Blog from July, 2021

Hannah Nelson

EHR integrations that include anatomical inventories and gender identity could improve quality of care for transgender and gender diverse patients.

Anatomical inventory and gender identity EHR integrations could help provide gender-affirming care for transgender and gender diverse (TGD) patients by recognizing each patient’s unique gender identify for clinical decision support and population health management, according to a study published in JAMIA.

While some TGD patients undergo gender-affirming interventions such as hormone therapies, hysterectomy, and breast augmentation, others do not undergo any medical or surgical procedures.

For providers to deliver patient-centered care, they must be aware of each patients’ unique gender identity, as well as their anatomy and any surgical procedures they may have undergone.

To keep record of each TGD patients’ medical history, the study authors recommended that hospitals and community health centers integrate anatomical inventories into EHRs. These EHR integrations would allow clinicians to document gender-affirming surgeries and track the presence or absence of specific organs in order to inform preventive health screenings and care plans.

“A clinician who is using an EHR system that does not include an integrated anatomical inventory may be prompted to recommend a Pap test to a transgender man who does not retain a cervix after gender-affirming surgery, because the only information in the EHR system about that patient’s organs may be based on a female sex assigned at birth,” Alex Keuroghlian, MD, MPH, senior author explained in a public statement.

“These are the types of mistakes that can increase mistrust in doctors and the medical system in general among transgender and gender diverse patients and lead to patients simply avoiding care,” continued Keuroghlian, who serves as director of education and training programs at The Fenway Institute. “This contributes to the disparities in health experienced by transgender and gender diverse people. The tools now exist to reduce these mistakes, and hospitals and community health centers should be using them.”

The study authors also suggested that health IT developers implement gender identity, sex assigned at birth, and anatomy data into clinical decision support tools and population health management systems.

“Clinicians use their best judgment based on experience and wisdom to provide quality care, but they also rely on clinical decision support tools derived from information in electronic health records,” noted Chris Grasso, MPH, lead author and associate vice president for informatics and data services at Fenway Health.

“Given the significant disparities in health that transgender and gender diverse people experience in comparison with their cisgender peers, it is incumbent upon health care systems and health information technology vendors, including electronic health records, to improve clinical care for these patients,” Grasso continued.

The study also noted the value anatomical inventories could have on population health management. Healthcare systems could use anatomical inventory data to create internal dashboards for care disparity detection.

For example, the study authors noted that a customized dashboard with anatomical inventory data may show that in the last year, only 60 percent of TGD patients received depression screening in primary care, compared to 85 percent of cisgender women and men. From there, the care team could review records and speak with providers to investigate potential reasons for the disparity.

“Without these customizable dashboards, it can be very difficult to detect disparities in care among patient populations. If disparities exist but cannot be measured, it is often impossible to address them,” noted co-author Hilary Goldhammer, SM.

The study authors also pointed out the importance of data interoperability when treating this population, as TGD patients may access care and services from several sites, such as clinics, hospitals, and pharmacies.

To promote care coordination, the researchers called for organizations, such as Health Level Seven International (HL7), to develop standardized terminology and fields that capture gender identity, sex assigned at birth, name and sex on insurance, name used, pronouns, and the anatomical inventory.

Interoperability of this data would allow providers who are seeing a patient for the first time to address the patient using their correct name and pronouns.

“EHR systems that integrate gender identity and anatomical inventories, and reference those fields and forms to produce clinical recommendations, identify health disparities, and promote culturally responsive communication, will allow for more tailored, gender-affirming, and timely care for patients,” said Julie Thompson, PA-C, co-author and medical director of trans health at Fenway Health.

Hannah Nelson

COVID-19 has advanced the digital health transformation, bringing executives to drive health IT innovation with urgency for business resilience.

Executives are driving health IT innovation after COVID-19 revealed the importance of digital capabilities for business resiliency; 93 percent of healthcare executives said that their organization is “innovating with an urgency and call to action this year” according to Accenture’s 2021 Digital Health Tech Vision report.

Kaveh Safavi, MD, JD, global health lead of Accenture Health, noted that digital capabilities are becoming increasingly vital for effective business strategies.

“We are clearly in this world now where you cannot tell the difference between a business strategy and a technology strategy,” Safavi told EHRIntelligence in an interview. “Our research says nine out of 10 executives basically say that they're inseparable. That is very different than it was a decade ago, where IT was a thing in service of your business strategy.”

“The fact that they're inseparable means increasingly that what choices you make from a technology perspective will actually determine your business strategy and your business capabilities, as opposed to making the business strategies and just going and finding the technologies to get it done,” he continued.

For instance, Safavi noted that every company Accenture works with has migrated much of their technology data center to public cloud.

“Public cloud is considered a relatively elastic way to run a business,” he explained. “You can scale up and scale down much more quickly because you obviously don't have all the physical store and compute capabilities. The cloud is primarily around giving businesses agility to respond either to crisis or opportunity.”

COVID-19 has accelerated the industry-wide shift to the cloud, Safavi noted.

“Care organizations realized that cloud wasn't something you do because it's a good idea, it was something you do as an essential part of having resiliency,” he explained.

Safavi said that many health IT executives are also integrating artificial intelligence (AI) solutions into their organizations.

“AI allows technologies to perform non-routine tasks,” he explained. “One of our challenges in healthcare is that much of what we do is somewhat non-routine and traditional automation only has a certain upper limit.”

“Our care model is now fundamentally based on an interaction between a person who needs something and a professional person who has expertise, and there's a shortage because demand is growing faster than supply,” he said. “We'll never train enough people to close that gap, so we need technology to scale.”

Additionally, Safavi noted that AI can help significantly cut healthcare costs. In fact,
the cost of labor is the single most dominant segment of cost growth inside of healthcare expenditures, he pointed out.

“If you can't figure out how to substitute technology for labor and create productivity, which is something other industries have done to reduce their cost to serve, then you really aren't going to solve the problem,” Safavi stated.

Safavi noted that as the digital health transformation progresses, technology will increasingly become a co-worker.

“We're not talking about technology replacing humans, we're talking about technologies taking tasks, but the people still have to do their tasks,” he clarified.

“As this technology becomes ubiquitously pervasive, it's as normal as the water cooler, and the skills that we need to interact with them are no different than the kinds of social skills we develop to deal with other people in our work,” Safavi said. “We're seeing the same kind of metaphor play itself out with technology.”

When companies integrate new technology, digital literacy is key to technology adoption, Safavi explained. Employees will have to develop different skills and adjust to new organizational cultures.

“For example, increasingly we're seeing the expansion of what's called no-code or low-code technologies,” Safavi said. “What that means is that the normal business user has the ability to go in and change something and get more out of the technology rather than putting a request into IT. That's designed to democratize technology.”

Companies predating the current crop of technologies will have to figure out how to move their data from the existing model to a new model, Safavi explained. However, if you’re a startup, you do not have to deal with data migration from legacy technologies.

“We see a lot of discussions about who's going to be in a better competitive position,” Safavi said. “The incumbents feel somewhat vulnerable or threatened that they know that their technology footprint is not modern, but the cost structure for them to go from the old to the new creates a whole set of problems that new competitors don't have any barriers to start with.”

Safavi concluded that while COVID-19 accelerated the digital health transformation, health IT executives still have work to do.

“It would behoove all of us to recognize that the impact of COVID enforcing the adoption of technologies doesn't necessarily mean that the problems that technology needs to address have been solved,” Safavi said. “This is a very complex issue.”