Patient Perspectives on Identifiers for Immigrant Patients in Electronic Health Records

Identifying immigrant patients within Electronic Health Record (EHR) systems has significant equity-related implications in care and research of immigrant populations in the United States (U.S.). This study builds upon previous work that utilized interviews with key stakeholders to determine effective, acceptable, and ethical identifiers for immigrant patients in EHRs; language, country of origin, time in the U.S., and race/ethnicity were determined suitable for use. Building upon these conclusions, we conducted interviews with non-English language preference (NELP) immigrant patients in the Emergency Department setting to glean their perspectives on the use of identifiers for immigrant patients in EHRs. Individuals endorsed language and country of origin as useful identifiers, but also expressed a general lack of understanding regarding what is documented in the EHR and why, along with significant concerns about potential implications related to the documentation of sensitive information. Given the rapidly shifting anti-immigrant policy landscape in the U.S., we maintain that providers seeking to utilize these identifiers to advance equity-centered clinical care and research must also exercise caution and consider all potential uses of these identifiers.