Transgender and gender diverse (TGD) individuals experience health disparities driven by stigma and barriers to care, including intersecting experiences of gender, race and socioeconomic status [1], [2]. Studies have found that TGD persons are at greater risk for mental health issues [3], cardiovascular disease [4], [5], and certain cancers; [6] yet are less likely to receive preventive services [7]. Despite documented disparities, high-quality data to address TGD-specific care needs remain limited [8].

Barriers to high-quality TGD care and health research include limited systematic collection of population-level sexual orientation and gender identity (SOGI) data. Electronic health records (EHRs) offer a unique opportunity to facilitate SOGI documentation and support clinical decisions – such as screenings, dosage calculations, and lab interpretations – often depend on sex assigned at birth. Without SOGI data in the EHR, providers risk misgendering [9] or using dead names [10], potentially causing distress for TGD patients when seeking care. Additionally, lack of SOGI reporting perpetuates underrepresentation of TGD persons in health research [11], which has negative implications on quality improvement, research efforts, and policy activities.

Federal agencies and national organizations have recommended routine SOGI data collection in EHRs [12], [13]. Despite this, studies report high levels of missing data [14], [15], [16], and few have examined factors influencing SOGI documentation among TGD persons [17], [18].

Kaiser Permanente (KP) serves a diverse patient population and has been a national leader in LGBTQ+ healthcare since 2013, particularly for its inclusive and equitable policies and practices [19], [20]. In 2019, KP began integrating a SOGI module into its Epic™ EHR system. This study assessed SOGI documentation completeness and factors associated with SOGI reporting among TGD persons enrolled in KP health plans.