Objectives 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. Materials and methods Patients ≥18 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. Results 1 576 120 patients met inclusion criteria: 100% had a Legal Sex, 20% a Gender Identity, and 19% a SAAB; 321 185 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 ≥2 changes; 20% of patients had ≥1 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. Discussion 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. Conclusion EHR metadata highlights areas for improvement of sex and gender field utilization.

中文翻译：

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电子健康记录性别和性别人口统计领域的利用：元数据和混合方法分析

目标 尽管联邦政府强制要求在电子健康记录 (EHR) 中收集性别和性别人口统计数据，但仍缺乏纵向评估。我们使用 EHR 元数据评估了性别和性别人口统计领域的利用率。材料和方法 本回顾性研究纳入了 2018 年 1 月 8 日至 2022 年 1 月 1 日期间在麻省总医院布里格姆卫生系统中首次合法性别登记（登记要求）的 18 岁以上患者。所有性别和性别字段（法定性别、出生时分配的性别 [SAAB]、性别认同）的元数据均通过完成率、用户类型和纵向变化进行量化。对现场使用率高低的专业提供者进行的嵌套定性研究确定了与利用率相关的主题。结果 1 576 120 名患者符合纳入标准：100% 具有合法性别，20% 具有性别认同，19% 具有 SAAB； 321 185 名患者除了最初的合法性别输入之外还进行了字段更改。大约 2% 的患者随后进行了合法性别改变，其中 25% 的患者发生了 ≥2 次改变； 20% 的患者对性别认同进行了≥1 次更新，19% 的患者对 SAAB 进行了≥1 次更新。除第一个合法性别条目外，管理员在所有字段中进行了最多的更改 (67%)，其次是患者 (25%)、提供者 (7.2%) 和自动健康级别 7 (HL7) 界面消息 (0.7%)。提供者的利用率因专科而异；确定了与系统障碍和个人看法相关的主题。讨论 性别和性别人口统计字段主要由管理员使用，并引起对数据准确性的担忧；提供商的使用是异构且缺乏的。提供商对现场可用性和可变工作流程的认识可能会妨碍使用。结论 EHR 元数据突出了性和性别领域利用的改进领域。