Representing Patient Sex (At Birth)

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard for observations	LOINC®	Final	Production		No	Free	N/A
Standard for observation values	For Male and Female, HL7® Version 3 Value Set; for Administrative Gender Unknown, HL7 Version 3 Null Flavor	Final	Production		Yes	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
Patient Sex (at birth), or Assigned Sex, is the sex (male or female) given to a child at birth, most often based on the child's external anatomy. HL7 Version 2 and 3 need to be harmonized. See LOINC projects in the Interoperability Proving Ground. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	LOINC code: 76689-9 Sex assigned at birth Administrative Gender (HL7 V3) 2.16.840.1.113883.1.11.1 ONC’s 2015 Edition certification requirements reference the following value set for birth sex that use a combination of HL7 Version 3 (V3) Standard value set for Administrative Gender and NullFlavor: (1) M (“Male”) (2) F (“Female”) (3) UNK (“Unknown”) (HL7 V3 NullFlavor code) Other HL7 V3 NullFlavor codes, while not specifically required, may also be useful: (1) OTH ("Other") (2) ASKU ("Asked, but Unknown") (3) NASK ("Not asked")

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

Patient Sex (at birth), or Assigned Sex, is the sex (male or female) given to a child at birth, most often based on the child's external anatomy.
HL7 Version 2 and 3 need to be harmonized.
See LOINC projects in the Interoperability Proving Ground.
For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

LOINC code: 76689-9 Sex assigned at birth
Administrative Gender (HL7 V3) 2.16.840.1.113883.1.11.1
ONC’s 2015 Edition certification requirements reference the following value set for birth sex that use a combination of HL7 Version 3 (V3) Standard value set for Administrative Gender and NullFlavor:

(1) M (“Male”)

(2) F (“Female”)

(3) UNK (“Unknown”) (HL7 V3 NullFlavor code)
Other HL7 V3 NullFlavor codes, while not specifically required, may also be useful:

(1) OTH ("Other")

(2) ASKU ("Asked, but Unknown")

(3) NASK ("Not asked")

Comment

Submitted by pwilson@ncpdp.org on 2019-09-23

NCPDP Comment

NCPDP recommends the addition of Non-Binary as a valid value.

Submitted by cmcdonald on 2018-10-01

LOINC has a number of…

LOINC has a number of observation codes that could appy including sex assigned at birth as suggested by at least 2 commentators.

46098-0 Sex 74698-2 Sex [AHRQ] 72143-1 Sex [HL7.v3] 21840-4 Sex NAACCR v.11 54131-8 Sex [USSG-FHT] 76689-9 Sex assigned at birth

Submitted by michael.e.prevoznik on 2018-08-30

Best Practice Recommendation from American Clinical Lab Assoc.

The American Clinical Laboratory Association (ACLA) has developed a Best Practice Recommendation for administrative sex and clinical patient gender used for laboratory testing and reporting. Please add the hyperlink below to the "Limitations, Dependencies, and Preconditions for Consideration" section, referencing ACLA's guidance document.

http://www.acla.com/acla-best-practice-recommendation-for-administrative-and-clinical-patient-gender-used-for-laboratory-testing-and-reporting/

Submitted by cgrasso on 2017-11-20

Need Sex Assigned at Birth

Administrative sex is used to indicate the sex a person has listed with their insurance company. Administrative sex and sex assigned at birth are not always the same. If someone legally changes their sex or the sex listed with their insurance company is different, then their administrative sex and sex assigned at birth no longer align. Therefore, it is necessary to ask both administrative sex and sex assigned at birth to accurately identify all transgender/GenderQueer patients. When insurance companies accept both sex assigned at birth and gender identity, then administrative sex will no longer be necessary.

Chris Grasso, MPH

Associate Vice President for Informatics and Data Services

Fenway Health

Submitted by kwboone on 2017-11-20

Is "Sex at birth" different…

Is "Sex at birth" different from Administrative Gender collected during registration? This needs clarification in the industry, as different approaches have been used in multiple places. It appears that "Sex at birth" has a) been considered a clarification of the meaning of "Administrative Gender", and b) been considered to be a separate demographic.

Submitted by rmcclure on 2017-10-04

Administrative sex is not…

Administrative sex is not perfectly aligned with "Sex at birth" because at birth an infant can be undifferentiated. In addition, if we want sex recorded on the birth certificate, then many sates allow this to be changed: https://www.lambdalegal.org/know-your-rights/article/trans-changing-birth-certificate-sex-designations And as of January 2017, NY has allowed a person to have "Non-binary" as her birth certificate gender identity, see http://www.pbs.org/newshour/rundown/new-york-city-issues-nations-first-birth-certificate-marked-intersex/

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