Anatomy, Gender EHR Integrations Boost Clinical Decision Support

Anatomical inventory and gender identity EHR integrations could help provide gender-affirming care for transgender and gender diverse (TGD) patients by recognizing each patient’s unique gender identify for clinical decision support and population health management, according to a study published in JAMIA.

While some TGD patients undergo gender-affirming interventions such as hormone therapies, hysterectomy, and breast augmentation, others do not undergo any medical or surgical procedures.

For providers to deliver patient-centered care, they must be aware of each patients’ unique gender identity, as well as their anatomy and any surgical procedures they may have undergone.

To keep record of each TGD patients’ medical history, the study authors recommended that hospitals and community health centers integrate anatomical inventories into EHRs. These EHR integrations would allow clinicians to document gender-affirming surgeries and track the presence or absence of specific organs in order to inform preventive health screenings and care plans.

“A clinician who is using an EHR system that does not include an integrated anatomical inventory may be prompted to recommend a Pap test to a transgender man who does not retain a cervix after gender-affirming surgery, because the only information in the EHR system about that patient’s organs may be based on a female sex assigned at birth,” Alex Keuroghlian, MD, MPH, senior author explained in a public statement.

“These are the types of mistakes that can increase mistrust in doctors and the medical system in general among transgender and gender diverse patients and lead to patients simply avoiding care,” continued Keuroghlian, who serves as director of education and training programs at The Fenway Institute. “This contributes to the disparities in health experienced by transgender and gender diverse people. The tools now exist to reduce these mistakes, and hospitals and community health centers should be using them.”

The study authors also suggested that health IT developers implement gender identity, sex assigned at birth, and anatomy data into clinical decision support tools and population health management systems.

“Clinicians use their best judgment based on experience and wisdom to provide quality care, but they also rely on clinical decision support tools derived from information in electronic health records,” noted Chris Grasso, MPH, lead author and associate vice president for informatics and data services at Fenway Health.

“Given the significant disparities in health that transgender and gender diverse people experience in comparison with their cisgender peers, it is incumbent upon health care systems and health information technology vendors, including electronic health records, to improve clinical care for these patients,” Grasso continued.

The study also noted the value anatomical inventories could have on population health management. Healthcare systems could use anatomical inventory data to create internal dashboards for care disparity detection.

For example, the study authors noted that a customized dashboard with anatomical inventory data may show that in the last year, only 60 percent of TGD patients received depression screening in primary care, compared to 85 percent of cisgender women and men. From there, the care team could review records and speak with providers to investigate potential reasons for the disparity.

“Without these customizable dashboards, it can be very difficult to detect disparities in care among patient populations. If disparities exist but cannot be measured, it is often impossible to address them,” noted co-author Hilary Goldhammer, SM.

The study authors also pointed out the importance of data interoperability when treating this population, as TGD patients may access care and services from several sites, such as clinics, hospitals, and pharmacies.

To promote care coordination, the researchers called for organizations, such as Health Level Seven International (HL7), to develop standardized terminology and fields that capture gender identity, sex assigned at birth, name and sex on insurance, name used, pronouns, and the anatomical inventory.

Interoperability of this data would allow providers who are seeing a patient for the first time to address the patient using their correct name and pronouns.

“EHR systems that integrate gender identity and anatomical inventories, and reference those fields and forms to produce clinical recommendations, identify health disparities, and promote culturally responsive communication, will allow for more tailored, gender-affirming, and timely care for patients,” said Julie Thompson, PA-C, co-author and medical director of trans health at Fenway Health.