What Box Do You Check Off In The Doctor’s Office

As the medical profession starts to switch over to “Electronic Medical Records” (EMR) there is a discussion going on with healthcare providers about trans-clients, they want to make sure we are not thrown under the bus.

‘Male,’ ‘female’ are not enough for trans patients seeking health care
by JR Tungol
Nov 23, 2011

If you’ve ever filled out a form online, it’s likely you’ve encountered the problem of needing to provide an answer for which no space is provided. Think, even, about the Y2K problem, when there was no option for any year beyond 1999.

As electronic medical records become more prevalent in hospitals and clinics, groups advocating for transgender people have looked for ways for forms to recognize that ‘male’ and ‘female’ are not adequate options in identifying people by gender.

The World Professional Association for Transgender Health formed a task force this fall to explore recommendations on how the systems that produce and manage medical records can be “trans-friendly.”

Registering trans patients in an electronic medical record – specifically identifying their sex – is a primary concern. No EMR vendors have a “trans” selection other than male or female, task force members said.

The problem was recognized back then and now it is starting to come to the forefront. In a recent Journal of the American Medical Informatics Association they wrote about the EMR and the trans-patient.

Meeting the Needs of Transgender Patients: Medical Informaticists Work through the EHR Challenges
Healthcare Informatics
May 30, 2013
By Mark Hagland

On April 30, 2013, JAMIA, the Journal of the American Medical Informatics Association, published online an article titled “Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group,” authored by Madeline B. Deutsch, M.D., Jamison Green, Ph.D., JoAnne Keatley, M.S.W.., Gal Mayer, M.D., Jennifer Hastings, M.D., and Alexandra M. Hall, M.D.

As the article’s abstract notes, “Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally,” the authors note, “sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender-variant persons.”

The article points out that,

Historically, in the paper-based environment, someone would just have put a post-it note on a record saying something like, “This patient prefers ‘Jennifer.’” So there are immediate issues such as that. Second, there is a set of issues around properly documenting that a patient is transgender, and provides the appropriate clinicians and caregivers with information to support that patient’s care.

What the worry is that we will be left out, that we will be the square peg of data that has to go into a round hole of data. How will we be recorded in the database, will it go under our birth gender? It is a problem not only for trans-people but intersex people, how will they be recorded?

In a blog by Ted Eytan, MD, he writes…

This just published paper (unfortunately behind a paywall, but you can access a summarized version at the transhealth.ucsf.edu website) explodes an inaccurate tenet within electronic health record systems – that a person’s sex and gender are tied together, and in turn fully inform a person’s medical destiny. This is not the case for a small percentage of patients.

    It is recognized that the overwhelming majority of patients are not transgender, which has led to implementation of a binary male/female oriented system across multiple platforms such as EHR systems, billing and coding systems, and laboratory systems; however, this structure inhibits the collection of accurate medical information, and therefore such systems should be modified.

What I do not want is to have,
Male
Female
Other

I don’t know about you but I’m not an “other.” In the website that Dr. Eytan cites suggestions on how the personal data should be recorded as a two-step process,

    What is your sex or current gender? (Check all that apply)

•     Male
•     Female
•     TransMale/Transman
•     TransFemale/Transwoman
•     Genderqueer
•     Additional Category (Please Specify): ______________
•     Decline to State

    What sex were you assigned at birth?

•     Male
•     Female
•     Decline to State

I think that they should also include “Intersex” because they might have medical problems related to either sex.

A word on why this is important to the trans-community; EMR is an electronic file of your medical history. I go to my primary care physician for my annual physical and when he accesses my medical file not only does it contain his medical records on me but it also contains all the medical records on me from the specialists that I have seen. And if I am ever need medical help out of state and I am rushed to a hospital they can access my medical records.

Therefore, it is vitally important that these records be accurate. My life might depend on my medical records.

If you are trans, which box would you check off?