"Fortunately, we're all on the same EHR. Technology can be a great tool, but sometimes there are barriers within the EHR itself," Steffens says.
While the vendor she works with has been focused on accommodating gender medicine workflows, Steffens says, not all products are set up to collect information about a person's sexual orientation, gender identity, gender marker change, name pronunciation, and correct pronouns, to name a few gaps.
"So foundational are names and pronouns," she says. "From the very start, it's crucial to interact with patients in a friendly and inclusive way, from the first phone call, throughout their visits, and across the continuum."
Part of The Fenway Institute's work is to advise EHR vendors on these issues—and training individuals on how to collect and use the information.
"We work with vendors of EHRs to build in anatomical inventories that track body modifications and retained organs that people have, so that preventive cancer screening is based on the actual organs in someone's body," says Keuroghlian.
But more fundamentally, registration staff must be trained to ask patients for their current gender identity as well as their sex assigned at birth.
"A lot of people aren't going to identify as transgender unless you ask both of those questions," he says. "It's called the two-step process."
Both steps are necessary, he explains, because oftentimes a transgender woman, if simply asked her gender, will say she is a woman—and vice versa for a transgender man. "And second, they may not want to out themselves in that way."
Even with the two-step process and a robust EHR, if staff aren't trained to be effective and affirming in their communication, that data collection "is not going to go very well," says Keuroghlian.
This means that the right technology must be paired with humanity, cultural competence, and humility, he says. "You want people to just have to tell you once what their pronouns are and for that to get transmitted throughout. You don't want people to get misgendered over and over again, because they're really not going to come back at that point and you'll lose people."
That said, Keuroghlian recommends "checking in with some regularity about people's name, pronouns, and sexual orientation and identity because those evolve throughout a person's life."
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.