Answering Your Questions about Epic ONE and Its Tools for Improving Care of LGBT Patients

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On November 7, Epic ONE will go live at Southern New Hampshire Health and Elliot Health System will undergo a major upgrade.

One feature to look for is the sexual orientation and gender identity (SOGI) Smartform. These optional questions help us determine proper pronouns for our transgender and non-binary patients. They also allow us to look specifically at their needs. 

In part two, we’re answering more frequently asked questions about Epic’s SOGI Smartform.

How will I call a patient to an exam room and confirm their identity?

As always, the preferred first name should be used to call a patient to an exam room and their identity is confirmed by asking for the patient’s last name and DOB. 

How will Epic determine the gender for my smart sets/Note Writer?

If the gender identity or legal sex do not match the sex assigned at birth, both male and female smart sets will appear for that patient.

How will radiology staff know if a patient was assigned female sex at birth, but has transitioned to male?

Epic will prompt pregnancy questions if the patient was assigned female at birth and/or if any patient has a uterus documented in the SOGI Smartform under organ inventory.  The use of testosterone DOES NOT act as a means of contraception, even if a patient no longer has menses.

How will SOGI effect medication warnings?

If legal sex/gender identity do not match the sex assigned at birth, both male and female medication warnings will be used. 

To determine whether a pregnancy warning should appear for a given patient, Epic checks:

  • If the patient’s Legal Sex or Sex Assigned at Birth are documented as Female.
  • If the patient’s Organ Inventory documents that they have a uterus.
  • If the patient has a recent positive pregnancy test.
  • If the patient is a carrier in a course of fertility treatment.
  • If the patient is of an age at which pregnancy warnings are relevant.

To determine whether a lactation warning should appear for a given patient, Epic checks:

  • If the patient’s Legal Sex or Sex Assigned at Birth are documented as Female.
  • The patient’s breastfeeding status and whether the patient recently gave birth.
  • If the patient is of an age at which lactation warnings are relevant.

How will the SOGI Smartform effect labs that are dependent on sex/gender?

When Epic has a patient with unreliable sex, the default will show both male and female ranges of normal. 

Will “Care Everywhere Organizations” see the SOGI data?

These organizations will receive preferred name in quotes, legal sex, and gender identity.

What should I do as a provider if a patient has a preferred name, but does not want it listed in their chart?

There are several reasons why a person may not want a preferred name on their chart. They may not be out to family or loved ones who may have access to their mail or accompany them to appointments. In this instance, it is sometimes better to make a personal comment on a sticky note in a patient’s chart. Sticky notes can be private and are not shared with other staff, which eliminates circumstances that could accidentally disclose a patient’s preferred name or gender identity. 

How do I determine a patient’s legal sex/legal name?

The best method is asking a patient what sex is on their driver’s license or what is listed on their insurance plan. If a patient seems uncomfortable about this, tell them we collect this data to be sure we are sending accurate information to insurance companies, so they do not deny claims. 

What name do I use to search for a patient in Epic?

A patient can have multiple aliases in Epic. You can search for a patient using a preferred name, legal name, or any other name that a patient has previously had listed in Epic. 

When do I update the legal sex field or legal name field in Epic?

This can be done when a government issued ID or legal paperwork is presented showing a change in legal name.

What Epic-generated documents will show preferred name vs legal name?

Patient-facing documents such as letters, after visit summaries, and lab results should all default with the preferred name. Billing information, lab specimens, and consents require legal names on them. To prevent any potential conflicts, patients should be made aware that we are sensitive to preferred names and pronouns, but there are some instances that the use of legal name and legal sex is required by law. Prior to sending any correspondence, content should be double checked to ensure the correct name and pronouns are being used. 

How does unreliable sex alter the growth charts?

If Epic determines that a child has unreliable sex, you will have options for both male and female charts.

How will unreliable sex change health maintenance and BPAs?

Whenever sex cannot be determined, Epic will give both male and female health maintenance alerts/BPAs. Please remember that transgender people who have used hormones or have had gender-affirming surgery will have different health maintenance needs. Please see the World Professional Association for Transgender Health for more details. 

What name or sex will appear on a hospital wrist band?

Wrist bands will display preferred name and legal name. The attending physician will no longer appear on wrist bands. Sex and gender will no longer appear on wristbands. 

To learn more about Epic ONE, click here.

For any questions or more information on LGBT patient care, please contact Eric Senneville, PA-C.