Harvey Makadon, M.D.
Original Article: bit.ly/1yfn4Ku
Efforts are underway to routinize the collection of patient data related to sexual orientation and gender identity (SOGI) as is practice for race and ethnicity information. The Institute of Medicine (IOM) has recommended this as the only way to end LGBT invisibility in healthcare as well measure quality and progress at eliminating disparities based on sexual orientation and gender identity. A number of healthcare providers are already doing this, or actively working on implementing SOGI data collection. These include Fenway Health in Boston, UC Davis Health System in Sacramento, Calif., Mt Sinai in New York City, and Partners Health Care in Boston.
Demonstrations have already shown ways to best collect this data and come to a consensus on how to do that, and researchers have shown that patients feel it is important to provide this information to their clinicians. But another critical step in this process will be figuring out how to incorporate all of this into electronic medical record (EMR) and insurance company billing systems.
EMRs have decision support systems built into them that can help providers do the right thing in a range of areas. For example, using established, evidence-based guidelines, a well organized EMR would remind a clinician examining a man in his sixties to conduct a prostate exam and recommend a blood cholesterol test. A doctor conducting an annual exam for a woman will be prompted to take a PAP smear to check for cervical cancer, and conduct a breast exam.
Along these lines, decisions will need to be made with regard to the questions and prompts that should be built into EMRs with regard to appropriate and sensitive care related to a patient’s sexual orientation and gender identity. Risks related to acquisition of HIV and sexually-transmitted infections (STIs) must be assessed for all patients. Clinicians must be comfortable discussing these issues. Additionally, they must be knowledgeable about these risks and recommended screenings as they relate to a patient’s sexual orientation and gender identity. While EMRs should remind clinicians that everyone between the ages of 15-65 should have an HIV test, men who have sex with men may need to be tested for HIV more frequently in addition to having screening for STIs based on their history.
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