Most algorithms deployed in healthcare do not consider gender and sex despite the effect they have on individuals' health differences. Missing these dimensions in healthcare information systems is a point of concern, as neglecting these aspects will inevitably perpetuate existing biases, produce far from optimal results, and may generate diagnosis errors. An often-overlooked community with distinct care values and needs are LGBT+ older adults, which has traditionally been under-surveyed in healthcare and technology design. This paper investigates the implications of missing gender and sex considerations in distributed ledger technologies for LGBT+ older adults. By using the value sensitive design methodology, our contribution shows that many value meanings dear to marginalized communities are not considered in the design of the blockchain, such as LGBT+ older adults' interpretations of trust, privacy, and security. By highlighting the LGBT+ older population values, our contribution alerts us to the potential discriminatory implications of these technologies, which do not consider the gender and sex differences of marginalized, silent populations. Focusing on one community throughout - LGBT+ older adults - we emphasize the need for a holistic, value sensitive design approach for the development of ledger technologies for healthcare, including the values of everyone within the healthcare ecosystem.

翻译：尽管性别和生理特征对个体健康差异有显著影响，但大多数医疗算法在设计时并未考虑这些维度。在医疗信息系统中缺失这些维度值得关注，因为忽视这些方面将不可避免地延续现有偏见、产生远非理想的结果，甚至可能导致诊断错误。拥有独特护理价值观和需求的LGBT+老年群体常被忽视，这一群体在医疗和技术设计领域历来缺乏充分调查。本研究探讨了在分布式账本技术设计中忽略性别和生理特征对LGBT+老年群体的影响。通过运用价值敏感设计方法论，我们的研究表明：区块链设计中并未纳入边缘化群体珍视的诸多价值意义，例如LGBT+老年群体对信任、隐私和安全性的独特诠释。通过凸显LGBT+老年群体的价值观，本研究警示我们：这些忽视边缘化沉默群体性别与生理差异的技术可能产生歧视性后果。我们以LGBT+老年群体作为贯穿始终的研究焦点，强调在开发医疗账本技术时需采用整体性的价值敏感设计方法，将医疗生态系统中所有参与者的价值观纳入考量。