council, a growing list of clinical departments, and its cultural and linguistic council. This process resulted in four recommendations that Ehrenfeld said are worth adopting at all medical centers:

  1. Patients should have the opportunity to self-identify their sexual orientation and gender identity.
  2. Patients should have the opportunity to define their relationship status.
  3. Patients should have the opportunity to identify their family.
  4. Patients should be asked about power of attorney/health care proxy and advanced health directives.

Vanderbilt has now developed a three-stage implementation plan for modifying the 210 unique clinical intake forms used by its 95 physician practices. The recommended text for use on the intake forms includes two parts. The gender identification section asks for patients’ legal name; their preferred name, if different; their sex at birth; and their gender identity—male, female, transgender, and prefer not to answer. The sexual orientation section asks if the patient is heterosexual, straight, lesbian, gay, bisexual, queer, something else, or prefer not to answer. In developing these questions, the Vanderbilt team considered the same issues that the previous speakers had identified: Who is asking the questions? Where is the information recorded in the EHR? How often is the patient asked for this information? What to ask in terms of identity versus behavior?

In summary, Ehrenfeld made the following three recommendations:

  1. Self-identified orientation, gender identity, and sexual behavior should be collected during routine clinical encounters in order to improve health outcomes.
  2. When collecting sexual orientation and gender identity data on health care intake forms, patients should have the right to opt out.
  3. Prior to collecting this information, health care institutions should develop and widely distribute educational materials, not just for staff but also for patients, that explain clearly why developing and collecting this information is important and how it remains confidential.


Given the importance of training providers and health care system staff prior to introducing questions about sexual orientation and gender identity, it is critical to begin thinking about how to accomplish that training early in the process, said Robin Weinick. For most health care systems,

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