The University of California, Davis (UC Davis) Health System began collecting demographic data in its EHR in 2009. At the time it was felt by the Health System’s EHR task force that it could not include sexual orientation or gender identity information in the EHR. A subsequent decision to appoint a new task force on inclusion of sexual orientation and gender identity in the UC Davis Health System elicited opposition from some administrators who felt that clinicians would not be comfortable discussing this issue or that the topic was too sensitive to be discussed in the context of an EHR. And even though this resistance was eventually UC Davis was set to roll out its sexual orientation and gender identity questions in November 2012—Callahan said this experience convinced him that the only way that this information will be collected in EHRs on a widespread basis is if the federal government requires it to happen.
The taskforce saw this opposition as an opportunity to make a compelling case to both the clinical and LGBT communities for the need to collect these data. In essence, said Callahan, the task force developed a business case based on the premise that there are significant, even devastating, health disparities that LGBT people experience because of the de facto “Don’t Ask, Don’t Tell” attitude that pervades the medical community. “If we can desensitize our providers to be able to talk about sexual orientation and gender identity,” said Callahan, “they might learn that LGBT people are part of us, not some group of ‘other.’” In fact, the task force’s efforts, he said, are changing attitudes and the culture at UC Davis. One tangible result of this attitude change is the development of a new medical school curriculum that incorporates LGBT health issues across the entire 4-year process.
One of the most compelling pieces of evidence for including sexual orientation and gender identity data in EHRs, said Callahan, comes from Caitlin Ryan and the Family Acceptance Project at the University of California, San Francisco. In a 2009 study, Ryan focused on young adult LGBT people and looked at their self-reports of how much acceptance and support they received from their families as they came out and the current status of their health. For those who got little support, the adverse effects were large: 8 times the amount of suicidal ideation, 8.4 times the amount of suicide attempts, almost 6 times the amount of serious depression, and significant increases in illegal drug use and unprotected sex. These data point to the value of being able to identify these young adults and provide them with necessary counseling and other health services.
For the past 3 years, Callahan and his collaborators at UC Davis have been conducting Grand Rounds about LGBT health disparities and are