Dropdown rights: Categorizing transgender discrimination in healthcare technologies

Area of Science:

• Health Law and Policy
• Sociology of Health
• Information Systems in Healthcare

Background:

• Section 1557 of the Affordable Care Act mandates non-discriminatory healthcare for patients based on gender identity.
• Healthcare organizations face challenges in implementing these legal requirements effectively.
• Socio-technical systems within organizations influence the practical application of discrimination protections.

Purpose of the Study:

• To analyze the implementation of gender identity non-discrimination policies in U.S. healthcare organizations.
• To examine the role of socio-technical systems, including information technology, in compliance with Section 1557.
• To understand how healthcare organizations' practices shape the lived experience of civil rights for transgender patients.

Main Methods:

• Qualitative study involving interviews with healthcare grievance handlers.
• Analysis of how information technologies are used to process patient civil rights claims.
• Examination of physician-led implementation groups and their methods for gender identity recognition.

Main Results:

• Grievance handlers' use of information technology can demobilize and erase civil rights claims, particularly transgender harassment.
• Physician-led groups actively tracked gender identity in electronic medical records and material objects, facilitating recognition.
• Default structures in healthcare software (e.g., dropdown menus) reflect and reinforce professional norms, financial incentives, and justice conceptions.

Conclusions:

• The implementation of gender identity protections is complex, influenced by socio-technical factors within healthcare organizations.
• Conflicting interpretations and practices regarding transgender rights persist across different organizational units.
• Legal mandates like Section 1557 face challenges in transforming healthcare delivery due to embedded socio-technical structures.