Advocacy groups and a growing number of medical associations and journals want electronic health records (EHRs) to replace the biological categories of male and female with “a more inclusive model” that includes gender identity.
Inclusivity requires abandoning the traditional model of sex, Stacy Stokes, M.D., a member of the American Academy of Pediatrics (AAP) Council on Clinical Information Technology, wrote on the AAP website, on December 1.
“Historically, EHRs have used a binary construct for sex and gender, often conflating the two terms as ‘male’ and ‘female,’” said Stokes. “However, the use of sex and gender in EHRs has evolved over the last five years toward a more inclusive mode.”
Science isn’t served by twisting the meaning of terms to suit political ends, says Merrill Matthews, Ph.D., a resident scholar at the Institute for Policy Innovation.
“It’s a sad day when medical science works so hard to deny biological science,” said Matthews. “The irony in trying to ‘improve’ on the ‘human binary design’ in health IT is that the computer code itself is almost certainly binary.”
Gender Harmony Model
One of the groups spearheading the effort to move away from the “binary construct” of male and female is the Gender Harmony Project (GHP), which is composed of advocates for adopting medical practices and language geared toward “improving outcomes for sex- and gender-marginalized people.”
GHP developed a “gender-inclusive” model for use in payments, data analysis, quality measurement, and EHRs, authors associated with the group explain in an article published in the Journal of American Medical Informatics Association (JAMIIA).
“Most clinical systems and current standards in health care do not meaningfully address, nor do they consistently represent, sex and gender diversity, which has impeded interoperability and led to suboptimal health care,” wrote the authors. “The Gender Harmony Model provides the informative guidance for standards developers to implement a more thorough technical design that improves the narrow binary design used in many legacy clinical systems.”
‘An Ongoing Problem’
GHP is a project of Health Level Seven International (HL7), a nonprofit organization with members in more than 50 countries that develops information technology standards to support clinical care, giving the GHP model a global digital platform.
The GHP model standardizes terminology, the JAMIIA article states.
“Within our model, sex is used to classify individuals as female, male, or specified (neither female nor male) and can be based on an infant’s anatomy, other biological characteristics, or can be associated with physical and physiological features,” wrote the authors. “…Gender is defined as a person’s inner sense of being a girl/woman/female/feminine, boy/man/male/masculine, nonbinary, … something else, or having no gender.”
Using inclusive terms could reduce bullying of patients and providers, states the APP Committee on Pediatric Workforce.
“Sexual and gender-based harassment is an ongoing problem in society, and those in medicine are not immune,” said the committee.
Bonner Russell Cohen, Ph.D. (firstname.lastname@example.org) is a senior fellow at the National Center for Public Policy Research.