Eliminating LGBTIQQ Health Disparities: The Associated Roles of Electronic Health Records and Institutional Culture
Successfully collecting and using SO (sexual orientation) and GI (gender identity) requires acknowledging both the obstacles to collecting them and the benefits of having them. Visibility through selfidentification or being perceived as LGBTIQQ can both expose individuals to mistreatment due to homophobia,4 including microaggressions,5 and perpetuate health disparities.6 Recognition of serious health disparities experienced by LGBTIQQ populations has created an ethical obligation for providers and systems to improve care for them. Current LGBTIQQ health disparities developed in an era in which providers rarely inquired about sexual orientation or gender identity. This neglect prevented recognition of LGBTIQQ patients and their unique health needs, rendering quality, personalized care impossible. Medicine continues to work to improve health for other disadvantaged populations by using the EHR to document identities and prompt appropriate care.7 EHRs hold similar promise and similar challenges for accelerating the changes needed in health care for LGBTIQQ patients. For example, LGBT youth experience higher rates of bullying, depression, and suicidal ideation than their heterosexual peers.8 After learning a youth’s SO and GI status, a health professional can intervene directly or through mental health services to address bullying, depression, and suicidal ideation.
Since the American Psychiatric Association removed homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders in 1973, there have been substantial increases in cultural acceptance of lesbian, gay, and bisexual persons and a somewhat lesser increase in acceptance of transgender individuals.20 This acceptance signals that it is now possible to make needed changes in health care, such as the introduction of SO and GI demographics into the EHR
While institutional changes will likely occur unevenly, introducing the expectation that providers seek to learn and document SO and GI in the EHR can accelerate needed changes. As health systems launch use of the EHR to improve care, they assume an increased ethical responsibility for protecting LGBTIQQ people from insensitive data collection, information misuse, and mistreatment because of their increased visibility. Currently, there is considerable variability across states on protections from discrimination based on SO and GI.
Callahan, E., Hazarian, S., Yarborough, M., & Sánchez, J. (2014). Eliminating LGBTIQQ Health Disparities: The Associated Roles of Electronic Health Records and Institutional Culture. Hastings Center Report, 44, S52-S52. doi:10.1002/hast.371