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This page which is maintained by the V2MG who is working on the V2 GH solution: SOGI Data Exchange
To be determined:
- What mechanisms can be used to carry each of the following. Need to determine if new element in existing segment, new segment, or how to use existing elements.
- Gender Identity (GI)
- Sex For Clinical Use (SFCU)
- Recorded Sex or Gender (RSG)
- Name to use
- Pronouns
For consideration:
- Create new fields for Patient level data in existing segments (PID, PD1, others?)
- GI
- SFCU - Patient level context. For all procedure-specific SFCU it should go in OBX
- pronouns
- RSG
- Create a new segment for the above named elements (and support the explicit context they need to be used in)
- PID-8 - should no longer be used
- Can use XPN data type in PID-5 aligned with FHIR Patient name (human name ) type Usual. for Name to use
- Use OBX
- For all elements (except Name to Use)
- Only for context-specific SFCU
...
Prior discussion linked to LIVID, ask at order entry
Summary
| Concept name | Location in V2 | Location in C-CDA | Location in FHIR | Code for the element | answer values | Code systems suggested for answers | ISA reference |
|---|---|---|---|---|---|---|---|
| Gender Identity | OBX | 76691-5 Gender Identity | Male Female Female-to-Male (FTM) Something else, please describe (Other) Choose not to disclose | SNOMED CT (US Edition) NULLFL (HL7V3) | https://www.healthit.gov/isa/representing-patient-gender-identity | ||
| Sexual Orientation | OBX | Lesbian, gay or homosexual Sexually attracted to neither male nor female sex | SNOMED CT (US Edition) NULLFL (HL7V3) | https://www.healthit.gov/isa/representing-patient-identified-sexual-orientation | |||
| Sex at Birth / Birth Sex | OBX | 76689-9 Sex assigned at birth | Male Female Undifferentiated Unknown Other Asked, but Unknown Not asked | ??? Rob McClure to fill in NULLFL (HL7V3) | https://www.healthit.gov/isa/representing-patient-sex-birth |
Other concepts may be important to consider by implementers, but are not included in the ISA and have not been explicitly discussed in detail by this group. These concepts will likely be amenable to the same OBX based solution as Sexual Orientation, Gender Identity and Birth Sex, but implementers should thoroughly investigate these concepts before implementing them.
Core OBX Segment Content
See Chapter 7 of the base standard for more details on the OBX segment.
| Field | Content |
|---|---|
| OBX-2 (Value Type) | Typically CE or CWE when the concept is codeable |
| OBX-3 (Observation Identifier) | Typically the LOINC code for the concept being conveyed (e.g. 76691-5 for Gender Identity) |
| OBX-5 (Observation Value) | The "answer", often as a coded value (formatted per the data type in OBX-2). Note that when the concept is codeable, the codes used may vary locally depending on what data needs to be captured and how the questions are asked (e.g. what is the list of options on form). There is no clear consensus on a complete, singular value set for any of these concepts but there are values that are common to many jurisdictions including: Gender Identity: Female, Male, Nonbinary, Other and Choose not to Answer Jurisdictions will need to define the complete set of local values for these concepts including adding additional codes not listed above. |
| OBX-11 (Observation Result Status) | Typically "F" for Final |
| OBX-14 (Date/Time of the Observation) | Typically the date the question was answered |
| OBX-29 (Observation Type) | Available only in later versions of the base standard. Typically QST for a "question" (often at the time of order entry) or SCI for "supporting clinical information" |
Example:
OBX|1|CWE|76691-5^Gender Identity^LN||446141000124107^Identifies as Female Gender^SCT||||||F|||202103011100|||||||||<performing Org name>|<performing org address usind XAD datatype|||||QST|