When & How to Talk to Your Patients About Their Gender & Sex

“Given the negative experiences many transgender and other gender-nonconforming patients experience in the healthcare system, it is important to capture gender identity in the EHR to study outcomes and uncover health disparities,” says Jinoos Yazdany, MD, MPH, associate professor of medicine at the University of California, San Francisco, and chair of the ACR’s Committee on Registries & Health Information Technology. The ACR’s qualified clinical data registry, Rheumatology Informatics System for Effectiveness (RISE), collects data on sex. RISE downloads information directly from users’ EHR systems. Dr. Yazdany says, “EHRs increasingly have the functionality to record gender identity, but as we look across RISE practices, few rheumatologists are using this functionality.”

In 2015, the Hospital for Special Surgery implemented mandatory training for registration and patient access staff on LBGT healthcare disparities, sensitivities and potentially challenging patient scenarios, says Ms. Rose. These moves were in response to new regulations designed to reduce health disparities in the LGBT population in the Affordable Care Act and from the Centers for Medicare and Medicaid Services (CMS), as well as best practices suggested by hospital accreditation organizations, such as the Joint Commission, that call for improving patient–provider communications, she says.

“If a clinician [selects] the chart of a patient who identified as intersex or [noted] their gender identity as different from their birth sex, before the clinician [accesses] the chart, a best practice warning pops up” that alerts the clinician to use the preferred name and pronoun, and prompts them to ask particular questions during the patient assessment, she says. These functions can make the clinic experience feel more inclusive to transgender or intersex patients, and aid the healthcare provider’s decision-making process, says Ms. Rose.

“If providers are aware of this information, they can provide screenings before surgeries, such as pregnancy testing for transgender male patients, and referrals for mammograms as appropriate. They can also refer transgender female patients for appropriate preventive screenings, such as a prostate exam,” she says.

If a patient’s birth sex does not match their gender identity, clinicians need to know that laboratory test values in the EHR may be atypical.

“Being aware of these issues is a key first step,” says Ms. Rose. “However, making the information relevant to clinical practice is critical.”