Technological Implementation of a Standardized SmartForm for Pronouns and Gender Identity

The Hospital for Sick Children is the largest paediatric academic health sciences center Canada and has had a clinic dedicated to providing medical care for gender diverse youth since October 2013. In 2018, SickKids upgraded to Epic as their Electronic Health Record and, as part of our vision to holistically care for the identity of all children, implemented the ability for staff to document a patient’s preferred name in one standardized location. At that time, we had the optionality of implementing the Sexual Orientation and Gender Identity (SOGI) SmartForm that would allow staff to document a patient’s gender identity and pronouns in one standardized location. However, the decision was made not to implement the SOGI SmartForm and to assess organizational readiness once more resources could be dedicated to a fulsome organization wide education on gender affirming care. The concern was that without proper education and dedication to change management, staff could inadvertently cause patients to revisit past trauma or unknowingly provide non inclusive care (Bhatt et al., 2022). 

In 2022, as part of fulfilling SickKids 2025 Equity, Diversity, and Inclusivity (EDI) strategic plan and an extensive review of safety reports, the Chief Nursing Informatics Officer and EDI Executive Lead and Strategic Advisor joined together to help implement the SOGI SmartForm. I was then brought in as the individual to lead the change management and design processes required for the successful implementation of a project that touches on both EDI and clinical informatics. The technical scope of this project was deemed to be implementing the SOGI SmartForm, allowing for documented pronouns to print on most hospital issued armbands, and showing pronoun information on specific lists of patient names within Epic. Three clinics championed the education and workflows processes to inform a future organizational wide adoption of the SOGI SmartForm and gender affirming care processes: transgender youth, solid tumour, and survivorship clinics. 

              I had three overall learning objectives for this fellowship. The first was to fully understand the psychological and physical implications of misgendering someone and, by extension, to build upon my existing knowledge of paediatric gender affirming care. From a gender affirming care perspective, I learned about developmental milestones for gender exploration and how to utilize principles of health equity in clinical practice. Gender safety was probably the biggest topic that I focused my attention on because EHRs make it easy to accidentally share someone’s private information to caregivers or other care providers without a patient’s fully informed consent (Goldhammer et al., 2022). 

The second learning objective was to understand what existing resources and policies existed within SickKids for providing gender affirming care to patients. What I learned was that the policies and e-Learning modules within SickKids were primarily dedicated to preferred name and how respecting a patient’s chosen name creates emotional well-being, safer spaces, and results in a more positive hospital experience. We originally thought that the policies could be modified to also include the importance of respecting a patient’s gender identity and pronouns. Unfortunately, due to time constraints and the intricacies of updating an existing policy, it was deemed out of scope for this project and fellowship. Educational resources were updated and now include an organizational wide collection of videos and infographics that can be studied in a self-directed manner. 

The final goal was to learn the role of the clinical informatician that is taking a project from problem to production. What I learned is that building expertise in change management and user centered design is integral to being a clinical information. My primary mentor taught me the ADKAR process which highlights how building Awareness of a change, Desire for the change, Knowledge of how to do the change, the Ability to put the change into your practice, and building resources to Reinforce the change allows for projects to succeed. User centered design is a philosophy which we embraced for the design process; understanding how end users help shape the design of the SOGI SmartForm.