What’s Next for Modernizing Gender, Sex, and Sexual Orientation Terminology in Digital Health Systems? Viewpoint on Research and Implementation Priorities

Abstract

In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions.

Authors’ Reply: Modernizing Gender, Sex, and Sexual Orientation Data Through Engagement and Education

“…The authors [ 1 ] agree with the letter to the editor [ 2 ] that education and engagement are necessary for the successful modernization of gender, sex, and sexual orientation in digital health systems. The participants in our knowledge translation project tended to focus on the need for more short-term education initiatives with providers, staff, patients, and family members related to implementing changes.…”

Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis

“…This study is responsive to recent calls in the literature to address the pronounced dearth of intersectionality theory-informed research investigating disparities related to digital health [38][39][40]. As we strive to narrow the digital divide, or the disparities in technology and internet access and use [75][76][77], we must understand disparities in willingness to use digital technologies for health-related purposes even when these tools are available.…”

“…This study examined the use of digital health tools for screening and tracking for the COVID-19 pandemic, focusing on a broader, more diverse range of the sexual minority population in the United States. In particular, the study used the conceptual [32,33] and methodological [34,35,39] frameworks of intersectionality theory to determine the presence of disparities between heterosexual and sexual minority adults across various intersections of identity (ie, age, gender, and race or ethnicity) in their willingness to use digital health tools for screening and tracking.…”

“…The intersectionality framework suggests that sexual minority people's multiple intersecting identities must be considered simultaneously (eg, sexual minority people who are also African American), rather than treating each identity as a mutually exclusive category [36,37]. A recent review [38] and commentaries [39,40] have emphasized the urgent need to use intersectionality theory in the conceptualization and methodology of examining digital health disparities.…”

Modernizing Gender, Sex, and Sexual Orientation Data Through Engagement and Education

“…We were pleased to read the article by Queen et al [ 1 ], which reports a sensitive, precise, and effective discussion on the need for and how to modernize the terminology of gender, sex, and sexual orientation (GSSO) in the digital health system. The authors warn us about the risks of inaccurate and potentially harmful clinical care due to the inability of most digital health systems to record, store, and manage GSSO data.…”