The preferred language standard required for 2014 Edition EHR certification (adopted at 45 CFR 170.207(g)) is “ISO-639-2 alpha-3 codes limited to those that also have a corresponding alpha-2 code in ISO-639-1.”

For EHR technology certification purposes, EHR technology can be modified to include additional language codes beyond those identified in the adopted standard. We view the standard adopted for preferred language as the minimum amount of language codes that need to be supported by EHR technology for the purposes of certification. Thus, it is possible for EHR technology to include the full set of ISO-639-2 codes even though it will only be tested to a subset of those codes. For instance, we are aware that “sign language” and Hmong are not part of the constrained preferred language standard we adopted for EHR technology certification.

The Library of Congress’ Frequently Asked Question #24 on ISO-639-2 explains that the standard was “intended for written languages primarily.” For instance, “Chinese” is represented by its official language, Mandarin, in the code list. This would not account for the commonly spoken Cantonese language/dialect or other spoken Chinese languages/dialects. As a result, EHR technology developers may find that particular spoken languages are not in all cases sufficiently supported by the constrained standard we adopted.

We encourage interested stakeholders to review the related CMS FAQ 9208 on meaningful use objective and measure that includes preferred language.