Correction: An Environmental Scan of Sex and Gender in Electronic Health Records: Analysis of Public Information Sources (Preprint)
Authors: Lau Francis , Antonio Marcy , Davison Kelly , Queen Roz , Bryski Katie 
Published: May 2021

UNSTRUCTURED

Historically, the terms sex and gender have been used interchangeably as a binary attribute to describe a person
as male or female, even though there is growing recognition that sex and gender are distinct concepts. The lack of sex and gender
delineation in electronic health records (EHRs) may be perpetuating the inequities experienced by the transgender and gender
nonbinary (TGNB) populations. This study aims to conduct an environmental scan to understand how sex and gender are defined and implemented
in existing Canadian EHRs and current international health information standards. We examined public information sources on sex and gender definitions in existing Canadian EHRs and international
standards communities. Definitions refer to data element names, code systems, and value sets in the descriptions of EHRs and
standards. The study was built on an earlier environment scan by Canada Health Infoway, supplemented with sex and gender
definitions from international standards communities. For the analysis, we examined the definitions for clarity, consistency, and
accuracy. We also received feedback from a virtual community interested in sex-gender EHR issues. The information sources consisted of public website descriptions of 52 databases and 55 data standards from 12
Canadian entities and 10 standards communities. There are variations in the definition and implementation of sex and gender in
Canadian EHRs and international health information standards. There is a lack of clarity in some sex and gender concepts. There
is inconsistency in the data element names, code systems, and value sets used to represent sex and gender concepts across EHRs.
The appropriateness and adequacy of some value options are questioned as our societal understanding of sexual health evolves.
Outdated value options raise concerns about current EHRs supporting the provision of culturally competent, safe, and affirmative
health care. The limited options also perpetuate the inequities faced by the TGNB populations. The expanded sex and gender
definitions from leading Canadian organizations and international standards communities have brought challenges in how to
migrate these definitions into existing EHRs. We proposed 6 high-level actions, which are to articulate the need for this work,
reach consensus on sex and gender concepts, reach consensus on expanded sex and gender definitions in EHRs, develop a
coordinated action plan, embrace EHR change from socio-organizational and technical aspects to ensure success, and demonstrate
the benefits in tangible terms. There are variations in sex and gender concepts across Canadian EHRs and the health information standards that
support them. Although there are efforts to modernize sex and gender concept definitions, we need decisive and coordinated
actions to ensure clarity, consistency, and competency in the definition and implementation of sex and gender concepts in EHRs.
This work has implications for addressing the inequities of TGNB populations in Canada.