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  1. FHIR Specification Feedback
  2. FHIR-29673

Update Patient Gender and Sex section for SfcU and recorded sex

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • FHIR Core (FHIR)
    • R5
    • Patient Administration
    • Patient
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      Gender Identity

      There is an existing genderIdentity extension.  This extension is conceptually aligned with the Gender Harmony model already.  However, we will make a few updates:

      • Update the description in that extension to match with the definition in the model. 
      • Make this extension available on all the various person resources (Patient, RelatedPerson, Person, and Practitioner).
      • Add a period as a sibling to the existing CodableConcept
      • We may update the example value set, but it will remain an example binding.

       

      genderIdentity.value 0..1 CodableConcept GenderIdentity (example)

      genderIdentity.period  0..1 Period

      genderIdentity.comment 0..*  string

       

      Sex for Clinical Use

      A new extension will be created for SFCU.  This extension will be allowed on:

      • Patient
      • ServiceRequest (probably all the "Request" pattern resources")
      • Observation

       

      The extension will include:

       sexForClinicalUse.value 0..1 CodableConcept SexForClinicalUse (Required)

      sexForClinicalUse.period  0..1 Period

      sexForClinicalUse.supportingInfo  0..*  Reference(Any)

       

      The SexForClinicalUse value set will include male, female, specified, and unknown.

      Recorded Sex and Gender

      The gender property for the following resources will be updated (description/comment only) to indicate that these elements represent a recorded sex and gender and are explicitly not a gender identity or SFCU.  We will include a pointer to the SFCU extension for Patient.gender.  We will include pointers to the GI extension for these resources:

      • Patient.gender
      • Practitioner.gender
      • RelatedPerson.gender
      • Person.gender

      Note: PractitionerRole does not have a gender.  Practitioner gender is discovered via the reference to Practitioner.

       

      We will create a swiss army knife extension for recording arbitrary recorded sex and gender concepts.  This extension would got on the person-type resources.

      recordedSexOrGender.value   0..1 CondableConcept  (Example)

      recordedSexOrGender.sourceDocument  0..*  Reference(DocumentReference)

      recordedSexOrGender.jurisdiction  0..* CodableConcept

      recordedSexOrGender.period 0..1 Period

       

      Pronouns

      A new extension will be added for pronouns on all person resources.

      pronoun.value  **  0..1 CodeableConcept (Example) (ValueSet)

      pronoun.period 0..1 Period

      pronoun.comment  0..1 string

       

      Show
      Gender Identity There is an existing  genderIdentity  extension.  This extension is conceptually aligned with the Gender Harmony model already.  However, we will make a few updates: Update the description in that extension to match with the definition in the model.  Make this extension available on all the various person resources (Patient, RelatedPerson, Person, and Practitioner). Add a period as a sibling to the existing CodableConcept We may update the example value set, but it will remain an example binding.   genderIdentity . value  0..1 CodableConcept GenderIdentity (example) genderIdentity . period   0..1 Period genderIdentity . comment  0..*  string   Sex for Clinical Use A new extension will be created for SFCU.  This extension will be allowed on: Patient ServiceRequest (probably all the "Request" pattern resources") Observation   The extension will include:   sexForClinicalUse . value  0..1 CodableConcept SexForClinicalUse (Required) sexForClinicalUse . period   0..1 Period sexForClinicalUse . supportingInfo   0..*  Reference(Any)   The SexForClinicalUse value set will include male, female, specified, and unknown. Recorded Sex and Gender The gender property for the following resources will be updated (description/comment only) to indicate that these elements represent a recorded sex and gender and are explicitly not a gender identity or SFCU.  We will include a pointer to the SFCU extension for Patient.gender.  We will include pointers to the GI extension for these resources: Patient.gender Practitioner.gender RelatedPerson.gender Person.gender Note: PractitionerRole does not have a gender.  Practitioner gender is discovered via the reference to Practitioner.   We will create a swiss army knife extension for recording arbitrary recorded sex and gender concepts.  This extension would got on the person-type resources. recordedSexOrGender . value    0..1 CondableConcept  (Example) recordedSexOrGender . sourceDocument   0..*  Reference(DocumentReference) recordedSexOrGender . jurisdiction   0..* CodableConcept recordedSexOrGender . period  0..1 Period   Pronouns A new extension will be added for pronouns on all person resources. pronoun.value   **  0..1 CodeableConcept (Example) (ValueSet) pronoun . period  0..1 Period pronoun . comment   0..1 string  
    • Alex de Leon / Joe Quinn: 3-0-0
    • Enhancement
    • Compatible, substantive
    • R5

    Description

      The HL7-Vocab led Gender Harmony project is proposing an informative logical model for sex and gender information.  This has a few differences from our current Patient Sex and Gender section.  I'd like to update that section to add two new bullet points, and update the SAAB language, and define two new standard extensions for SfcU and Recorded Sex 

      (Added) Sex for Clinical Use 

      (Added)Recorded Sex

      (Updated) Sex assigned at birth

       

      These are the (pre-ballot/draft) descriptions of the new concepts:

      Recorded Sex and Gender

      Definition: The Recorded Sex and Gender is a multi-element attribute that describes the sex and/or gender information recorded on a document at some time.

      Description:

      Usage Note(s): A single patient may have zero to many such attributes.  For example, the person's birth certificate information, passport information, and national identity document information may all be present.

      Cardinality: 0…n

       

      Sex for Clinical Use (SFCU)

      Definition: Sex for Clinical Use (SFCU) is a category that is based upon observations related to a biological distinction between male and female.

      Description:

      Usage Note(s): This is the sex derived from observable information (e.g., Clinical Observation, Radiology report, Lab report, genetic testing.) This sex context element is intended to help identify when a patient has observations that vary from the statistical norm for female or male. Examples of observation types are: Karyotype, phenotype, sex from Imaging, hormonal values, organ inventory,  genetic observations, external genital morphology and internal organ morphology

       

      The Sex Assigned at Birth language will be updated to indicate that Recorded Sex and Gender is a more generic way to communicate SAAB info.  Currently we don't have anything in the base spec about SAAB, we just reference the US Core IG.

       

       

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            cooper.thompson Cooper Thompson
            cooper.thompson Cooper Thompson
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              Updated:
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