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UC Davis Health System to Include Sexual Orientation, Gender as EHR Elements

June 21, 2013
by Rajiv Leventhal
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The University of California, Davis Health System will become the first academic health system in the country to incorporate sexual orientation and gender identity as standard demographic elements within the electronic health records (EHRs) for its patients, according to UC Davis officials.

The Sacramento-based health system’s physicians and patient advocates say the new measure is an important step toward improving health care for lesbian, gay, bisexual and transgender (LGBT) individuals who often have avoided medical clinics out of fear of being humiliated or rejected.

The health system posted a questionnaire that invites its patients to share their sexual orientation (attraction to one’s own gender or a different gender) and gender identity (the gender an individual identifies with) with their providers. The questionnaire is accessible to about 76,000 patients who use UC Davis’ secure, online communications system to schedule appointments, request prescription refills and exchange messages with their physician's office.

By having birth gender and current gender recorded in the medical chart, a patient’s physician would know to consider monitoring for more gender-specific health risks such as prostate or ovarian cancers. Likewise, knowing an individual’s sexual orientation could enable a physician to ask about family acceptance and support. Patients whose families were not accepting when they came out as lesbian, gay, bisexual or transgender, experience higher rates of suicidal thoughts and attempts, alcohol and drug abuse, and riskier sexual behaviors. They also suffer rates of depression six times higher than other populations. Having better and more complete patient information, including family history, allows a physician to consider a broader range of treatment options, which could include anything from medications to specialized counseling.

UC Davis Health System’s LGBT questionnaire is voluntary. It simply invites patients to declare their sexual orientation and gender identity as part of each individual’s highly confidential health record. Patients also will have the option of providing such information in person, during a clinic appointment, and choosing whether to have it recorded in the EHR. Each patient will also have the choice not to answer the questions at all.

“Patients and physicians, even in the clinical setting, are not very good at talking about sex,” Edward Callahan, professor of family and community medicine and one of the key coordinators for the new initiative, said in a statement. “Unfortunately, the problem is more than just one of embarrassment. LGBT individuals face significant health challenges that can be better addressed when a doctor’s office is seen as a truly welcoming and understanding environment. We’re inviting patients to voluntarily share their gender identity and sexual orientation information to help us create an atmosphere in which we’re able to provide the most knowledgeable and informed care possible.”

Other efforts have been underway to find ways to modify EHRs in order to meet the special needs of transgender patients, as seen in a recent article in JAMIA, titled “Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group.” HCI’s Editor-in-Chief Mark Hagland recently interviewed the lead author of that article in regards to the challenges and opportunities inherent in honoring the wishes and needs of transgender and gender-variant patients while working with EHRs.

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