Patient Demographics/Information

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

Additional Supporting Documentation for CDC's SOGI Submission

Please see the attached

ONC Letter of Comment for SOGI v3_0.docx

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

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

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.

Additional values

Sexual orientation should include additional options such as asexual, demisexual, and aromantic. See https://about.gitlab.com/handbook/people-group/gender-pronouns/ for further discussion.

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.

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

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."