Feds: Gender-Inclusive EHR Data Standards Support Health Equity

Gender-inclusive EHR data standards are essential for achieving health equity, Steven Posnack, deputy national coordinator for health IT wrote in a recent ONC HealthITBuzz blog post.

Posnack noted that in a field like healthcare where precision is vital, it is ironic how unstandardized and ambiguous EHR documentation practices are for sex and gender across the industry.

Misunderstanding the meaning, context, and expected use of sex and gender identity can significantly impact patient safety and care quality, Posnack pointed out.

“This ranges from missing preventative screening notifications to inaccurate reference ranges on lab tests, all the way to denied claims because the patient’s ‘administrative sex’ on the clinical side didn’t match their ‘gender’ on the health insurance side,” he said.

Earlier this month, Posnack and several co-authors published a study in JAMIA that outlined a conceptual HL7 model for clinical EHR documentation that aims to more accurately record patients’ sex and gender within the EHR to boost care delivery for gender-marginalized patients.

The HL7 Gender Harmony Logical Model has five major elements:

• Gender identity (GI): an individual's personal sense of being a man, woman, boy, girl, or something else.
• Sex for clinical use: a summary sex classification element based on clinical observations like organ survey, hormone levels, and/or chromosomal analysis.
• Recorded sex or gender (RSG): sex values or gender values that are specified administrative documents such as identity cards or insurance cards.
• Name to use (NtU): the name that the patient wishes to use in healthcare interactions.
• Pronouns: the English language third-person personal pronoun determined by the patient for use in healthcare interactions, clinical notes, and written instructions to caregivers.

“Future interoperable transactions including this information will provide the specificity and precision that’s sorely lacking right now,” Posnack noted in the blog post. “It will take time to see these new concepts take shape in the health IT ecosystem. But as we look to promote a more inclusive healthcare system, it is hard work worth doing.”

The study authors noted in the article that they have begun working with the HL7 community of standards to incorporate the proposed changes into each of the existing HL7 data standards: V2, CDA, and FHIR.

“When these improvements are implemented based on standards accompanied by certification expectations, exchange of these data between healthcare organizations will improve the patient experience by reducing requirements for data re-entry and improving the reliability of sex and gender information made available to clinicians, enabling quality care relationships for gender-marginalized people from intake,” the researchers wrote.