Our Medical Records

Have you noticed a change when you now go to the doctor’s?

Instead of scribbling away on a paper they are typing on a computer, your medical records are now online. I see it as both a blessing and a curse, the blessing is wherever you are your medical records are available to the doctors. If you are on vacation and need medical attention the doctor can pull up your records. The curse is that they can be hacked.

But that is not what I want to write about this afternoon, what I want to write about is how we as trans-people are handled by the Electronic Medical Records (EMR). WPATH members of the Transgender Health EMR Working Group published a report in the Journal of the American Medical Informatics Association titled “Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group.” In the article they write about the problems that are unique to the trans-community with using EMR, in the old days (before electronic records) the doctor just stuck a note to your records saying that you are trans and it was not a part of your office medical record. But now everything is part of your electronic record.

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, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems…

And that is the problem I ran into a couple of weeks ago, my insurance didn’t want to pay for my PSA test.

Some of the recommendations that they made are;

• Preferred name, gender identity, and pronoun preference, as identified by patients, should be included as demographic variables (such as with ethnicity).
• Provide a means to maintain an inventory of a patient's medical transition history and current anatomy.
• The system should allow a smooth transition from one listed name, anatomical inventory, and/or sex to another, without affecting the integrity of the remainder of the patient's record.
• A system should exist to notify providers and clinic staff of a patient's preferred name and/or pronoun (if either or both of these differ from the current legal documented name/sex).

As more trans-people become covered by insurance having some way to document our changes while still respecting our right to privacy become a tightrope walk. Another challenge for doctors and insurance carriers is how to assure our right to medically necessary treatments.