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How athenahealth Built a Trans-Inclusive EHR

by Allie Brouckman and Susanne Fortunato, Product Innovation, athenahealth

Fifty percent of transgender patients report postponing medically necessary care due to fear of discrimination from a healthcare provider1. For a transgender patient, using the wrong name or gender can be an uncomfortable or even unsafe experience.

Health IT has an extraordinary power to shape how doctors care for their patients, from how information is displayed to the workflows they use and decision support tools they consult. Unfortunately, many providers caring for trans patients have identified a blind-spot in the EHR:  They are unable to record the nuances in their patients’ gender identities, resigned instead to label every patient with their legal name and simply an ‘F’ (female) or an ‘M’ (male). Many patients, in fact, cannot be adequately described with a single sex field.  

At athenahealth, many of our providers care for transgender patients.  But, unlike the workflows developed for many clients’ provider specialties or billing segments, until now no workflows in athenaNet specifically addressed transgender patients’ needs. For providers seeing a large population of trans patients, workarounds and clever customization were the last resort to fill this functionality gap in their EHRs, as in the example below:

sample

A sample patient banner for a transgender woman whose legal & billing name is her birth name, before these changes.

athenahealth’s Trans Inclusion Committee (TIC) formed in 2015 with a goal of growing inclusive spaces for transgender and gender non-conforming individuals on athenahealth’s campuses and in our technology.  As part of this initiative, a team of employees from across the company came together to identify where our services stymied providers treatment of transgender patients.

Our challenge: Design a workflow for our EHR, athenaClinicals, and practice management service, athenaCollector which would support transgender patient care by addressing preferred name and gender identity fields, while simultaneously supporting billing under a patient’s birth name and display of a patient’s sex assigned at birth.

Through collaboration with the Fenway Institute, a pioneering community health organization dedicated to trans-inclusive care, a review of industry standards and government regulations, and a series of usability studies performed with an array of providers and practice managers, the Trans Inclusion Committee designed and developed functionality that lets physicians and staff properly address, treat, and bill for care of their transgender and cisgender patients.

With our workflow enhancements, doctors can see at a glance their patients’ preferred name and pronouns. The accessibility of this information helps providers quickly determine their assigned sex at birth and their gender identity in order to provide appropriate clinical care – including accurate screenings, correct medication dosing, and understanding of risk factors.

Providers can also access a pre-configured flowsheet that tracks trans-specific health metrics.

sample2

The same patient’s banner, after these changes.

Designing a fully-inclusive EHR is an iterative process, and this functionality is now live in clinics for alpha testing and continued improvement. athena’s Transgender Inclusion Committee will continue to tackle improvements to this functionality by creating more robust clinical content for transgender patients, augmenting confidentiality, and allowing patients to self-report their gender identity.

As the old management adage goes, “you can’t manage what you don’t measure.”  With the real-time intelligence and surveillance power of the athenahealth network, we can collect data on the care of trans patients in athenahealth providers’ offices around the U.S. in order to understand how different providers conform to best practices of transgender care, and how our new features are enabling compassionate care for all patients.

At athenahealth, we believe in letting doctors be doctors – allowing providers to treat their patients unhindered by technology. By building a workflow that supports care for all patients, regardless of their gender identity, our goal is to make it easy for physicians to provide high quality and considerate care.



1 “Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center” LGBT Health. 2014 Sep 1; 1(3): 177–184.

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