The Office of the National Coordinator for Health IT's rule implementing Stage 3 of Meaningful Use, which requires certified electronic health record technology to include sexual orientation (SO) and gender identity (GI) fields, is a "historic" advance in health for lesbian, gay, bisexual and transgender (LGBT) people, according to a team of researchers from Boston, the District of Columbia and San Francisco.
In an article published in the journal LGBT Health, the authors, from the Fenway Institute, Harvard Medical School and Northeastern University in Boston; the Center for American Progress in Washington, D.C.; and the University of California, San Francisco, call the inclusion of this information in the demographic section of EHRs a "critical step" in making LGBT data collection standard in clinical settings. It will enable such patients to obtain better care because it will provide clinicians with a more accurate understanding of the patient's life and possible health needs, they say, and also will facilitate population-specific data analysis.
"Certainly, including SO/GI in the Meaningful Use incentive program is one of the most important things the U.S. government has done to promote better understanding of LGBT health disparities and interventions to reduce them," the authors say. "Comprehensive and accurate patient data are an indispensable component of efforts to assess health risks and disparities of particular populations and to build a truly patient-centered healthcare system. Among the data that are relevant for these efforts are demographic data on various aspects of patient identity."
They recommend that clinicians collect information on a patient's assigned sex at birth, his or her gender identity and preferred name and pronouns. They also suggest that providers be better trained to collect and use SO/GI data, that vendors developing these fields into their EHR infrastructure obtain any necessary assistance in doing so, and that patients be educated about the importance of providing the information.
They also suggest that privacy, confidentiality and non-discrimination issues be addressed.
There have long been concerns that LGBT patients suffer health disparities such as higher rates of sexually transmitted infections, HIV and behavioral health issues. However, clinicians often don't inquire about SO and GI, missing an opportunity to treat these conditions. Some clinicians are also biased against such patients.
The Institute of Medicine was one of the first stakeholders to recommend that EHRs be used to gather data to address the unique healthcare needs of LGBT patients.
To learn more:
- read the article