2015 ONC item a5 (Demographics) analysis - Needs work


Need to add the following 2 entries to demographics form which also include a “Declined to Specify” option:

  1. ‘Sex’. btw, this is considered the “birth sex”.
    -Need another option called ‘Unknown’ with HL7 code of ‘UNK’ (with NullFlavor whatever that means)

  2. ‘Sexual Orientation’. Need to add this with following options:
    Lesbian, gay or homosexual. SNOMED:38628009
    Straight or heterosexual. SNOMED:20730005
    Bisexual. SNOMED:42035005
    Something else, please describe. HL7:OTH (with NullFlavor whatever that means)
    Don’t know. HL7:UNK (with NullFlavor whatever that means)
    Choose not to disclose. HL7:ASKU (with NullFlavor whatever that means)

  3. ‘Gender Identity’. Need to add this with following options:
    Male. SNOMED:446151000124109
    Female. SNOMED:446141000124107
    Female-to-Male (FTM)/Transgender Male/Trans Man. SNOMED:407377005
    Male-to-Female (MTF)/Transgender Female/Trans Woman. SNOMED:407376001
    Genderqueer, neither exclusively male nor female. SNOMED:446131000124102
    Additional gender category or other, please specify. HL7:OTH (with NullFlavor whatever that means)
    Choose not to disclose. HL7:ASKU (with NullFlavor whatever that means)

I am guessing the NullFlavor stuff can be ignored and mapped when downstream when building the ccda docs.

So, overall, this is a moderate one that just requires 2 new entries to layout_options along with 2 new lists and then a new option in sex list. The “please describe/specify” may require a new mod/feature to support well. If anybody is interested in doing this, just let me know

You may also want to consider Fluid State. I worked on a HIPAA compliance NPP for the Florida Area and this was requested. Fluid meaning transitory.

Hi @APerez ,

Gender Fluid should fall within ‘Genderqueer, neither exclusively male nor female.’:

Did the Florida Area request both of these?


No and I now that I think of it the reasoning may have been to avoid controversy with the wording. If that was the case I believe we might want to follow similar suit. Some folk might find the word “queer” offense or improper.

Hi @APerez ,

That terminology is required for 2015 ONC though. So, every single 2015 ONC certified product will potentially be offensive.

There is some interesting information on this topic here:

And there are a bunch of articles where folks are identified as genderqueer(ie. i think this likely means it is not considered an offensive term):


Hi Brady,
I see what you mean. Well the world has grown-up and matured. Glad to see that.

I’ll take ownership of this. It was something I had discussed with @MatthewVita and @brady.miller separately anyway.

Hi Brady,

ViSolve Team had already implemented these demographics changes in OpenEMR 5.0 and we would like to share these codes to openemr community .

We have also completed the database changes as part of the code changes for this feature. Since, we don’t have ZH Mirth server credentials we couldn’t able to generate the CCDA report.

Hence, except for the CCDA part, the rest has been completed and commited the code.

The following is the commit link for this feature :

Kindly review the code and share your feedback. Do let us know if any further changes required.


Hi @visolveemr ,

Thanks! Can you submit a pull request with your code?


Hi Brady,

We have sent you the pull request from github .com .
Please check and review it .


I’ll take over correspondence on this particular issue.

I saw the PR, I’ll review and likely add to it. Looks like it doesn’t quite cover every stipulation of this item

@robert.down @visolveemr

Could I also get a pull request? Thank you