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.
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Explore This IssueJune 2018
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“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.”
Susan Bernstein is a freelance medical journalist based in Atlanta.
Sex & Gender: Useful Terms
Transgender: Gender identity that doesn’t conform with a person’s assigned sex at birth. Also called “trans” for short. May not reflect hormonal makeup, sexual orientation or physical characteristics.
Cisgender: A person who identifies with their assigned sex at birth. Also called “cis” for short. This term may not reflect hormonal makeup, sexual orientation or physical characteristics.
Genderqueer: Someone who may not define themself as either male or female gender, or does not wish to conform to binary gender identities or labels.
Intersex: A group of chromosomal conditions that involve a discrepancy between a person’s external genitalia and internal genital organs, such as ovaries or testes. People who are intersex may have uncommon combinations of hormones, chromosomes and anatomical characteristics that are typically used to assign sex at birth.