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Behavioral Health Org Pursues EHR Optimization for Gender-Affirming Care

Clinical documentation of chosen names and pronouns jumped from 52.5 percent to 99 percent after the gender-affirming care EHR optimization project.

Rogers Behavioral Health in Wisconsin is working to advance gender-affirming care through a three-part EHR optimization plan.  

The behavioral healthcare organization was prompted to change its EHR documentation workflows after gender-minority patients reported staff members were frequently using their dead names, incorrect pronouns, or incorrect gendered terms.

"We believe that all people deserve environments where they're respected, treated with dignity, and can be their authentic selves," Jessica Langill, equity, diversity, and inclusion coordinator at Rogers Behavioral Health, said during a presentation at the Oracle Cerner Health Conference 2022.

"We have committed to continually grow and hold ourselves accountable to being an equitable, diverse, and inclusive environment for employees while offering culturally responsive and affirming care for our patients and families," Langill added.

Rogers collaborated with its LGBTQIA employee resource group to make the language used in the EHR more inclusive.

This included changing the term "preferred name" to "chosen name" and "legal name" to "given name." They also made "chosen name," "given name," and "pronouns" required fields for registration.

Further, Rogers added new options for gender identity, sex assigned at birth, and pronouns in the dropdown menu.

The organization suppressed the visibility of the "given name" and "sex assigned at birth" whenever possible through patient charts. Now, the banner bar highlights "chosen name" instead of the patient's "given name" to increase visibility at the bedside.

"We're always leading with the chosen name and pronouns to demonstrate empathy for our patients," Sarah El-Ali, solution strategist for medical staff services at Rogers Behavioral Health, said during the presentation.

"Research has been clear that the impact of gathering and consistently using a patient's chosen name and pronouns is likely to make a measurable impact on the patient's overall experience with your organization," El-Ali emphasized. "It can be the first of a string of affirming behaviors a patient observes throughout the care pathway."

The leaders also noted that comprehensive training is key to helping staff deliver high-quality, equitable, and compassionate care.

The Rogers team developed and deployed education at each phase of their gender-affirming care initiative. Training included an expectations document, FAQs, role-playing complex scenarios, scripting, engaging external experts, and more.

To address the unique needs of patients without adding time to the registration process, Rogers officials recommend strategies such as:

  • Always asking rather than assuming
  • Searching for patients by last name and date of birth instead of by given first and last name to accommodate those who may go by different names
  • Using gender-neutral terms/pronouns until you have verified the patient's pronouns
  • Asking questions such as: What first name should we use to address you? What name should we use for billing purposes? How do you identify in terms of gender? What sex were you assigned at birth?

These strategies and training helped Rogers boost the documentation of chosen names and pronouns at registration from 52.5 percent to 99 percent.

"We delivered a person-centric, synchronous training that allowed for candid discussion and questions," Jessica said. "We had to work closely with our admissions leadership and talent development to make sure we were putting together relevant and helpful training, and we also had to get creative around scheduling and offering training times."

"Before our go-live date, we measured the team's self-reported confidence and competence to evaluate for readiness," Langill added.

The Rogers officials also pointed out that to make a significant impact in gender-affirming care, organizations should ensure that clinicians and staff members are treated equitably and supported using their chosen names.

For example, the organization modified its standard email signature to include pronouns and encourages everyone to share their pronouns when introducing themselves to peers or patients.

"Shifting culture requires education and behavior change that's transmitted through modeling behavior, leadership support, and widespread adoption," Sarah said. "This was all a key factor in the success of this initiative."

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