Healthcare professionals’ perspectives on sex and gender documentation in electronic health records: an exploratory qualitative study of Sweden and China

Sex and gender, though often conflated in clinical settings, are distinct concepts that are essential for equitable healthcare. Despite the growing recognition of diverse gender identities, many healthcare information systems still adhere to a binary perspective. The lack of inclusive sex and gender documentation in electronic health records exacerbates healthcare inequities for transgender and gender nonconforming individuals. This study investigated how healthcare professionals in Sweden and China currently document gender and sex in electronic health records, aiming to identify issues that could improve healthcare inclusiveness and equity. Fifteen interviews were conducted with healthcare professionals from Sweden and China, and a thematic analysis was applied to identify key themes. Six key themes were identified. Most participants observed that healthcare professionals prioritize patients’ sex over gender in patient communication due to limited gender-focused medical education, binary-based clinical procedures, and inadequate electronic health record fields for documenting sex and gender. They also noted that biased sociocultural and political context influence documentation practices, and may raise concerns about the privacy of patients’ gender information. This study identifies key challenges in sex/gender documentation within electronic health record systems, including binary-focused practices, electronic health record design limitations, educational training gaps, and sociocultural barriers. Despite recognizing its importance, healthcare providers face implementation challenges due to operational constraints and a lack of standardization. The findings highlight the need for electronic health record redesign, improved training, and policy reforms to ensure equitable, gender-affirming care while protecting patient privacy. Further research should explore implementation strategies across diverse healthcare settings.