BY AJ TRAGER
DETROIT – The Fenway Institute and the Center for American Progress recently lobbied the U.S. Department of Health and Human Services, who will soon begin addressing the disparities affecting LGBT people in health care by including sexual orientation and gender identity data in requirements for electronic health records certified under the Meaningful Use program.
These changes will allow medical health professionals to record, change and access structured data on sexual orientation and gender identity to better assist LGBT individuals when they seek out health care. The new requirement is part of the 2015 Edition “demographics” certification criterion and will add sexual orientation and gender identity to the 2015 Edition Base Electronic Health Records Technology.
The requirement will help those within the patient’s care team have more information on the patient that can aid in identifying interventions and treatments most helpful to the LGBT patient. It will also help to replace outdated and offensive terminology and endorses tested sexual orientation and gender identity question designs as best practice questions for health care providers and institutions to consider adopting for their electronic data collection efforts.
“Including sexual orientation and gender identity in the Meaningful Use incentive program is one of the most important things our government has done to promote better understanding of LGBT health disparities and interventions to reduce them,” said Sean Cahill, director of health policy research at the Fenway Institute.
In 2014, representatives from Beaumont, CHE Trinity Health, Henry Ford Health System, Oakland County Health Division, St. John Providence Health System, diversity and inclusion professionals, LGBT community organizers and LGBT community members met for the first time as the newly formed Sexual Orientation and Gender Identity Health Equity Council of Southeast Michigan to begin the process on identifying and addressing issues that put LGBT people at risk for poor health outcomes.
The group is coordinated by Affirmations and is the first of its kind in the state which aims to systematically impact the health of local LGBT communities.
Jerry Peterson, executive director of the Ruth Ellis Center, was one of many to attend the meeting which brought together 50 professionals all focused on improving LGBT-related health concerns.
“I do know about the standards that Fenway is using, and I knew about the process. I do think it is an excellent step forward. While policy change and the federal government forcing change from the top is a good thing, it does not address the issue that most communities have insufficient resources to train medical personnel, particularly frontline staff who do assessments and ask these questions in an appropriate way. It is a vital step forward in the overall process to have medical record technology that supports gathering the information. But it does not automatically spell an immediate improvement for primary care for LGBT folks,” Peterson said.
Fenway Health has been working to help people in all neighborhoods, including the LGBT and HIV/AIDS affected communities, since 1971. In 2013, AIDS Action Committee of Massachusetts joined the Fenway Health family, allowing both organizations to improve delivery of care and services across the state and beyond.
LGBT people are often invisible in care settings. This invisibility masks disparities and impedes the provision of important health care services for LGBT individuals, such as appropriate preventive screenings; assessments of risk for HIV and other sexually transmitted infections; and effective interventions for mental and behavioral health concerns, particularly those that may be related to experiences of anti-LGBT stigma and discrimination.
According to authorities such as the Institute of Medicine and The Joint Commission, collecting sexual orientation and gender identity data in health care settings is essential to providing high-quality, patient-centered care to LGBT individuals, as well as an important part of efforts to better understand and address LGBT population health disparities.
Training clinical staff is essential in how to provide culturally competent and affirming care to LGBT patients. Part of that care includes asking patients about their sexual orientation and gender identity in an efficient, effective and respectful manner that aims to further help the patient, instead of used as a means to “other.”
“Fenway is the premiere program nationally. As we’ve been looking at our own health and wellness center, Fenway is an example,” Peterson describes.
Peterson says that there is still much to do in Michigan surrounding health disparities and LGBT treatment within the health system and that it is the collective voice of allies and LGBT people that will help bring about that shift. He says that until members of the LGBT community can walk into a health care provider’s office and be treated fairly and equally, many LGBT people will feel uncomfortable approaching doctors when they have an illness.
“Definitely appropriate care for the trans community is still a real issue,” Peterson said. “I know people who leave Wayne County and go to Ann Arbor. There is insufficient resources for the trans community. And in general there is a lack of culturally competent care.”
The new requirements are currently slated to take effect in 2018, which offers a critical window of time for work to provide technical assistance to providers, health systems and vendors relating to the collection of these data. With generous support from the Robert Wood Johnson Foundation, Fenway and CAP have been providing technical assistance to health system stakeholders from across the U.S. who are in the process of adding sexual orientation and gender identity questions into their EHR systems. As part of this project — titled “Do Ask, Do Tell” — Fenway and CAP have developed an online toolkit for collecting sexual orientation and gender identity data in electronic health records that can be accessed at http://www.doaskdotell.org.