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This chapter discusses the use of health information technology (HIT), including electronic health records (EHRs), to improve care for transgender and gender diverse (TGD) patients. It also addresses the policy changes that led to the requirement of data collection fields for gender identity in EHRs and the US Health Resources and Services Administration’s Bureau of Primary Health Care (HRSA/BPHC) annual data reporting for Federally Qualified Health Centers (FQHCs).


Sexual and gender minority (SGM) people face significant barriers to adequate and culturally responsive health care, leading to numerous health disparities. Ongoing efforts supported by both federal and other funding agencies are responding to the need to reduce these health inequities by increasing SGM visibility through data collection in health care. In 2015, the Office of the National Coordinator for Health Information Technology (ONC) officially made patient sexual orientation and gender identity (SOGI) data collection a requirement for the Base EHR Meaningful Use certification. The requirement mandated that by January 2018, all certified EHRs were required to have a place to document SOGI using standard definitions and value sets. In 2016, HRSA/BPHC mandated the collection of SOGI demographic information by all FQHCs, a necessary step for improving FCHQs’ ability to identify and better serve their SGM patients.

Health care organizations are often reluctant to ask gender identity questions, believing that patients will become offended or will refuse to answer the questions. It is important, however, to understand both patient and staff perspectives. Several studies have evaluated the feasibility of collecting gender identity data in health care organizations. These various studies came to similar conclusions: that patients will answer the questions when asked.1–3 Providing patients with informational pamphlets about gender identity data collection can alleviate confusion and reduce staff concerns (Figure 4-1).

Figure 4-1

Patient education pamphlets about sexual orientation and gender identity (SOGI) data collection. Informational pamphlets are available in many languages to help educate patients about why gender identity data collection is important. The pamphlets shown here are available from the National LGBTQIA+ Health Education Center at The Fenway Institute (Reproduced with permission from Ready, Set, Go! A Guide for Collecting Data on Sexual Orientation and Gender Identity. Updated 2020. National LGBT Health Education Center. A Program of the Fenway Institute.)

Collecting gender identity data for patients is critical for health care organizations to provide a welcoming, inclusive environment and allow health care professionals to better understand their patients. Routine gender identity data collection within the EHR can be used to measure and track health outcomes at the individual and population levels. EHRs have the potential to improve quality of care, provide timely clinical information, and improve communication among patients and members of the health care team, creating a more patient-centered care ...

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