Capturing Sex Partner Information in the Electronic Health Record: Implications for Research on Sexual Minorities Within an Integrated Health Care Delivery System
sexual orientation and gender identity, LGBT
Background/Aims: To better characterize and reduce health disparities faced by sexual and gender minorities (SGM), efforts to collect sexual orientation and gender identity within the electronic health record (EHR) are currently burgeoning across the United States. In 2006, Kaiser Permanente Northwest (KPNW) began collecting information about sexual activity of patients and the sex of their partners in the social history module of its EHR. The aims of our work were to describe trends in the capture of this information over a 9-year period and discuss the relevance of these findings to current sexual orientation and gender identity data collection and SGM health research efforts.
Methods: We included all KPNW members with at least one day of health plan enrollment and at least one in-person encounter (outpatient, inpatient or emergency department) from Jan. 1, 2006, to Dec. 31, 2014. We analyzed sexual activity and sex partner variables at encounter and individual levels over the study period.
Results: From 2006 to 2014, the proportion of encounters at which a patient’s sexual activity was recorded increased from 1.2% to 15.1% for males and from 2.9% to 27.4% for females, with an increase among primary care encounters from 2.8% to 29.6% for males and 4.6% to 49.1% for females. Of our study population still enrolled in 2014, 37,890 males (22.1%) had a sex partner recorded, 94.6% of which had female only, 5.1% male only and 0.3% both. At the same time, 87,851 females (40.7%) had a sex partner recorded, 96.8% of which had male only, 2.8% female only and 0.4% both.
Conclusion: Our findings suggest an increasingly systematic capture of sexual activity and sex partner information within the KPNW EHR. Sexual behavior is only one component of sexuality orientation. As such, we are likely underestimating the size of our SGM population, especially for those reporting both male and female partners, based on previously published estimates. However, our research supports the idea that successful routine capture of sexual orientation and gender identity data within the EHR is possible. We argue that inclusion of these data would lead to a better understanding of the size and representativeness of the SGM population, more robust research studies and better interventions to reduce SGM health disparities.
Schmidt MA, Varga AM, Crawford PM, Sengupta S, Gillespie SE, Donald JL, McBurnie MA. Capturing sex partner information in the electronic health record: implications for research on sexual minorities within an integrated health care delivery system. J Patient Cent Res Rev. 2016;3:195.