The motto E pluribus unum, “out of many, one,” fits our “melting pot” Nation well. Perhaps this same phrasing is in some ways befitting of hospitals, as nurses, front desk staff, physicians, environmental staff, and many others of unique backgrounds and skills serve those of varying backgrounds and walks of life.
Many of these patients arrive on some of their worst days of life. They may have congestive heart failure, cancer, arthritis, epilepsy, and/or any combination of hundreds of other conditions. Regardless of their need, it is imperative that hospitals help patients to feel safe and welcome during their visits. Though not often used for those purposes, Penn Medicine is looking to electronic health records (EHRs) – a critical tool that holds important information about a patient, such as their medical history, immunizations, and lab results – to play a role in ensuring patients’ feelings of health and wellbeing.
Starting today, Penn Medicine hospitals in Philadelphia are asking patients to share more information in their EHRs. For example, in addition to reporting their sex at birth, patients are now offered the opportunity to provide specific information about their gender identity and sexual orientation, as well as their ethnicity and preferred spoken and written language.
The first such update in 10 years, the changes follow national Healthy People 20/20 recommendations as well as the Institute of Medicine (National Academy of Medicine) National Academies report on what to collect on patients’ background and characteristics. Knowing about ethnicity and gender identity can help a clinician be more adept at communicating with patients and more accurate in diagnosing and treating conditions.
In addition to collecting this information during the check-in process with front desk staff, patients will soon be able to report this information privately through the online patient accessible health record platform mypennmedicine, or at kiosks and tablets on site.
“We are always seeking to be the best in the way we provide care and services for all of our patients,” said Mona Matson, director of Patient and Guest Relations. “We stand strong in our pledge to treating the whole person – this is our latest example of this pledge.”
In the spirit of inclusivity, the changes to electronic health records were rolled out to make sure front desk staff, care teams, hospital leadership, and others understand the importance of the new data fields and their role in the upgrade.
“You can’t just train staff or conduct graduate medical education in a vacuum,” said Jaya Aysola, MD, MPH, an assistant professor of General Internal Medicine and assistant dean of Graduate Medical Education. “You have to change the system around them, so you’re not just teaching these principles, but also ensuring their clinical environment reflects these changes.”
Changing that system included training patient service representatives, conducting town hall meetings, and taking steps to educate patients and care providers. Nationally, most groups are in favor of such changes. A study last month in JAMA Internal Medicine reported that while 78 percent of clinicians thought patients would object to disclosing sexual orientation data, only 10 percent of patients reported that they would refuse to share this information.
To ensure successful implementation of these changes, Aysola, Rosemary Thomas, program coordinator of the Penn Medicine Program for LGBT Health, and Patrick Healy, director of operations at Clinical Practices of the University of Pennsylvania, worked closely with Scott Schlegel, MBA, chief operating officer, Clinical Practices of the University of Pennsylvania, and Patrick J. Brennan, MD, chief medical officer and senior vice president of the University of Pennsylvania Health System.
Part of the inspiration for Penn’s initiative was borne out of the blueprint for health equity and inclusion. This blueprint, modeled after Penn Medicine’s Blueprint for Quality and Patient Safety, was created in April 2016 by a health equity task force chaired by Aysola with support from Brennan, as well as Jeffrey Burns, MD, associate dean and designated institutional official for Graduate Medical Education, and Eve Higginbotham, SM, MD, a professor of Ophthalmology and vice dean for Inclusion and Diversity.
A lot of the task force’s work focuses on reducing unnecessary variations in care by understanding personal characteristics such as ethnicity, sexual orientation, gender identity and other attributes. Accurate and thorough data collection is key to determine the proper metrics to ensure value for all patients.
“If you look at care quality and patient experience nationally according to ethnicity or gender, you will likely notice differences,” said Aysola, who also serves as associate designated institutional official for health equity and inclusion. The best way of fixing such inequities is to redesign health delivery systems. This is an important step in that direction.”
While all people should be treated fairly, there are inequities in treatment of some conditions based on a patient’s identity. For example, among patients with end-stage renal disease that seek a renal transplant, black patients are significantly less likely than white patients to be referred to a renal transplant center and placed on a transplant waiting list, even after adjusting for several potential confounders.
“The better we understand a patient’s background, the better we can look at how we’re delivering care to ensure equal care is provided,” said Aysola. “It helps us further measure how well we’re doing our jobs to give each individual patient the best care possible.”