Treating LGBT Status as a Patient
By Sally Deming, RHIT; Julie Dooling, MSHI, RHIA, CHDA; Lesley Kadlec, MA, RHIA, CHDA; Annessa Kirby; and Megan Munns, RHIA
THE 2015 SUPREME Court decision requiring states to license a
marriage between two people of the same sex and to recognize
same sex marriage across state lines has widespread implications for health records management. 1
This article will describe these implications and issues of importance to health information management (HIM) professionals in addressing some unique needs of the lesbian, gay, bisexual, and transgender (LGBT) population.
HIM’s Role in Data Collection
Beginning or enhancing the collection of demographic, social,
and clinical information about a provider’s LGBT patient population is an important initiative that should be on all HIM professionals’ to-do list. Developing and refining healthcare processes,
culture, and systems to include key data elements for these patients is critical to ensuring patient care providers have important
information to effectively treat patients and interact respectfully.
Traditional health information technology (HIT) barriers still
need to be addressed. For example, the identification of gender
can be an issue. Healthcare documentation systems typically
contain gender selection of male, female, “unknown,” indeterminate, or “other” on forms or electronic health records (EHRs).
Gender as a data component often helps determine which tools
are available (such as templates) to help providers treat a patient and order ancillary testing. Gender-related data is also sent
via interfaces to ancillary systems, and then those systems use
gender to report acceptable result ranges to providers.
Utilizing “other” and “unknown” options for gender can be of-
fensive to patients. Patients know their gender even if it is not
recognized by technology. One way to consider addressing this
is to expand the gender pronoun list. The term “unknown” does
have its place in the record, such as in situations with trauma
patients or newborns that require surgery immediately after
birth. For example, some infants may require immediate sur-
gery after birth, but orders may need to be placed in advance of
the delivery. So orders placed for the newborn prior to delivery
may need to indicate the gender as “unknown.”
Other examples of barriers or potential issues include the follow-
ing. Collecting a patient’s next of kin data, such as parents, spouses,
etc., is important for communication with key family members.
Fields to collect these important data elements must have flexibil-
ity to accurately identify the relationship. 2 For example, husband/
wife/spouse, mother/father, and marital status are fields that in
today’s systems may not be inclusive of LGBT patients. System
designers need to be mindful of the need for additional responses
when building a structured format to capture this information.
HIM professionals should work with their vendor to ensure their
systems are updated to include options for the LGBT population.
HIM professionals should also inquire about retrofitting these new
data elements into prior versions once they become available.
Patients undergoing a gender transition should have the flex-
ibility to identify their preferred gender throughout the transi-
tion process. Healthcare and billing systems must provide some
flexibility in allowing for “sex assigned at birth” and “preferred
gender,” which can change throughout the process.
A patient’s preferred pronoun and preferred name are also key
data fields that assist with interactions between patient and pro-
vider. Preferred pronouns may include he, she, they, etc. Preferred
name is the name the person prefers to be called, such as “Caitlyn”
instead of “Bruce” in the recent famous transgender case of Caitlyn
Jenner. Furthermore, a history of the patient’s historical names is
also important for patient matching and sharing data across multi-
Navigating Privacy & Security / e-HIM Best Practices / Standards Strategies / Road to Governance
Working Smart a professional practice forum