Personalized care

UW Health aims to be more sensitive to gender identity and sexual orientation

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For most patients, the easiest part of going to the doctor is introducing themselves. For LGBTQ people, this can instead be the first of many challenges. If a provider doesn’t ask, should the patient explain his or her identity?

A new approach to medical records could facilitate those conversations. In an effort to improve care for LGBTQ people and reduce the misgendering of patients, UW Health is implementing the Sexual Orientation and Gender Identity SmartForm developed by Epic Systems.

Ald. Shiva Bidar-Sielaff, UW Health’s first-ever chief diversity officer, is helping to implement the new technology. “The organizations that really want to provide inclusive and affirmative care for LGBTQ [people] are integrating [the SmartForm] into their electronic medical records,” says Bidar-Sielaff.

Since Epic released the standard version of the SmartForm last November, Janet Campbell, Epic’s vice president of patient engagement, estimates that between 20 and 40 healthcare providers around the world have either started or have already completed the process of implementation.

UW Health — which sees more than half a million patients a year and has more than 16,000 employees — is the only group with facilities in Madison that is implementing the SmartForm. It hopes to have it ready by early fall. A few groups in Green Bay are also implementing it, says Epic spokesperson Meghan Roh.

The SmartForm is meant to walk clinicians through getting information on sexual orientation and gender identity from patients so they can add it to their electronic records, says Campbell. Designed to be intuitive, the SmartForm starts with a question about the patient’s gender identity and, if it aligns with the gender the provider already has on file, the SmartForm will stop there.

If the gender identity doesn’t match the sex on file, that’s when “the form gets smart,” Campbell says. It has follow-up questions regarding pronoun usage (which includes gender-neutral pronouns), what steps, if any, the patient has taken to transition, among others.

“Our goal is that patients get the right and appropriate treatment no matter who they are,” Campbell says. “I think that starting to collect this information from everyone will normalize it in many people’s eyes. It’s not that we’re asking certain people whether they happen to be trans, we’re just asking everybody.”

For Epic, this rollout has been a long process.

The company first started strategizing in 2004, and one of its customer requested a form in 2005, Campbell says. Four years later, several more customers had the same request.

Epic has been recommending that health care providers build their own forms for a few years, Campbell says, before supplying its own last November. Campbell says the evolution of medical information systems has been remarkable since Epic was founded in 1979. “People didn’t think that way, and certainly didn’t think about documenting that way,” Campbell says. “We’ve become more understanding.”

Aiming to have the implementation process completed in fall, UW Health is still in the process of planning to train staff and clinicians on LGBTQ-specific care, says Bidar-Sielaff. Although the SmartForm will likely have little impact on many patients at UW Health, she’s excited about the effect it could have on traditionally marginalized people and their health care.

In addition to easing introductions and aiming to eliminate misgendering, the form should help if the patient has had gender reassignment surgery, according to Bidar-Sielaff. There are two questions on the form to capture this information, first asking what organs were present at birth and then asking what organs the patient currently has.

This avoids making patients restate that information if they have different providers in the future, and Bidar Sielaff says gathering this information in clearly and in a practical way will improve clinical care.

“We can actually just capture, in a regular way, sexual orientation and gender identity for patients,” Bidar-Sielaff says. “I think it’s really going to make a huge difference.”