008	Asked but unknown
UNK	2.16.840.1.113883.5.1008	Unknown	UNK	2.16.840.1.113883.5.1008	Unknown
Asked- declined	2.16.840.1.113883.4.642.4.1048	Asked but declined	Asked- declined	2.16.840.1.113883.4.642.4.1048	Asked but declined

Note: USCDI and HL7 Implementation

FHIR US Core Profile references these codes in:

• Patient.extension[race]

• Patient.extension[ethnicity]

HL7® FHIR® US Core Implementation Guide uses these extensions:

• http://hl7.org/fhir/us/core/StructureDefinition/us-core-race

• http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity

Both extensions support:

• OMB Category (required)

• Detailed code (optional)

• Text (optional narrative)