Overcoming technical and cultural challenges to delivering equitable care for LGBTQ+ individuals in a rural, underserved area

Improving radiology information systems for inclusivity of transgender and gender-diverse patients: what are the problems and what are the solutions? A systematic review

INTRODUCTION

In medical radiation science (MRS), radiology information systems (RISs) record patient information such as name, gender and birthdate. The purpose of RISs is to ensure the safety and well-being of patients by recording patient data accurately. However, not all RISs appropriately capture gender, sex or other related information of transgender and gender-diverse (TGD) patients, resulting in non-inclusive and discriminatory care. This review synthesises the research surrounding the limitations of RISs preventing inclusivity and the features required to support inclusivity and improve health outcomes.

METHODS

Studies were retrieved from three electronic databases (Scopus, PubMed and Embase). A quality assessment was performed using the Johns Hopkins Nursing Evidence-Based Practice Research and Non-Research Evidence Appraisal Tools. A thematic analysis approach was used to synthesise the included articles.

RESULTS

Eighteen articles were included based on the predetermined eligibility criteria. The pool of studies included in this review comprised primarily of non-research evidence and reflected the infancy of this research field and the need for further empirical evidence. The key findings of this review emphasise how current systems do not record the patient's name and pronouns appropriately, conflate sex and gender and treat sex and gender as a binary concept.

CONCLUSION

For current systems to facilitate inclusivity, they must implement more comprehensive information and data models incorporating sex and gender and be more flexible to accommodate the transient and fluid nature of gender. However, implementation of these recommendations is not without challenges. Additionally, further research focused on RISs is required to address the unique challenges MRS settings present to TGD patients.

Analyzing Patient-Provided Responses to Improve Collection of Health Equity Data Elements

Self-report is purported to be the gold standard for collecting demographic information. Many entry forms include a free-text "write-in" option in addition to structured responses. Balancing the flexibility of free-text with the value of collecting data in a structured format is a challenge if the data are to be useful for measuring and mitigating health disparities. While much work has been done to improve collection of race and ethnicity information, how to best collect data related to sexual and gender minority status and military veteran status has been less commonly studied. We analyzed 3,381 patient-provided free-text responses collected via a patient portal for gender identity, sexual orientation, pronouns, and veteran experiences. We identified common responses to better understand our patient population and help improve future iterations of data collection tools.

Analysis of Inclusive Gender, Sexuality and Sexual Orientation Data Elements in Academic Electronic Health Records

Findings from an analysis of three vended academic electronic health records used in health science education are presented in this article. The quality assurance project examined the lexical and semantic fit and content coverage of gender, sexuality, and sexual orientation data elements within the academic electronic health records. A semantic comparative content analysis using a cognitive walkthrough was conducted as a means of comparing the ideal set of gender, sexuality, and sexual orientation data elements with those found in the three vended academic electronic health records. The results indicated a need for alignment to the research literature, expert consensus, and technical standards similar to what is expected for electronic health records used in clinical practice because of a lack of ideal state data elements. The findings align with ongoing issues with bias and disparities seen in the care of the lesbian, gay, bisexual, and transgender population and a lack of diverse, inclusive media and teaching technologies in health science education. The quality project and findings can inform academic electronic health record vendors on how they can create more inclusive systems and bring awareness to healthcare educators about the potential for implicit and explicit bias in their teaching technologies.

Self-Reported Barriers to Care Among Sexual and Gender Minority People With Disabilities: Findings From The PRIDE Study, 2019-2020

Objectives. To examine the associations of self-reported disability status with health care access barriers for sexual and gender minority (SGM) people. Methods. The Population Research in Identity and Disparities for Equality (PRIDE) Study participants lived in the United States or its territories, completed the 2019 annual questionnaire (n = 4961), and self-reported their disability and health care access experiences, including whether they had a primary care provider, were uninsured, delayed care, and were unable to obtain care. We classified disabilities as physical, mental, intellectual, and other; compared participants to those without disabilities; and performed logistic regression to determine the associations of disability status and health care access barriers. Results. SGM people with disabilities were less likely to have a usual place to seek health care (69.0% vs 75.3%; P ≤ .001) and more often reported being mistreated or disrespected as reasons to delay care (29.0% vs 10.2%; P ≤ .001). SGM people with disabilities were more likely to delay care (adjusted odds ratio [AOR] = 3.28; 95% confidence interval [CI] = 2.83, 3.81) and be unable to obtain care (AOR = 3.10; 95% CI = 2.59, 3.71). Conclusions. Future work should address culturally competent health care to ameliorate disparities for the SGM disability community. (Am J Public Health. 2023;113(9):1009-1018. https://doi.org/10.2105/AJPH.2023.307333).

Patterns of gender identity data within electronic health record databases can be used as a tool for identifying and estimating the prevalence of gender-expansive people

Objective

Electronic health records (EHRs) within the United States increasingly include sexual orientation and gender identity (SOGI) fields. We assess how well SOGI fields, along with International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes and medication records, identify gender-expansive patients.

Materials and Methods

The study used a data set of all patients that had in-person inpatient or outpatient encounters at an academic medical center in a rural state between December 1, 2018 and February 17, 2022. Chart review was performed for all patients meeting at least one of the following criteria: differences between legal sex, sex assigned at birth, and gender identity (excluding blank fields) in the EHR SOGI fields; ICD-10 codes related to gender dysphoria or unspecified endocrine disorder; prescription for estradiol or testosterone suggesting use of gender-affirming hormones.

Results

Out of 123 441 total unique patients with in-person encounters, we identified a total of 2236 patients identifying as gender-expansive, with 1506 taking gender-affirming hormones. SOGI field differences or ICD-10 codes related to gender dysphoria or both were found in 2219 of 2236 (99.2%) patients who identify as gender-expansive, and 1500 of 1506 (99.6%) taking gender-affirming hormones. For the gender-expansive population, assigned female at birth was more common in the 12-29 year age range, while assigned male at birth was more common for those 40 years and older.

Conclusions

SOGI fields and ICD-10 codes identify a high percentage of gender-expansive patients at an academic medical center.