Data used to categorize individuals for identification, records matching, and other purposes.

Data Element
Sexual Orientation
Description
A person’s identification of their emotional, romantic, sexual, or affectional attraction to another person

Applicable Vocabulary Standard(s)

Applicable Standards
Sexual orientation must be coded in accordance with SNOMED CT® and HL7 Version 3 Standard, Value Sets for AdministrativeGender and NullFlavor, attributed as follows:
  • Lesbian, gay or homosexual. 38628009
  • Straight or heterosexual. 20430005
  • Bisexual. 42035005
  • Something else, please describe. nullFlavor OTH
  • Don't know. nullFlavor UNK
  • Choose not to disclose. nullFlavor ASKU
Adopted at 45 CFR 170.207(o)(1)
Submitted By: A. Taylor / ONC
Data Element Information
Use Case Description(s)
Use Case Description A user can record a patient’s sexual orientation according to HL7 Version 3 and SNOMED CT® codes. The user must be able to record whether the patient declined to specify sexual orientation. Note that while sexual orientation is included in this 2015 Edition “demographics” certification criterion and the 2015 Edition Base EHR definition, it is not included in the Common Clinical Data Set definition. This means that sexual orientation is not required to be exchanged using certain standards, only that systems enable a user to record sexual orientation. [see also 80 FR 62619]

We provide the following OID to assist developers in the proper identification and exchange of health information coded to certain vocabulary standards.
SNOMED CT® code system OID: 2.16.840.1.113883.6.96 [see also 80 FR 62612]
Health IT Modules can present for certification to a more recent version of the U.S. Edition of SNOMED CT® than the September 2015 version. [see also 80 FR 62612]
Estimate the breadth of applicability of the use case(s) for this data element Users of the 572 certified health IT products, out of 901 total products certified to ONC's 2015 Edition, that successfully tested to the 170.315(a)(5) demographics
certification criterion has the ability to record, change, and access gender identity data within these products.
Link to use case project page https://www.healthit.gov/test-method/demographics
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) https://www.healthit.gov/isa/representing-patient-identified-sexual-orientation
Additional Specifications N/A
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) While it is required under the 2015 Edition 170.315(a)(5) demographics certification criterion to be able to record, change, and access sexual orientation data, it is not required for exchange. One restriction may be the ability to restrict exchange based on patient consent by element.
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns None
Estimate of Overall Burden Already implemented for record, change, and access, but not for exchange.

Comment

Submitted by tcarr_sonoma on 2023-03-16

Additional values in the valueset Comments: 

Current sexual orientation values in USCDI v2 has ‘Something else, please describe’ which represents different sexual orientation categories that may have specific and different needs when compared to another distinct group with different sexual orientation. For example, as per USCDI v2, person with sexual orientation as ‘pansexual’ falls in the same group as person with e.g. ‘asexual’ as their orientation. These two groups may have completely different physical, social, emotional health needs which goes unnoticed in the current context of health equity. The sexual orientation valueset being proposed is as follows:
  • Straight or Heterosexual
  • Gay, Lesbian or Homosexual
  • Bisexual
  • Pansexual*
  • Queer*
  • Asexual*
  • Two-spirit*
  • Questioning/not sure*
  • Choose not to disclose
  • Not listed, please describe
  *New values being proposed

Submitted by RUy on 2022-04-29

Collecting SO/GI data is…

Collecting SO/GI data is essential to providing high-quality, patient-centered care for transgender people. ONC has provided good leadership on the standardization of this content in USCDIv2. FQHCs are required to collect these data for all their patients and report them to HRSA so these data are well established and are imperative to the patient-centered provision of care.
  • SO/GI data can be collected in several ways: 
  1. Information can be obtained through patient portals and transmitted to an individual’s EHR. This approach is attractive because it puts the patient in charge of defining their own identity and needs.
  2. Questions can be included on registration forms for all patients as part of the demographic section along with information about race, ethnicity, and date of birth. 
  3. Providers and their care team can ask questions during the patient visit, for instance, as part of a social or sexual-history discussion. 
To address the lack of SO/GI data in health systems, the Department of Health and Human Services’ (HHS’s) Healthy People 2020 included an objective to “increase the number of states, territories, and the District of Columbia that include questions that identify sexual orientation and gender identity on state level surveys or data systems” to improve “the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals.” Increasing the number of population-based data systems that collect standardized data on (or for) lesbian, gay and bisexual populations and on (or for) transgender populations and expanding the availability of sexual orientation/gender identity (SO/GI) statistics have also been priorities for other federal agencies. NACHC believes sexual orientation is a core component of many patients’ identities. However, it is also associated with serious health inequity and health disparities. Furthermore, it is clinically relevant to a number of domains of sexual health, trauma and interpersonal violence, substance abuse and mental health risk factors. Michigan students identifying as lesbian, gay, or bisexual reported higher rates than their peers for measures of bullying, missing school due to fear for their safety, and were more than three times as likely to report seriously considering suicide in the past year. We strongly support the requirement for sexual orientation data to be captured in a standardized way in EHRs to support patients’ identities, reduce health disparities and facilitate effective clinical risk that may be modified by sexual orientation.

2022-04-30 NACHC USCDIv3 Letter of Support_10.pdf

Submitted by nedragarrett_CDC on 2022-04-29

CDC's comment on behalf of ASTHO (WA DOH)

Subject: Additional values in the valueset Comments: Current sexual orientation values in USCDI v2 has ‘Something else, please describe’ which represents different sexual orientation categories that may have specific and different needs when compared to another distinct group with different sexual orientation. For example, as per USCDI v2, person with sexual orientation as ‘pansexual’ falls in the same group as person with e.g. ‘asexual’ as their orientation. These two groups may have completely different physical, social, emotional health needs which goes unnoticed in the current context of health equity. The sexual orientation valueset being proposed is as follows:
  • Straight or Heterosexual
  • Gay, Lesbian or Homosexual
  • Bisexual
  • Pansexual*
  • Queer*
  • Asexual*
  • Two-spirit*
  • Questioning/not sure*
  • Choose not to disclose
  • Not listed, please describe
  *New values being proposed

Submitted by nedragarrett_CDC on 2022-04-28

CDC's Consolidated Comment

  • Addressing health equity tasks through the USCDI in a scope of the SOGI, the USCDI should contain 5 data elements (Gender Identity, Sex assigned at birth, Sexual Orientation, Sex for Clinical Use Note and Patient Pronoun). The last two mentioned data elements were not included into the v.3. We recommend including the Sex for Clinical Use Note (within the Clinical Notes data class) and Patient Pronoun (within the Patient Demographic) into the next, the USCDI v.4 version.
  • We are proposing adding to the USCDI v.3 a LOINC code for the question as the following: 76690-7, Sexual orientation.
CSTE Comment:
  • CSTE recommends that strong consideration be given to employing the sexual orientation value set put forward by the HL7 gender harmony project - which include lesbian, gay or homosexual; straight or heterosexual; bisexual; asexual; exploring or questioning sexual orientation; something not listed (specify); choose not to disclose; and unknown.

Submitted by lhiatt on 2022-01-19

Additional Values in value set, seconded

I agree with the comment by Ravi.kafle; It is better to expand options to accurately capture and destigmatize other sexualities. The new values being proposed by them appear a marked improvement.

Submitted by ravi.kafle@doh… on 2021-09-29

Additional values in the value set

Current sexual orientation values in USCDI v2 has ‘Something else, please describe’ which represents different sexual orientation categories that may have specific and different needs when compared to another distinct group with different sexual orientation. For example, as per USCDI v2, person with sexual orientation as ‘pansexual’ falls in the same group as person with e.g. ‘asexual’ as their orientation. These two groups may have completely different physical, social, emotional health needs which goes unnoticed in the current context of health equity. The sexual orientation valueset being proposed is as follows:
  • Straight or Heterosexual
  • Gay, Lesbian or Homosexual
  • Bisexual
  • Pansexual*
  • Queer*
  • Asexual*
  • Two-spirit*
  • Questioning/not sure*
  • Choose not to disclose
  • Not listed, please describe
  *=New values being proposed

Submitted by zbarber on 2020-11-12

Sexual Orientation Description

The NY eHealth Collaborative (NYeC) supports including sexual orientation in the USCDI v2 due to its widespread use and clinical value for LGBTQIA individuals. We suggest revising the element description to refer to the Lamda Legal definition: "People’s sexual attraction to same or different-sex people."

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