Overcoming technical and cultural challenges to delivering equitable care for LGBTQ+ individuals in a rural, underserved area.

The lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) community is vulnerable to health-care disparities. Many health-care organizations are working to collect sexual orientation and gender identity in their electronic health records (EHRs), with the goal of providing more inclusive care to their LGBTQ+ patients. There are significant human and technical barriers to making these efforts successful. Based on our 5-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), this case report provides insights to overcome challenges in 4 critical areas: (1) enabling the EHR to collect and use information to support the health-care needs of LGBTQ+ patients, (2) building a culture of awareness and caring, empowering members of the health-care team to break down barriers of misunderstanding and mistrust, (3) developing services to support the needs of LGBTQ+ patients, and (4) partnering with local communities to become a trusted health-care provider.

Bringing Cultural Competency to the EHR: Lessons Learned Providing Respectful, Quality Care to the LGBTQ Community.

The lesbian, gay, bisexual, transgender, queer (LGBTQ) community is vulnerable to healthcare disparities. Many healthcare organizations are contemplating efforts to collect sexual orientation and gender identity in the electronic health record (EHR), with a goal of providing more respectful, inclusive, high-quality care to their LGBTQ patients. There are significant human and technical barriers that must be overcome to make these efforts successful. Based on our four-year experience at Geisinger (an integrated health system located in a rural, generally conservative area), we provide insights to overcome challenges in two critical areas: 1) enabling the EHR to collect and use information to support the healthcare needs of LGBTQ patients, and 2) building a culture of awareness and caring, empowering members of the healthcare team to break down barriers of misunderstanding and mistrust.

Medical Evaluation Board for Mental Health Condition: U.S. Army Officer Medical Evaluation Board Data by Branch and Component.

OBJECTIVE: A retrospective review of Medical Evaluation Board (MEB) data to determine the effect of career field or Army component on the relative risk for mental health (MH) related MEBs among Army Officers, may identify specific populations for enhanced screening before accession, or groups that may require targeted preventive resources during their careers. METHOD: 4 years' of data available on Army Officers from the Department of the Army's Electronic Disability Evaluation System database, contained specific information on the officers' physical profiles, career fields, and service component. This information was compared with a dataset provided by the Defense Manpower Data Center (DMDC), reporting documented force strength by career field and service component for the corresponding years, allowing for calculation and comparison of MEB and MH-MEB rates between Army components and between career fields. RESULTS: Significant differences in MEB and MH-MEB rates were found between Army components, but database gaps make this assessment uncertain. When comparing MEB and MH-MEB rates between career fields (regardless of service component), 9 career fields had statistically significant higher risk rates of MEB and/or MH-MEB, whereas 13 career fields showed significantly lower rates of MEB and/or MH-MEB. CONCLUSION: Frequency of Army Officer MEBs and/or MH-MEBs were variable and career field dependent; the underlying causes of these variations warrant further research. The use of the Electronic Disability Evaluation System database for the Integrated Disability Evaluation System process is a rich source of data for in-depth analysis, but the program itself and the procedures for its use need to be improved to obtain more complete information.