Equity in the EHR

One of the initial challenges I faced while adjusting to my position at the Squirrel Hill Health Center was learning how to navigate the electronic health record. At first, it seemed impossible to track down the information I needed to schedule appointments for patients, but as time went on it became second nature. The EHR contains a patient’s entire story, with documentation of all of their previous office visits and diagnoses, current medications, referrals and imaging- it’s all there.

There was something that stuck out to me when I first explored the EHR- I was surprised that many of the categories seemed to be binary or heteronormative. For example, the only options for a patient’s current gender were male, female, or “undifferentiated”. A M,F, or U would appear right next to the patient’s name, with no options for non-binary individuals. When it came to sexual orientation, there were similar limited options: heterosexual, homosexual, bisexual, or “other”.

While there is some inclusivity, the limitation in the EHR has an unintended underlying message- if your gender identity or sexuality doesn’t fit into these boxes, you’re an “other”. One of my biggest concerns was that the EHR may cause patients to feel misrepresented or overlooked by their providers, and the healthcare system overall. Especially when it comes to a patient’s mental health and sense of autonomy, seeing that their identity isn’t validated by the healthcare system can be incredibly detrimental and unfair. In addition, if a patient’s sexuality is not accurately represented, they may miss out on crucial preventative care and pertinent health information.

Each month, NHC has nationwide training days where Corps members are able to learn more about relevant topics surrounding disparities in healthcare. RN Elizabeth Sekera (she/her) spoke on Affirming Sexual Orientation and Gender Identity in Healthcare. Elizabeth shared valuable information and insight on how important representation is in the EHR. This is one way through which providers can prevent patients from experiencing gender dysphoria, as well as anxiety surrounding their autonomy in the examination room. When a new provider is using the EHR as their main tool to learn a patient’s narrative, it’s important that the record reflects that patient’s identity. The EHR can also provide valuable data to increase patient-centered care. As stated in a recenet Nature Medicine article, “data on sexual orientation, gender identity and intersex status are required to inform research, engage in population-level monitoring, determine resource allocation and set policies that effectively address these inequities” (Keuroghlian, 2021).

In this case, there isn’t necessarily anyone in particular to blame; unfortunately the reason this EHR setup exists is because of logistical difficulties that can arise when it comes to insurance matters. Regardless, this inequity is present, and therefore needs to be addressed. Change happens slowly in the healthcare system, and hopefully we will see the EHR mirror the current understanding of gender, sexuality, and self-expression that caring physicians bring to their patients. It’s crucial that patients feel seen and represented in order for their care to be truly personalized, equitable, and complete.

This post was written by NHC member Hannah Salvucci. Hannah serves at Squirrel Hill Health Center as a Patient Population Management Specialist.

References: Keuroghlian, A.S. Electronic health records as an equity tool for LGBTQIA+ people. Nat Med 27, 2071–2073 (2021). https://doi.org/10.1038/s41591-021-01592-3