The purpose of this page is to discuss decisions related to how to model documented sex and gender identity in OMRSE.

We have decided to model documented instances of sex and gender identity in OMRSE rather than sex and gender themselves. The reason for this because it is usually discrepancies in documentation that cause problems when delivering health care to transgendered and inter-sexed individuals. For example, ordering a pap smear for a patient whose documented sex/gender in an EHR is male and billing that service with an insurance company who also has been identified as male with their insurance company is often problematic.

In 2010 the Institute of Medicine (IOM) issued a report recommending that data on gender identity and sexual orientation be collected EHRs and that this goal be incorporated into meaningful-use objectives. As a result several LGBT health organizations such as the Fenway Institute and The Center for Excellence for Transgender Health have conducted research and issued recommendations regarding the best way to gather information about gender identity. They recommend a two-part question.

What is your current gender identity?
What was your sex assigned at birth?

Typical recommended options for the first question include

Male
Female
Transmale/transman/FTM Other
Transfemale/transwoman/MTF

And May include options such as:

5. Genderqueer/gender-non-conforming

6. Different identity: please state________________

Proposed Classes

Because the two-question format is likely to be widely adopted, I think it is best if the ontology, at a minimum accomodates the data gathered by these questions. The answer to the first question is a document act and results in a documented gender identity, so we will need something like self-identified gender identity in the ontology.

Likewise, the second question asks about sex assigned at birth.

Proposed Approach

There is no fixed set of unambiguous terms that are used to indicate a person's gender identity. Furthermore, it is unrealistic to expect that there ever will be. Some terms are used differently by different communities of persons. For example, a transgender man may consider "transgender" to be part of his gender identity. Alternatively, he may consider his gender to "male" and regard "transgender" as part of his gender history. Imposing a standard vocabulary in either case would not be appropriate insofar as it could engender an atmosphere of proscribing gender identities, and what we are interested in is managing documented gender identities.

Furthermore, the language used to descirbe gender identities is both community specific and constantly changing. In the past the word "queer" has been used in a derogatory sense. However, some communities are reclaiming it. "Gender fluid", "gender non-conforming", "gender varient" are all terms that can have specific meanings in specific communities. Similarly, some individuals consider themselves to be trans-feminine, but would not identify as women or females. In order to accommodate the fact that specific gender identities will vary from community to community and over time, I propose that we take an approach to gender identities that is similar to that taken in the proper name ontology.

The proper name ontology is designed to be able to accommodate different cultural conventions of naming by remaining very general and allowing the user to extend the ontology with different subtypes of names. Similarly, I propose that we do not attempt to include a comprehensive list of gender identities, and encourage end users to extend the ontology to include the kind of gender identities that are appropriate for the community they are working with. In the same way that the proper name ontology facilitates interoperability by providing an ontology at the general level, the account of gender identity in OMRSE should facilitate interoperability by providing a general framework for gender identity acts. How to best achieve this still needs to be investigated, but I think that this is the best approach.

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