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New Paper Shows That Electronic Health Records Can Be Used As A Tool To Advance LGBTQIA+ Health Equity

BOSTON, November 22, 2021—A paper published in Nature Medicine outlines the ways in which electronic health records can be used as a tool to reduce health disparities affecting LGBTQIA+ people. The paper is part of Nature Medicine’s “Series on Diversity, Equity and Inclusion,” and anchors the journal’s reporting on how lack of diversity in medical research data affects patient populations. Authored by Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program, the paper details how sexual orientation and gender identity (SOGI) data collection can improve patient and community care and offers actionable ways to implement SOGI data collection in healthcare settings.

“There is no doubt that collection of basic information related to sexual orientation and gender identity improves the experiences of sexual and gender minorities in healthcare settings,” said Keuroghlian. “But most clinicians do not discuss sexual orientation or gender identity with their patients out of concern about causing patient discomfort or offense, because they are unaware that this information is relevant to patient care.”

The paper, titled “Electronic health records as an equity tool for LGBTQIA+ people,” demonstrates that collecting SOGI data can reduce clinical errors and insurance reimbursement denials for necessary interventions and preventative screenings, such as failing to offer or pay for routine cervical Pap tests with trans masculine patients who retain a cervix. Collecting SOGI data also provides clinicians with information that they can then use to proactively address issues relevant to sexual and gender minority patients, such as offering effective advice on how to maintain sexual health during the pandemic or reduce risk for HIV transmission.

Healthcare organizations that collect and analyze SOGI data have identified disparities based on sexual orientation, gender identity, or both, in screening rates among patients for cervical cancer, depression, and tobacco use. In addition to identifying and addressing these disparities, other examples of the ways in which collecting and analyzing SOGI data may advance LGBTQIA+ health equity including the following:

  • Helping to understand and reduce disparities related to SARS-CoV-2 in testing, infection, outcomes, and vaccination among sexual and gender minority populations experiencing adverse social determinants of health.
  • Incorporating gender identity data collection during isotretinoin prescription registration for treating severe acne could prevent teratogenicity among people who can become pregnant and do not identify as female.

Implementing SOGI data collection can begin by inclusively revising language in the forms that patients are asked to fill out and by training patient-facing staff and clinicians in how to inclusively address patients.

“All healthcare staff should be required to have training to mitigate the adverse impact of implicit bias against sexual and gender minority patients and clinician education ought to emphasize mastery of basic concepts related to sexual orientation, gender identity and sex development, how to sensitively and effectively communicate with LGBTQIA+ patients, and how to build inclusive and affirming healthcare environments for LGBTQIA+ communities,” added Keuroghlian.

To advance SOGI data collection throughout systems of healthcare research, treatment, and prevention, people with diverse sexual orientations, gender identities, and sex development should be recruited and financially compensated for work in EHR-related technology, protocols, and policy design.

“Community advisory boards that influence organizational leadership and service delivery ought to include LGBTQIA+ people,” said Keuroghlian. “They should also be included on medical coding boards that inform administrative classification and billing for health services and hold meaningful positions in health data standards development organizations, such as the Health Level Seven International Gender Harmony Project.”

“Electronic health records as an equity tool for LGBTQIA+ people” is available online here. It is the latest in a series of papers by Fenway Health-affiliated scientists, researchers, and clinicians that study ways to advance LGTQIA+ health equity. Other recent papers include “Still in the Dark Regarding the Public Health Impact of COVID-19 on Sexual and Gender Minorities,” published in the American Journal of Public Health; “Organizational Strategies and Inclusive Language to Build Culturally Responsive Health Care Environments for Lesbian, Gay, Bisexual, Transgender, and Queer People,” published in the Journal of Health Care for the Poor and Underserved; and “City-level Structural Stigma and Patient Sexual Orientation and Gender Identity Data Collection at U.S. Health Centers, 2018,” published in the American Journal of Public Health.

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