New guidance from the American Health Information Management Association urges a new approach for providers treating the LGBT community. The association maintains that, too often, the needs of these patients are not being adequately met or even addressed.

The professional association of healthcare records professionals has taken input from patients and clinical professionals to develop guidelines and suggestions for treating patients who are lesbian, gay, bisexual or transgender.

The guidance is not an advocacy brief but a patient engagement brief, says Lesley Kadlec, director of HIM Practice Excellence at AHIMA. The organization hopes that its guidance may compel provider organizations to change some processes in how they treat LGBT patients and how their care is documented in electronic health records systems.

For instance, according to the association, a lesbian patient may visit a local clinic to get a female examination and find that all educational materials specifically address heterosexually transmitted diseases. Or, a transgender person may seek treatment from a new physician, but the physician may use the patient’s birth name and pronoun, leaving the patient uncomfortable and wondering about the accuracy of the medical records.

Also, LGBT partners may wish to use a patient portal with each partner granted proxy access to the other’s portal, but barriers may exist to prevent such access, Kadlec says.

If partners go to separate providers and give proxy access, then they should be able to exchange log-in information for both portals. “Shared portal access is especially important for those with minor children to allow input of data on children in the portal,” she explains.

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Further, depending on state laws, LGBT partners may or may not be able to list both parents on a birth certificate. Kadlec says, she believes the guidance could prod HIM departments to ask their states to look at birth certification processes.

An example of this would be what is called “organ inventory.” A transgender person may have undergone a complete transformation to another sex, yet still retained certain organs. A former female may still retain a uterus and ovary but present as a male, so reminders are needed in the EHR that these organs remain, and the patient can be seen by a gynecologist. This also is true for a former male who now is a female but may still have some male anatomy.

“We need to build electronic health records to include these anatomy data with an organ inventory as a discrete field capture in the EHR,” Kadlec says.

Some LGBT patients may use hormone treatments and not go through the entire transformation, so they may still need to get mammograms or prostate exams.

While developing the guidelines, AHIMA learned from patients that they want a trusted healthcare provider that is open and accommodating to treat them and address their individual needs, and not be afraid to seek care, Kadlec emphasizes. “This is going to require a new way of doing business.” The guidance is available here.

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