EHR use of fields "Clinical Sex", "Administrative Sex", and "Gender"

Hi Lara,

The US Office of the National Coordinator - as part of their certification criteria - makes reference to:
- Sex (later clarified to be birth sex) with a value set of:
(i) Male. M
(ii) Female. F, and
(iii) unknown (nullFlavor UNK)

- Gender Identity with a value set of:
(i) Male. 446151000124109
(ii) Female. 446141000124107
(iii) Female-to-Male (FTM)/Transgender Male/Trans Man. 407377005
(iv) Male-to-Female (MTF)/Transgender Female/Trans Woman. 407376001
(v) Genderqueer, neither exclusively male nor female. 446131000124102
(vi) Additional gender category or other, please specify. nullFlavor OTH
(vii) Choose not to disclose. nullFlavor ASKU

There are a few ongoing discussion on how EHRs define the information relating to a patient's sex and gender.

Please share your thoughts and you EHR's application/uses in regards to the following:

• Gender: a patient's self-identified gender.
• Administrative Sex: defined in Infoway's Terminology Gateway with a subset of M/F. FIHR standard expands the subset (ref: www.hl7.org/fhir/valueset-administrative-gender.html) with different codes.
• Clinical Sex: is it a different subset? What additional information to "Administrative Sex" would it provide to clinicians? What codes would then be relevant?

I am looking to this community to gain further understanding on how an EHR can help support the different subsets to provide clinicians and patients a more comprehensive understanding.

Thank you,
Lara Ibrahim