Representing Patient Gender Identity

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Type Standard / Implementation Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard for observations
Final
Production
Rating 3
No
Free
N/A
Standard for observation values
Final
Production
Rating 3
Yes
Free
N/A
Standard for observation values
Final
Production
Rating 3
Yes
Free
N/A
Limitations, Dependencies, and Preconditions for Consideration Applicable Value Set(s) and Starter Set(s)
  • Collect discrete structured data on patient gender identity, sex, and sexual orientation following recommendations issued in a report by The Fenway Institute and the Institute of Medicine.
  • Even though clinicians and their patients would benefit from having these data in patient records, this does not suggest that it is the sole responsibility of clinicians and their staffs to collect these sensitive data.
  • When patients provide a response to this question in a patient portal, it could contradict with the information collected by providers.
  • See LOINC projects in the Interoperability Proving Ground.
  • For more information about observations and observation values, see Appendix II for an informational resource developed by the Health IT Standards Committee. 

Comment

NCPDP - Comment

NCPDP currently uses sex/gender values of (M)ale, (F)emale and (U)nknown.  NCPDP is evaluating future modifications to include additional gender identity concepts.

Please consider appropriate…

Please consider appropriate vocabulary for preferred pronoun.  It would be extremely helpful to improve the patient-provider experience.

 

Prounouns and name used are necessary too

We think that the Applicable Value Set(s) and Starter Set(s) provide appropriate answer options to measure current gender identity. We also encourage the Office of the National Coordinator of Health Information Technology to encourage providers to ask the patient what pronoun and name the patient uses, use that pronoun and name when interacting with the patient, and enter this information into the Electronic Health Record. Knowledge of this information is essential to providing affirming health care to transgender patients.

Chris Grasso, MPH

Associate Vice President for Informatics and Data Services

Fenway Health

 

standard for preferred pronoun

Please consider also a standard for preferred pronoun. Assuming gender based on the first name or registered sex and/or gender preference can present challenges to health care providers and their teams. In 2013, the World Professional Association for Trangender Health Electronic Medical Record Workging Group published recommendations for how gender should be recorded in EHRs. These recommendations specify that “Preferred Name, gender identity and pronoun preference, as defined by the patient, be included as demographic variables collected in the EHR.

https://academic.oup.com/jamia/article/20/4/700/2909343

  AllianceChicago

 

JAMIA - Transgender Health and EMRs.pdf

Personal Pronoun Value Set needed

It is important and respectful to the patient to record their personal pronoun. Establish a value set for personal pronoun and include in transition of care documents.