A team at Epic is working to integrate patients' gender identity information into EHRs despite facing a range of barriers, according to a Wired analysis.
Here are six things to know about the process.
1. The Epic platform initially only allowed entries for patients' sex assigned at birth or legal sex, which comprised three values: male, female or unknown. However, some healthcare and LGBT advocacy organizations have urged EHR developers to include gender identity information to improve physicians' ability to provide appropriate preventative screenings and risk assessments.
2. In January 2012, Epic software developer Janet Campbell — now vice president of patient experience at the company — presented Epic with her ideas on how to address the issue. She envisioned a design change that would utilize a two- or three-step sex and gender question, including sex assigned at birth, legal sex and gender identity.
3. However, integrating gender identity information into the EHR platform has proved more challenging than simply adding a new data value. The code referencing patient sex appears in a range of locations in the EHR, including the patient demographic header and in a section of code that ascertains whether a blood test is "normal," based on typical variation between males and females.
4. Since early 2016, a team at Epic has been reviewing each use of the patient sex code in the EHR, to determine whether the information is related to sex assigned at birth, legal sex or gender identity. Although the work is ongoing, the company released an update in June 2016 that involves a two-item gender identity question.
5. Ms. Campbell told Wired she estimates only 10 percent to 20 percent of Epic's EHR customers have turned on the update. One issue healthcare facilities face is determining whether the physician, registration desk or other staff members should take responsibility for collecting the additional information.
6. Healthcare facilities will need to address how to collect gender identity information in the near future as recent government mandates go into effect. For example, all outpatient clinics that receive federal incentive payments for EHRs must use software with sexual orientation and gender identity collection capabilities by 2018, according to ONC regulations.
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