Improving documentation of sexual orientation, gender identity, and pronouns in electronic medical records among heart failure patients

Documentation of sexual orientation, gender identity (SOGI), and pronouns in electronic medical records (EMRs) is essential to providing inclusive, patient-centered care, but remains incomplete in many health systems. At our institution, a system-wide diversity, equity, and inclusion (DEI) educational program was launched in September 2023 to emphasize the importance of collecting and documenting SOGI and pronouns. Our objective was to evaluate the effect of a hospital-wide diversity-focused educational initiative on documentation of SOGI and pronouns in the EMR for patients discharged with heart failure (HF). We conducted a single-center, retrospective chart review which included adults (≥ 0.6 years) discharged with a primary diagnosis of HF between August 14, 2022, and March 21, 2024. Data was extracted from the EMR (Epic) and entered into REDCap for analysis. Patients were categorized as pre-initiative (August 14, 2022–February 10, 2023) or post-initiative (September 1, 2023–March 21, 2024). Documentation rates of SOGI and pronouns were compared before and after the initiative using Z-test statistics. Of 1,489 eligible patients (449 pre-initiative, 1,040 post-initiative), documentation rates increased for sexual orientation (13.8% to 19.5%; +5.7%, P = 0.008), gender identity (81.5% to 93.5%; +12.0%, P < 0.001), and pronouns (12.2% to 18.6%; +6.3%, P = 0.003). Implementation of a DEI-focused educational program was associated with modest but statistically significant improvements in SOGI and pronoun documentation. While education is an important step, persistent documentation gaps highlight structural and cultural barriers and the need for multifaceted strategies.