How health IT can advance health equity for transgender and nonbinary patients

Photo: athenahealth

The Biden Administration recently issued an executive order advancing LGBTQ+ health equity.

Health IT experts contend technology can advance health equity for the transgender patient population, as this group has traditionally been marginalized by the healthcare industry. In fact, evidence shows transgender people experience much higher rates of chronic health conditions compared with the general population – and discrimination and stigma impacts their physical and mental health.

athenahealth, a vendor of cloud-based enterprise software – including EHRs – for medical groups and health systems, and epocrates, an athenahealth company that serves essential clinical content to more than one million physicians, nurses, pharmacists and other healthcare professionals, are taking steps to empower clinicians and health systems to better serve transgender patients.

athenahealth recently introduced a new capability to its EHR that allows providers to record and display important information in a patient’s chart including pronouns, name used (plus legal name), and gender identity (plus gender assigned at birth). Further, epocrates recently introduced a new clinical guidance that gives clinicians access to the latest transgender care guidance at the point of care.

Allyson Livingstone is executive director of diversity and inclusion at athenahealth. Dr. Acey Albert is director of clinical content at epocrates.

Healthcare IT News interviewed them to learn from Livingstone EHR technology’s role in helping health systems create a more welcoming space for transgender patients and how this can ultimately improve health outcomes and from Albert insight into the challenges clinicians face due to the current gaps in transgender care guidance and the growing need for technology to help clinicians find accurate information as care guidance evolves.

Q. Why did athenahealth and epocrates take steps to record transgender information in EHRs and provide transgender care guidance?

Livingstone: The transgender and non-binary communities are vulnerable patient populations that have traditionally been marginalized by the healthcare system. As a result, they’re at a much higher risk for negative health outcomes – evidence shows transgender and non-binary patients experience much higher rates of chronic health conditions, mental illness, and sexual and physical violence compared with the general population.

This is our reality because the LGBTQ+ community often feels unwelcome and discriminated against within the healthcare system. Research from the Center for American Progress has found that 15% of LGBTQ Americans said they’ve avoided medical care due to discrimination and one in three transgender patients had to educate their doctors on trans health.

In response to these inequities, we saw a way to address many of these concerns and help patients feel seen and heard with a new EHR functionality. The technology records a transgender patient’s information (for example, gender assigned at birth, pronouns, preferred name and more) and displays this information to providers in an accurate and comprehensive manner throughout important steps in the healthcare journey.

While it may seem like a minor adjustment, the positive impact of the enhancement is far-reaching. By bringing these aspects of patient identities and experiences into the treatment space, we can ultimately create a more welcoming healthcare environment that eliminates feelings of fear or isolation and leads to better health outcomes for all.

Albert: At epocrates, we provide qualified expert guidance from trusted global and national medical societies and associations, so that clinicians can provide high-quality and personalized care to all patients, including those in the non-binary and transgender communities.

“Far too often, transgender patients have to educate their own doctors on trans health, and it shouldn’t be this way.”

Dr. Acey Albert, epocrates

We placed a strong focus this year on adding gender-affirming care clinical guidelines within our app because unfortunately there are still glaring gaps in the industry when it comes to accessing and leveraging transgender care guidance.

And especially as misinformation spreads and transgender healthcare rights are under fire with new legislation being proposed across the country, we needed to do our part as curators of clinical information to be sure that clinicians have the most accurate and up-to-date care guidance at the point of care when treating transgender patients.

With athenahealth’s EHR functionality and our updated clinical guidance, I really believe that we can help foster a more welcoming and supportive healthcare system for transgender and non-binary patients.

Q. What does the transgender update do in the athenahealth EHR, and what must physicians and nurses do?

Livingstone: This specific product enhancement is a patient registration solution that lives within our athenaOne platform. It enables the accurate labeling of a patient’s name, gender identity and pronouns, in addition to their legal name and gender assigned at birth.

Like any doctor’s visit, the patient will complete an intake process. However, our technology allows patients to share their gender information, if they’re comfortable doing so, with their provider ahead of the appointment.

The technology then records this data and presents it to clinicians and administrative staff throughout every step of the patient’s healthcare journey – including registration, scheduling, check-in, checkout, patient communications, all the way through to billing, follow-up and beyond.

The technology doesn’t tack on any additional work for the clinicians or administrative staff. It only brings this important data to the forefront, empowering healthcare providers to leverage the correct data points over time so their patients receive the most personalized, gender-affirming and appropriate care.

The goal with this specific enhancement is to enable a more inclusive healthcare experience by improving the usability and visibility of a patient’s preferred name, gender identity and pronouns. More broadly, this is just one aspect of our continued goal to improve health equity.

The initiative was born out of our first-ever company-wide hackathon in 2021, Hack for Health Equity, in which groups of employees from across the country brought a range of solution ideas, whether code-based or creative, to the table to bridge the gap of equity across the healthcare ecosystem.

Given the positive impact we’ve seen from this innovation, we’ll continue to sharpen our focus on how we can innovate to advance health equity and build a thriving and supportive healthcare ecosystem.

Q. What is the nature of the epocrates transgender care guidance, and how do physicians and nurses access and use it?

Albert: Physicians and nurses can access the interactive care guidance tool for free through the epocrates mobile app, which is designed to be accessible at the point of care to support clinical decision making.

Our care guidance sources and consolidates the latest up-to-date guidelines from four major organizations: World Professional Association for Transgender Health (WPATH), Endocrine Society, American Academy of Pediatrics (AAP), and American College of Obstetrics and Gynecology (ACOG).

With so much misinformation spreading on the topic of transgender healthcare, we felt responsible for making sure clinicians had fast and digestible access to the most accurate care guidance, especially since there is still so much to learn on this topic from the clinical perspective.

Additionally, the tool includes guidance to help clinicians interact with transgender patients and approach care with a more inclusive mindset. One example includes cancer screening guidelines.

We incorporated gender-neutralized terminology and transgender-specific recommendations for cervical cancer, breast cancer and prostate cancer screening guidelines. We also incorporated guidance on how clinicians can normalize gender expression and encourage a multidisciplinary care environment when treating patients.

Q. How does health IT create a more welcoming space for transgender patients? And how can this ultimately improve health outcomes?

Livingstone: Health IT creates opportunities for healthcare providers to help all patients feel seen. For transgender people specifically, when they can see themselves genuinely reflected within their interactions with the healthcare system, they’re more likely to place trust in their providers.

Additionally, with the ability to understand a transgender patient’s whole identity during care, clinicians can think more holistically when treating them. While subtle, these changes are major steps to building trust, which advances health equity and positive health outcomes amid the trans and non-binary populations.

As more healthcare practices place a focus on respectfully affirming their patient’s gender throughout care, we’re continuing to learn about the nuances of trans healthcare and navigate how technology can play a larger role in this journey.

Albert: Far too often, transgender patients have to educate their own doctors on trans health, and it shouldn’t be this way. The HIT industry, particularly companies that create clinical decision support technology, can play an important role by serving up education that most medical schools currently don’t provide on caring for transgender and non-binary patients.

By equipping clinicians with the most modern tools, resources and insights, they will be able to better support and deliver the most personalized care to these marginalized patient populations, which will in turn lead to better patient experiences and outcomes.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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