Sex, Gender Identity and Preferred Name

1. Sex, Gender Identity and Preferred Name Improving patient experience and supporting patient-centered care.

2. Disclaimer: Please note that based on feedback from Validation and User Acceptance testing changes to the build were possible after the development of this presentation.Therefore screen shots available in the presentation may not represent the final build delivered.

3. SOGI Project Goals 2017- 2018 • Make Epic more inclusive of sexual and gender minorities • Help clinicians make accurate decisions about patient care • Assist the organization to improve LGBTQ patient satisfaction and engagement • Assist the organization to improve health outcomes for LGBTQ patients, especially transgender patients • Meet requirements for MU, TJC, UDS and OCR 1557 non-discrimination standards • Rollout build to 3 Epic instances

4. Current SOGI Epic Build • We already capture nuances in a patients sex and gender identity beyond their legal sex today in Epic • The SOGI Smartform allows collection of sexuality, gender identity, transition status and organ inventory data. • The form allows users to collect complete and accurate medical histories on sexual and gender minorities. • We provide decision support that help clinicians make accurate decisions when there is a documented incongruence between legal sex, sex assigned at birth and gender identity • A full list of current tools are in appendix

5. SOGI Phase 3 Project Overview • SOGI phase 3 focuses on improving the patient experience and on better supporting patient-centered care. • The upgrade brings additional features throughout the system to use and show patient’s gender identity or sex assigned at birth instead of legal sex when appropriate. • There are also updates throughout the system that make it easier for users to see a patient's preferred name. • Preferred name is especially important for transgender patients, but also helps improve the patient experience for any patient with a preferred name that differs from their legal name. • User can now collect additional sex information when capturing demographics. • Patient facing tools now show preferred name and respect gender identity

6. Impact • The 2018 Epic upgrade brings new features throughout the system • This presentation does not show these features in every application

7. SOGI Workgroup Decisions SOGI Workgroup Task • Reconvened SOGI experts to review new features coming with 2018 Epic Upgrade Identified Risk • The new gender identity and preferred name features focused on patient experience but didn’t consider patient identification • Taking these automatic updates would have negative impacts on patient safety • It would not have been clear to clinicians that they were seeing the patient’s gender identity displaying in the Sex field • It would not be clear to clinicians that they were seeing the patient’s preferred name displaying in the Legal Name field • Gender identify would be assessed (in addition to legal sex) by Epic Beaker when applying lab result reference ranges Decisions to Restrict Automatic Updates • Better Support for Patient Preferred Names that allows the patients preferred name to auto replace legal first name where its displayed in Epic • Better Support for Transgender, Intersex, and Nonbinary Patients that allows patients legal sex to be auto replaced with their gender identity where its displayed in Epic • Better Support for Transgender, Intersex, and Nonbinary Patients that allows Beaker to assess gender identity when applying lab result reference ranges Solutions • Fields displaying legal sex, gender identity and sex assigned at birth are labeled as such Legal Sex: Male Gender Identity: Female Sex Assigned at Birth: Male • Preferred name will display in quotes after legal name Patient Name :Thompson, Joanne “Jojo” • Lab governance will lead future work that addresses sex, gender identity and range references for all Lab Information Systems

8. Preferred Name in Header and Chart Tab • Preferred name now displays in quotes next to legal name on the patient header and chart tab • Preferred name no longer appears with orange highlight below legal name in patient header

9. Displaying Preferred Name on Labels • Preferred Name now display on patient labels and Beaker lab labels • Truncating criteria already exists for patient names that go beyond the maximum amount of characters • SOGI lab team worked to mitigate identification issues for lab and blood workflows • Preferred name is a discrete field and will not be passed through interfaces or to third party systems • Wristbands display preferred name today Beaker Lab Label Patient Label Wristband

10. Preferred Name in Schedule • The patients preferred name now displays in the schedule for clinic and outpatient appointments

11. Patient List Columns and Preferred Names • Any columns that have patient name now display the preferred name alongside them Column Examples

12. Users can now review, assess, add, and remove LDAs from an Avatar The avatar will respect the patients gender identity Avatar Respects Gender Identity

13. SmartLinks Respect Gender Identity and Preferred Pronouns • SmartLinks now respect a patient’s documented gender identity and preferred pronouns • Sex SmartLinks now show Boy or Girlinstead of Manor Woman when applicable • If the patient has a sexual incongruence documented .sex will return “adult” in a note or “child” if the patient is under 18.

14. Patient List Columns and Sex • Columns displaying Legal Sex ,Gender Identity or Sex Assigned at Birth are labeled as such

15. Using Mother’s Preferred Name in Baby Naming • Thenewborn naming convention standardin Epic includes the mothers first name (Last Name,) (Sex) (Mom) (First Name) Smith, Boy Mom Elizabeth • The baby naming convention standardwill now include mothers preferred name (Last Name,) (Sex) (Mom) (First Name) (Moms Preferred Name) Smith, Boy MomElizabethLizzy

16. Report Headers • Reports headers now display Preferred Name, Legal Sex ,Gender Identity • Facesheet, Todays Patients , Patient List and Summary Reports etc..

17. Demographics • Sex field now displays areas to capture gender identity, sex assigned at birth, and sexual orientation

18. In Basket Messaging • Preferred name now shows with In Basket messages • Sex or Gender Identity displays based on context • Patient facing message types display patients gender identity • Billing and referral message types display legal sex

19. Bed Planning • Bed Planning now displays preferred name • Reports respect gender identity to assure patients are bedded appropriately

20. Unit Manager • Unit Manager now displays the Preferred Name, Legal Sex and Gender Identity

21. ED Manager and Trackboard • Sex no longer displays in the same column as patient name • Age and Legal Sex are combined into one column • Reports and columns are updated with preferred name standard and legal sex. • Some reports include gender identity where appropriate

22. MyChart has Expanded Personal Information • MyChart now allows patients to self report Gender Identity, Sex Assigned at Birth and Sexual Orientation

23. Radiology • Radiant tools are updated with preferred name and gender identity

24. Beaker Lab • Beaker reports, headers and lists now display preferred name and gender identity to lab staff • Beaker lab labels display preferred name • Gender identity and preferred name will not be sent to 3rd party lab systems • There are no changes to lab reference ranges related to gender identity • Legal sex continues to be the only sex field used when applying lab reference ranges

25. Lab • Gender identity and preferred name will not be sent to 3rd party lab systems • There are no changes to lab reference ranges as part of SOGI project • Legal sex continues to be the only sex field used when applying lab reference ranges

26. Training Resources https://community.providence.org/sites/LearnLib/LLNurSupMstr/BETA_How_to_Access.pdf • Epic Beta environment is available for informatics and end users to test new SOGI features before their released to live environment • Epic Learning Resources Website https://epiclearning.providence.org/Content/Home.htm?tocpath=Home|_____0 • Epic Learning Home Dashboard allows users to access training materials from inside Epic

27. Appendix

28. 2017 Organizational Change • Our organization is responding to section 1557 of the Affordable Care Act as its provisions come into force. This includes requirements to ensure nondiscrimination in access to health care programs. • A new policy and processes are in place to meet these requirements. The policy includes language prohibiting discrimination on the basis of Sex or Gender Identity.PROV-ICP-729-Nondiscrimination Policy • Caregiver tools and resources have been developed including guidelines for patient interactions with transgender patients and a sexual orientation and gender identity expression glossary of terms document. online toolkit • Sensitivity training will be delivered for all caregivers. Clinicians will be trained how to discuss sexual orientation and gender identity with patients and how to ask the questions when collecting data. • The organization is working to improve LGBTQ patient satisfaction ,engagement and health outcomes , especially transgender patients. • The organization has asked the ECO program to deliver an Epic build to support the new regulatory requirements and the collection of this structured data.

29. SOGI Epic Solutions Delivered in 2017 • Implement Smartform that allows collection of sexuality, gender identity, transition status and organ inventory data. • Implement a MyChart questionnaire • Highlight Preferred Name in patient banner • Add Preferred Name to Wristband • Highlight Sex field in Patient Banner when there is incongruence between sex fields • Launch smartform from Sex field in Patient Banner • Develop system Smartphrases • Make OB Tools availablewhen a patient has a documented sex of Male and is receiving obstetric care • Modify sex filters/rules to allow access to Genetalia and Pregnancy documentation irrespective of documented sex • Update Clinical Decision Support tools • Update Health Maintenance logic for cervical and breast cancer screening • Provide Help Resources inside Smartform • Add option of Other to Legal Sex field in Kadlec

30. Caregiver Guidelines for Patient Interactions • Transgender patients will be addressed and referred to on the basis of their self-identified gender, using their pronouns and name in use, regardless of appearance, surgical history, legal name, or sex assigned at birth • If a patient’s family members suggest that the patient is of a different gender from that with which the patient self-identifies, the patient’s views should be honored. • Caregivers will not use language or a tone that a reasonable person would consider to demean, question or invalidate a patient’s actual or perceived gender identity or expression. • Caregivers will not ask questions or make statements about a transgender person’s genitalia, breasts, other physical characteristics, or surgical status except for professional reasons that can be clearly articulated. • Information about a patient’s transgender status or any transition-related services that the patient is seeking and/or has obtained is sensitive medical information and caregivers will treat it as such. • Caregivers asking patients about sex at birth or transgender status or related procedures should explain why the information is relevant to the patient’s care, the confidentiality of the information (unless disclosure is permitted or required), and direct patients to the HIPAA policy for information on permitted disclosures.