Analyzing Patient-Provided Responses to Improve Collection of Health Equity Data Elements.

Self-report is purported to be the gold standard for collecting demographic information. Many entry forms include a free-text "write-in" option in addition to structured responses. Balancing the flexibility of free-text with the value of collecting data in a structured format is a challenge if the data are to be useful for measuring and mitigating health disparities. While much work has been done to improve collection of race and ethnicity information, how to best collect data related to sexual and gender minority status and military veteran status has been less commonly studied. We analyzed 3,381 patient-provided free-text responses collected via a patient portal for gender identity, sexual orientation, pronouns, and veteran experiences. We identified common responses to better understand our patient population and help improve future iterations of data collection tools.

Overcoming technical and cultural challenges to delivering equitable care for LGBTQ+ individuals in a rural, underserved area.

The lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) community is vulnerable to health-care disparities. Many health-care organizations are working to collect sexual orientation and gender identity in their electronic health records (EHRs), with the goal of providing more inclusive care to their LGBTQ+ patients. There are significant human and technical barriers to making these efforts successful. Based on our 5-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), this case report provides insights to overcome challenges in 4 critical areas: (1) enabling the EHR to collect and use information to support the health-care needs of LGBTQ+ patients, (2) building a culture of awareness and caring, empowering members of the health-care team to break down barriers of misunderstanding and mistrust, (3) developing services to support the needs of LGBTQ+ patients, and (4) partnering with local communities to become a trusted health-care provider.

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development.

OBJECTIVE: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. METHODS: IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives. RESULTS: All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits. CONCLUSIONS: Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted.

Bringing Cultural Competency to the EHR: Lessons Learned Providing Respectful, Quality Care to the LGBTQ Community.

The lesbian, gay, bisexual, transgender, queer (LGBTQ) community is vulnerable to healthcare disparities. Many healthcare organizations are contemplating efforts to collect sexual orientation and gender identity in the electronic health record (EHR), with a goal of providing more respectful, inclusive, high-quality care to their LGBTQ patients. There are significant human and technical barriers that must be overcome to make these efforts successful. Based on our four-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), we provide insights to overcome challenges in two critical areas: 1) enabling the EHR to collect and use information to support the healthcare needs of LGBTQ patients, and 2) building a culture of awareness and caring, empowering members of the healthcare team to break down barriers of misunderstanding and mistrust.