A new field is beginning to pop up on patient registration forms: preferred pronouns. The healthcare industry, notoriously slow to change culturally and technologically, is beginning to speed up in both areas when it comes to gender identity.
To do that, electronic health record vendors and health systems alike are pushing to include gender identity alongside other patient information. As with any piece of data in an EHR, the question is where to put it, which options to include, and what to do with the information once it's there.
But there's a problem: The healthcare industry doesn't like gray areas, and gender identity can be one such area. "From the technical standpoint, electronic health records are structured in such a way where it allows the clinician to capture information that's binary when we're working with a community that's not binary," said Toby Weiss, director of cultural sensitivity at MJHS Health System in New York City.
Indeed, a gender identity can literally be nonbinary. So in the face of software that only has two options, health system informatics directors and others are demanding that their EHR vendors give them ways to describe people whose identities don't fit "male" or "female."
The government is demanding the same—if meaningful use requirements hold, that is. As regulations currently stand, providers must use 2015 edition certified EHRs beginning in 2019; these EHRs must provide fields for recording gender identity, as well as a patient's sex. The Joint Commission also recommends that providers incorporate gender information into patient records—when patients are willing to disclose that information.
Not only does inclusion of such information lead to more compassionate, empathetic care, but it also leads to higher-quality care, Weiss said. "The biggest problem is that EHRs don't allow for fields to capture information that accurately reflects the needs of patients, which can lead to a ripple effect of how care is delivered."
It also doesn't bode well for patient satisfaction. One-third of people surveyed by the National Center for Transgender Equality who saw a healthcare provider in the previous year had at least one negative healthcare experience that involved their gender identity. And 8% of those surveyed who saw a provider in the previous year said clinicians refused to deliver transition-related care because of their gender identity.