How EHR Functionality Can Support Gender-Affirming Care, Health Equity

"There's so much in a name," according to Allyson Livingstone, PhD, executive director of diversity and inclusion at athenahealth, an health IT vendor that recently created EHR functionality to improve health equity by optimizing clinical documentation for gender-affirming care.

The capabilities enable the documentation of the patient's name used, legal name, gender identity, pronouns, and gender or sex assigned at birth throughout all appropriate workflows.

Livingstone said that this change in EHR functionality will help improve the patient experience for marginalized groups and drive positive health outcomes.

"For some people, it might feel like such a small tweak to ensure that folks are being referred to correctly, but this is a huge deal when folks have been excluded from a space for so long," Livingstone told EHRIntelligence in an interview. "To see themselves reflected in affirming ways in that space will bring folks into the healthcare setting, which ultimately drives positive healthcare outcomes."

Livingstone explained that transgender and non-binary patients face many barriers while accessing healthcare.

"When trans and non-binary folks access care, perhaps they are greeted in ways that are assuring at the front of the office visit, but they are inconsistently cared for in a holistic manner, where folks are thinking about their physical, mental, social, and health needs and wellbeing while also respectfully affirming their gender," Livingstone said.

That level of inconsistency leads to a negative healthcare experience, she noted.

"When groups of people move into the healthcare setting and they're not even sure if their provider will use the right name for them, it creates a condition of fear," Livingstone explained. "When people feel fear in healthcare settings, they are less likely to access those settings repeatedly, and we know that preventive care leads to positive health outcomes."

Additionally, transgender and non-binary patients often are left to teach their providers about particular issues they experience in the community.

Livingstone noted that 29 percent of transgender patients report having to educate their healthcare provider on trans health issues.

"This means that there are groups of patients who go into health settings, and they're not sure if that provider will be truly prepared to engage with them," she noted. "When we're talking about health issues, that's such a vulnerable place."

There's also a lack of ongoing education for providers regarding the nuances of working with trans patients, which becomes even starker when other social determinants of health come into play.

For instance, trans people of color and trans people with disabilities face additional barriers that are important to consider, Livingstone said.

"Our goal at athenahealth is to help providers in this process by leveraging the technology that will help them consider the many different ways that patients show up in spaces," she emphasized.

"Gender is a complex, multifaceted space," Livingstone said. "These enhancements and the reflections that come off of these enhancements impact all of us in different ways because it means your provider is thinking holistically about your particular context and what you bring into the space."

Livingstone explained that the enhancements will drive reassurance and trust, two conditions that anyone would want to experience in the treatment space, regardless of identity.

The gender-affirming EHR enhancements originated from multiple athenahealth events.

In May 2021, the company's corporate social impact program, athenaGives, hosted the Hack for Health Equity event. Two dozen teams from across office locations, cohorts, and divisions collaborated to identify and submit solutions to the industry's most significant health equity challenges.

The team that proposed the gender-affirming care functionality moved forward into the company's first-ever Codefest. More than 100 employees came together to design, develop, test, and release production-quality features to customers across athenaOne in just five days.

Livingstone noted that these product enhancements are just the tip of the iceberg regarding athenahealth's work to support health equity.

"As we start deepening our understanding about health equity data and the ways to leverage it, we're going to be expanding how we're thinking across identities," she said. "It makes us think about race, color, disability, age, sexuality, and language differently because groups within groups are currently being excluded from appropriate affirmative healthcare."

"As we deep-dive into these areas, we have an opportunity to impact many other groups, providers, and clients," she pointed out. "This is part of a beginning of a journey, and there's so much more work for us to do. This gender-affirming care piece is only one example of our commitment to making sure every patient feels safe and supported by the medical space."

Livingstone said that athenahealth plans to continue its Hackathon Codefest model to foster innovation to solve some of healthcare's most complex issues.

"It's not just about us at athena talking to one another to get this done," she emphasized. "It's about engaging with external partners and with the data to embrace this mutual conversation of innovation."

"One of the major goals of diversity and inclusion is bringing people with different perspectives together to innovate," Livingstone added. "This is an incredible opportunity, not just for us to be industry leaders in this space, but to engage external markets and external sources of data and subject matter expertise so that we are impacted by our environment, and they're impacted by us."

"Being part of a healthcare ecosystem is about partnership," she said. "To live it out loud and end up with these kinds of product enhancements is incredible."