ORCID

0009-0001-1745-2893 (Munjwani), 0009-0003-5158-8684 (Schinderle), 0000-0003-3086-8014 (Qayyum), 0000-0001-5947-4778 (Yehya)

Document Type

Article

Publication Date

2026

DOI

10.1186/s12982-026-03069-5

Publication Title

Discover Public Health

Volume

23

Issue

1

Pages

1653 (7 pp.)

Abstract

Background

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.

Aims and objectives

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).

Methods

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.

Results

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).

Conclusion

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.

Rights

© The Authors 2026

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if you modified the licensed material. You do not have permission under this license to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Data Availability

Article states: "The datasets generated and/or analyzed during the current study are not publicly available due to institutional privacy regulations and patient confidentiality but are available from the corresponding author on reasonable request and with appropriate institutional approvals. Ethics approval was obtained from the Institutional Review Board at Macon & Joan Brock Virginia Health Sciences Department of Medicine at Old Dominion University, which waived the requirement for individual informed consent."

Original Publication Citation

unjwani, D., Schinderle, C., Qayyum, R., & Yehya, A. (2026). Improving documentation of sexual orientation, gender identity, and pronouns in electronic medical records among heart failure patients. Discover Public Health, 23(1), Article 1653. https://doi.org/10.1186/s12982-026-03069-5

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