Now Reading: Electronic medical records and the transgender patient – to eliminate, not create, disparities

WPATH recommends1—in concert with policy statements from the American Medical Association,2 the American Psychiatric Association,3 the American Psychological Association,4 the American College of Obstetricians and Gynecologists,5 and the Center of Excellence for Transgender Health at the University of California, San Francisco6—that the healthcare needs of transgender people should be openly and properly addressed, at the same level of quality and thoroughness as is afforded to any other person.

This just published paper (unfortunately behind a paywall, but(no longer behind a paywall, updated 8/11/14) you can access a summarized version at the website) explodes an inaccurate tenet within electronic health record systems – that a person’s sex and gender are tied together, and in turn fully inform a person’s medical destiny. This is not the case for a small percentage of patients.

It is recognized that the overwhelming majority of patients are not transgender, which has led to implementation of a binary male/female oriented system across multiple platforms such as EHR systems, billing and coding systems, and laboratory systems; however, this structure inhibits the collection of accurate medical information, and therefore such systems should be modified.

The paper describes a recommended two-step process to collect two pieces of information, gender identity and sex assigned at birth, that is already in use at the CDC. In addition, there are recommendations for recording preferred pronouns, common treatments and procedures, and status of a person’s transition and anatomy. In 2010 The Institute of Medicine recommended that gender identity be accurately collected in electronic health records and be part of meaningful use.

The Working Group producing the recommendations is EHR experienced and the ideas make sense in terms of what is doable in an electronic health record. The alternative today is not very healthful for this population – having to change the “sex” field back and forth to order necessary preventive exams, or to not have ready access to transition history or preferred pronouns in establishing a relationship.

As WPATH guidelines become followed more regularly and medically necessary services are covered and performed across health care (37 Universities and counting), the health of trans people will be more and more about ongoing preventive care, just like the population at large.

Why do this?

A recent non-peer reviewed report on transgender discrimination showed some 28% of respondents had experienced harassment in a clinic setting and that 2% had been subject to physical abuse.12

Electronic Health Records are for health, and should not codify or indirectly create misunderstanding in the clinical setting. The results can be devastating. Fortunately, health information technology can be used to eliminate disparities in health instead of creating them.

I love hearing about great things HIT “does” for people rather than what HIT “is,” don’t you? 🙂

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Ted Eytan, MD