{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T11:29:48Z","timestamp":1773401388451,"version":"3.50.1"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T00:00:00Z","timestamp":1706832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"CRICO"},{"name":"The Risk Management Foundation"},{"name":"Harvard Medical Institutions Incorporated"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23HL161332"],"award-info":[{"award-number":["K23HL161332"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI150295"],"award-info":[{"award-number":["R01AI150295"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01HS028916"],"award-info":[{"award-number":["K01HS028916"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Despite federally mandated collection of sex and gender demographics in the electronic health record (EHR), longitudinal assessments are lacking. We assessed sex and gender demographic field utilization using EHR metadata.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and methods<\/jats:title>\n                  <jats:p>Patients \u226518 years of age in the Mass General Brigham health system with a first Legal Sex entry (registration requirement) between January 8, 2018 and January 1, 2022 were included in this retrospective study. Metadata for all sex and gender fields (Legal Sex, Sex Assigned at Birth [SAAB], Gender Identity) were quantified by completion rates, user types, and longitudinal change. A nested qualitative study of providers from specialties with high and low field use identified themes related to utilization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1\u00a0576\u00a0120 patients met inclusion criteria: 100% had a Legal Sex, 20% a Gender Identity, and 19% a SAAB; 321\u00a0185 patients had field changes other than initial Legal Sex entry. About 2% of patients had a subsequent Legal Sex change, and 25% of those had \u22652 changes; 20% of patients had \u22651 update to Gender Identity and 19% to SAAB. Excluding the first Legal Sex entry, administrators made most changes (67%) across all fields, followed by patients (25%), providers (7.2%), and automated Health Level-7 (HL7) interface messages (0.7%). Provider utilization varied by subspecialty; themes related to systems barriers and personal perceptions were identified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Sex and gender demographic fields are primarily used by administrators and raise concern about data accuracy; provider use is heterogenous and lacking. Provider awareness of field availability and variable workflows may impede use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>EHR metadata highlights areas for improvement of sex and gender field utilization.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocae016","type":"journal-article","created":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T16:44:43Z","timestamp":1706978683000},"page":"910-918","source":"Crossref","is-referenced-by-count":7,"title":["Utilization of electronic health record sex and gender demographic fields: a metadata and mixed methods analysis"],"prefix":"10.1093","volume":"31","author":[{"given":"Dinah","family":"Foer","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital , Boston, MA 02115, United States"},{"name":"Harvard Medical School , Boston, MA 02115, United States"}]},{"given":"David M","family":"Rubins","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115, United States"},{"name":"Mass General Brigham Digital , Somerville, MA 02145, United States"}]},{"given":"Vi","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital , Boston, MA 02115, United States"}]},{"given":"Alex","family":"McDowell","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115, United States"},{"name":"Health Policy Research Institute, Mongan Institute, Massachusetts General Hospital , Boston, MA 02114, United States"}]},{"given":"Meg","family":"Quint","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Hypertension, Brigham and Women\u2019s Hospital , Boston, MA 02115, United States"}]},{"given":"Mitchell","family":"Kellaway","sequence":"additional","affiliation":[{"name":"Adult Primary Care, Boston Medical Center , Boston, MA 02118, United States"}]},{"given":"Sari L","family":"Reisner","sequence":"additional","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115, United States"},{"name":"Division of Endocrinology, Diabetes and Hypertension, Brigham and Women\u2019s Hospital , Boston, MA 02115, United States"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA 02115, United States"}]},{"given":"Li","family":"Zhou","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital , Boston, MA 02115, United States"},{"name":"Harvard Medical School , Boston, MA 02115, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6268-1540","authenticated-orcid":false,"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital , Boston, MA 02115, United States"},{"name":"Harvard Medical School , Boston, MA 02115, United States"}]}],"member":"286","published-online":{"date-parts":[[2024,2,2]]},"reference":[{"issue":"1","key":"2024040320065181400_ocae016-B1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1089\/lgbt.2013.0001","article-title":"Sexual orientation and gender identity data collection in clinical settings and in electronic health records: a key to ending LGBT health disparities","volume":"1","author":"Cahill","year":"2014","journal-title":"LGBT Health"},{"issue":"7","key":"2024040320065181400_ocae016-B2","doi-asserted-by":"crossref","first-page":"991","DOI":"10.2105\/AJPH.2020.305722","article-title":"Sexual orientation and gender identity data collection: clinical and public health importance","volume":"110","author":"Streed","year":"2020","journal-title":"Am J Public Health"},{"issue":"3","key":"2024040320065181400_ocae016-B3","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.amepre.2017.11.009","article-title":"Gender identity disparities in cancer screening behaviors","volume":"54","author":"Tabaac","year":"2018","journal-title":"Am J Prev Med"},{"issue":"2","key":"2024040320065181400_ocae016-B4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/jamia\/ocab136","article-title":"Transgender data collection in the electronic health record: current concepts and issues","volume":"29","author":"Kronk","year":"2022","journal-title":"J Am Med Inform Assoc"},{"issue":"8","key":"2024040320065181400_ocae016-B5","doi-asserted-by":"crossref","first-page":"e1297","DOI":"10.1200\/OP.22.00084","article-title":"Sexual orientation and gender identity data collection in oncology practice: findings of an ASCO survey","volume":"18","author":"Kamen","year":"2022","journal-title":"JCO Oncol Pract"},{"key":"2024040320065181400_ocae016-B6","doi-asserted-by":"crossref","first-page":"104245","DOI":"10.1016\/j.ijmedinf.2020.104245","article-title":"Using sexual orientation and gender identity data in electronic health records to assess for disparities in preventive health screening services","volume":"142","author":"Grasso","year":"2020","journal-title":"Int J Med Inform"},{"issue":"8","key":"2024040320065181400_ocae016-B7","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1177\/1744987120927206","article-title":"Purposive sampling: complex or simple? Research case examples","volume":"25","author":"Campbell","year":"2020","journal-title":"J Res Nurs"},{"issue":"4","key":"2024040320065181400_ocae016-B8","first-page":"16","article-title":"Qualitative descriptive methods in health science research","volume":"9","author":"Colorafi","year":"2016","journal-title":"Health Environ Res Des J"},{"issue":"9","key":"2024040320065181400_ocae016-B9","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual Health Res"},{"issue":"18","key":"2024040320065181400_ocae016-B10","doi-asserted-by":"crossref","first-page":"2938","DOI":"10.1093\/bioinformatics\/btx364","article-title":"UpSetR: an R package for the visualization of intersecting sets and their properties","volume":"33","author":"Conway","year":"2017","journal-title":"Bioinformatics"},{"issue":"1","key":"2024040320065181400_ocae016-B11","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/1090198120963102","article-title":"Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox","volume":"48","author":"Thompson","year":"2021","journal-title":"Health Educ Behav"},{"issue":"4","key":"2024040320065181400_ocae016-B12","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1007\/s11606-022-07671-6","article-title":"Experiences of transgender people reviewing their electronic health records, a qualitative study","volume":"38","author":"Alpert","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"3","key":"2024040320065181400_ocae016-B13","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1136\/emermed-2018-207669","article-title":"Collecting sexual orientation and gender identity information in the emergency department: the divide between patient and provider perspectives","volume":"36","author":"Kodadek","year":"2019","journal-title":"Emerg Med J"},{"issue":"6","key":"2024040320065181400_ocae016-B14","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1080\/00918369.2019.1667162","article-title":"Provider practices and perspectives regarding collection and documentation of gender identity","volume":"68","author":"Nadler","year":"2021","journal-title":"J Homosex"},{"issue":"5","key":"2024040320065181400_ocae016-B15","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.pec.2019.12.006","article-title":"Oncology patients\u2019 preferences regarding sexual orientation and gender identity (SOGI) disclosure and room sharing","volume":"103","author":"Alexander","year":"2020","journal-title":"Patient Educ Couns"},{"key":"2024040320065181400_ocae016-B16","doi-asserted-by":"publisher","author":"Beltran","year":"2023","DOI":"10.22541\/au.167886006.60405995\/v1"},{"issue":"2","key":"2024040320065181400_ocae016-B17","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/jamia\/ocab196","article-title":"Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation","volume":"29","author":"McClure","year":"2022","journal-title":"J Am Med Inform Assoc"},{"issue":"2","key":"2024040320065181400_ocae016-B18","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1093\/jamia\/ocab183","article-title":"Toward an inclusive digital health system for sexual and gender minorities in Canada","volume":"29","author":"Antonio","year":"2022","journal-title":"J Am Med Inform Assoc"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/31\/4\/910\/57148533\/ocae016.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamia\/article-pdf\/31\/4\/910\/57148533\/ocae016.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T20:07:25Z","timestamp":1712174845000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/31\/4\/910\/7597706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,2]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2,2]]},"published-print":{"date-parts":[[2024,4,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocae016","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4,1]]},"published":{"date-parts":[[2024,2,2]]}}}