{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T21:03:47Z","timestamp":1786136627933,"version":"3.56.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,4,4]],"date-time":"2018-04-04T00:00:00Z","timestamp":1522800000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"funder":[{"name":"Department of Veterans Affairs, Health Service Research & Development"},{"name":"VA Informatics and Computing Infrastructure","award":["VA HSR RES 13-457"],"award-info":[{"award-number":["VA HSR RES 13-457"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status. The objective of this study was to determine the extent to which patients\u2019 clinician notes in EMR contained transgender-related terms that could corroborate ICD-coded transgender identity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data are from the US Department of Veterans Affairs Corporate Data Warehouse. Transgender patients were defined by the presence of ICD9 and ICD10 codes associated with transgender-related clinical services, and a 3:1 comparison group of nontransgender patients was drawn. Patients\u2019 clinician text notes were extracted and searched for transgender-related words and phrases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 7560 patients defined as transgender based on ICD codes, the search algorithm identified 6753 (89.3%) with transgender-related terms. Among 22\u2009072 patients defined as nontransgender without ICD codes, 246 (1.1%) had transgender-related terms; after review, 11 patients were identified as transgender, suggesting a 0.05% false negative rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Using ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy022","type":"journal-article","created":{"date-parts":[[2018,2,26]],"date-time":"2018-02-26T20:17:15Z","timestamp":1519676235000},"page":"905-908","source":"Crossref","is-referenced-by-count":96,"title":["Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes"],"prefix":"10.1093","volume":"25","author":[{"given":"John R","family":"Blosnich","sequence":"first","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Cashy","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J","family":"Gordon","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA"},{"name":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA"},{"name":"MIRECC, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian C","family":"Shipherd","sequence":"additional","affiliation":[{"name":"LGBT Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, 20420, USA"},{"name":"VA Boston Healthcare System, National Center for PTSD, Women\u2019s Health Sciences Division, Boston, MA, 02130, USA"},{"name":"Department of Psychiatry, Boston University, Boston, MA, 02118. USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Kauth","sequence":"additional","affiliation":[{"name":"LGBT Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, 20420, USA"},{"name":"South Central MIRECC, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA"},{"name":"Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, 77021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson, TN, 37604, USA"},{"name":"Mountain Home VA Medical Center, Mountain Home, TN, 37684, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Fine","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA"},{"name":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,4,4]]},"reference":[{"key":"2020110612384292000_ocy022-B1","volume-title":"The Health of Lesbian, Gay, Bisexual, and Transgeder People: Building a Foundation for Better Understanding","author":"Institute of Medicine","year":"2011"},{"issue":"3","key":"2020110612384292000_ocy022-B2","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/S1473-3099(12)70315-8","article-title":"Worldwide burden of HIV in transgender women: a systematic review and meta-analysis","volume":"13","author":"Baral","year":"2013","journal-title":"Lancet Infect Dis"},{"issue":"10","key":"2020110612384292000_ocy022-B3","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.2105\/AJPH.2013.301507","article-title":"Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care","volume":"103","author":"Blosnich","year":"2013","journal-title":"Am J Public Health."},{"issue":"4","key":"2020110612384292000_ocy022-B4","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1089\/lgbt.2014.0050","article-title":"Mortality among veterans with transgender-related diagnoses in the Veterans Health Administration, FY2000-2009","volume":"1","author":"Blosnich","year":"2014","journal-title":"LGBT Health"},{"issue":"2","key":"2020110612384292000_ocy022-B5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1177\/1534765610395614","article-title":"Potentially traumatic events in a transgender sample: frequency and associated symptoms","volume":"17","author":"Shipherd","year":"2011","journal-title":"Traumatology"},{"key":"2020110612384292000_ocy022-B6","volume-title":"National Transgender Discrimination Survey Report on Health and Health Care","author":"Grant","year":"2010"},{"key":"2020110612384292000_ocy022-B7","volume-title":"How Many Adults Identify as Transgender in the United States?","author":"Flores","year":"2016"},{"issue":"3","key":"2020110612384292000_ocy022-B8","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.annepidem.2016.01.004","article-title":"A novel method for estimating transgender status using electronic medical records","volume":"26","author":"Roblin","year":"2016","journal-title":"Ann Epidemiol"},{"issue":"4","key":"2020110612384292000_ocy022-B9","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1136\/amiajnl-2012-001472","article-title":"Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group","volume":"20","author":"Deutsch","year":"2013","journal-title":"J Am Med Inform Assoc"},{"issue":"6","key":"2020110612384292000_ocy022-B10","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s11606-014-3148-7","article-title":"Electronic health records and transgender patients\u2014practical recommendations for the collection of gender identity data","volume":"30","author":"Deutsch","year":"2015","journal-title":"J Gen Int Med"},{"issue":"8","key":"2020110612384292000_ocy022-B11","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1001\/jama.1990.03440080092030","article-title":"Medical informatics: an emerging academic discipline and institutional priority","volume":"263","author":"Greenes","year":"1990","journal-title":"JAMA."},{"issue":"16","key":"2020110612384292000_ocy022-B12","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1001\/jama.288.16.1955","article-title":"Medical informatics: improving health care through information","volume":"288","author":"Hersh","year":"2002","journal-title":"JAMA."},{"issue":"1","key":"2020110612384292000_ocy022-B13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/1524839904270389","article-title":"Public health informatics: the nature of the field and its relevance to health promotion practice","volume":"6","author":"Kukafka","year":"2005","journal-title":"Health Promotion Pract"},{"issue":"3","key":"2020110612384292000_ocy022-B14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1089\/lgbt.2014.0009","article-title":"Transgender health disparities: comparing full cohort and nested matched-pair study designs in a community health center","volume":"1","author":"Reisner","year":"2014","journal-title":"LGBT Health"},{"issue":"7","key":"2020110612384292000_ocy022-B15","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1080\/09540121.2013.855701","article-title":"Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center","volume":"26","author":"Reisner","year":"2014","journal-title":"AIDS Care"},{"issue":"3","key":"2020110612384292000_ocy022-B16","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jadohealth.2014.10.264","article-title":"Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study","volume":"56","author":"Reisner","year":"2015","journal-title":"J Adolesc Health"},{"key":"2020110612384292000_ocy022-B17","volume-title":"Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1","author":"Institute of Medicine","year":"2014"},{"issue":"1","key":"2020110612384292000_ocy022-B18","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1089\/trgh.2016.0031","article-title":"Identifying the transgender population in the medicare program","volume":"1","author":"Proctor","year":"2016","journal-title":"Transgender Health"},{"key":"2020110612384292000_ocy022-B19","doi-asserted-by":"crossref","first-page":"S532","DOI":"10.2105\/AJPH.2014.302086","article-title":"Access to care for transgender veterans in the Veterans Health Administration: 2006-2013","volume":"104","author":"Kauth","year":"2014","journal-title":"Am J Public Health"},{"issue":"2","key":"2020110612384292000_ocy022-B20","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1089\/lgbt.2015.0058","article-title":"Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the veterans health administration: a case-control study","volume":"3","author":"Brown","year":"2016","journal-title":"LGBT Health"},{"issue":"7","key":"2020110612384292000_ocy022-B21","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1377\/hlthaff.2014.0054","article-title":"Insights from advanced analytics at the Veterans Health Administration","volume":"33","author":"Fihn","year":"2014","journal-title":"Health Affairs"},{"key":"2020110612384292000_ocy022-B22","volume-title":"R Core Team. R: A language and environment for statistical computing. [computer program]","year":"2013"},{"key":"2020110612384292000_ocy022-B23","volume-title":"Introduction to the TM Package Text Mining in R","author":"Feinerer","year":"2013"},{"key":"2020110612384292000_ocy022-B24","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM-5","author":"American Psychiatric Association","year":"2013"},{"key":"2020110612384292000_ocy022-B25","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.socscimed.2015.11.010","article-title":"Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions","volume":"147","author":"Hughto","year":"2015","journal-title":"Soc Sci Med"},{"issue":"3","key":"2020110612384292000_ocy022-B26","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1089\/lgbt.2016.0047","article-title":"Transforming a system: improving patient-centered care for sexual and gender minority veterans","volume":"3","author":"Kauth","year":"2016","journal-title":"LGBT Health"},{"issue":"4","key":"2020110612384292000_ocy022-B27","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.jsxm.2016.02.001","article-title":"Prevalence of transgender depends on the \u201ccase\u201d definition: a systematic review","volume":"13","author":"Collin","year":"2016","journal-title":"J Sexual Med"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/905\/34150111\/ocy022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/905\/34150111\/ocy022.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T18:02:32Z","timestamp":1604685752000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/7\/905\/4961208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,4]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,4,4]]},"published-print":{"date-parts":[[2018,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocy022","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,7]]},"published":{"date-parts":[[2018,4,4]]}}}