in the process of rolling out some written educational materials for all of the system’s providers. They are also surveying these providers to identify those who are willing to be listed as LGBT friendly. The UC Davis Health System is going to use the MyChart patient portal feature of the Epic2 EHR to provide a questionnaire that patients can answer in the privacy of their own home that includes questions about sexual orientation and gender identity. It is also working with Epic to systematize where and how questions on sexual orientation and gender identity are located in the EHR. One idea is to tie the EHR to systematic prompts in response to certain answers to these questions. For example, when someone identifies as being transgender, the prompts would alert the care provider about what organ systems need to be monitored, what kind of preventive care needs to be presented, and how best they can be a good provider for that person. Callahan noted that Epic appears willing to make these changes to its EHR system.

In fact, said Denise Rasmussen, Epic is eager to receive input from users as to how to collect information on sexual orientation and gender identity in its EHR systems. Epic already has a field to capture information on sexual partners and runs reports and triggers alerts based on the sex of that partner. She noted, too, that at least some of the 260 organizations that use Epic have extended the sex category list to capture items related to gender identity and sexual orientation.

What would be helpful to Epic as an EHR vendor, she said, is a more standardized way to document information about sexual orientation and gender identity and more direction on where each birth sex, legal gender, and identified gender should be used in terms of billing, health information exchanges, clinical decision support, and preparing materials designed for patients. Epic is also concerned about who should document this information and who should be allowed to see it. For example, while it is obvious that the primary care physician should see this information, should the patient’s chiropractor?

Regarding technical issues, Rasmussen said that Epic knows that it needs to create a new field or fields to represent the sex of a patient in a way that better captures birth sex, legal gender, and identified gender and then display that information in appropriate places in the EHR. The company is also interested in making alerts more meaningful, that it is alerting the primary care physician to the issues that are appropriate to the patient in front of them: telling a physician to order a prostate exam for a female-to-male transgender patient is not helpful.

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2 Epic is a company that makes software, including EHRs, for health providers and facilities. They are one of several large commercial vendors.



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