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  1. FHIR Specification Feedback
  2. FHIR-38861

Consider adding additional guidance on the use of patient.gender vs. RSG extension

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • FHIR Core (FHIR)
    • R5
    • Patient Administration
    • Patient
    • 8.1.8
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      Whether to use Patient.gender, RSG, or any of the other listed sex and gender properties depends on the use case.  We will update the top-level narrative as follows:

       

       

      Many systems and organizations only provide for a single attribute that aspires to represent all aspects of a patient's gender and sex with a single value. However, there are many considerations around sex and gender documentation and interoperability. Listed below are various social and biological attributes that are relevant in the healthcare setting, as well as information on how each can be communicated. Each of these attributes may be useful to address different use cases, and it is up to the implementer to identify which attribute or combination of attributes are most appropriate.  

       

       

      Additionally, the typos will be corrected.

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      Whether to use Patient.gender, RSG, or any of the other listed sex and gender properties depends on the use case.  We will update the top-level narrative as follows:     Many systems and organizations only provide for a single attribute that aspires to represent all aspects of a patient's gender and sex with a single value. However, there are many considerations around sex and gender documentation and interoperability. Listed below are various social and biological attributes that are relevant in the healthcare setting, as well as information on how each can be communicated.  Each of these attributes may be useful to address different use cases, and it is up to the implementer to identify which attribute or combination of attributes are most appropriate.        Additionally, the typos will be corrected.
    • Brian Postlethwaite / Rob McClure : 7-0-3
    • Clarification
    • Non-substantive
    • R5

    Description

      Section 8.1.8 states the following for the existing patient.gender element

      "Administrative Gender - in order to interoperate with systems that use a single generic property, the basic Patient.gender property represents an administrative gender: the gender that the patient is considered to have for administration and record keeping purposes. This property is often used as an input to patient matching algorithms. Systems should not infer any specific clinical meaning from Patient.gender without pre-coordination with exchange partners."

      This followed by a description of the Recorded Sex or Gender extension 

      "Recorded Sex or Gender - the recorded sex or gender concept includes the various sex and gender concepts that are often used in existing systems but are not known to represent a gender identity or sex for clincal use. Examples of recorded sex or gender concepts include administrative gender, administrative sex, and sex assigned at birth. Other examples include the sex or gender marker on a birth certificate, insurance card, driver's license, passport or other document. These sex or gender concepts vary widely in their use and possible values. For the purposes of exchanging these concepts, implementers are encouraged to define the specific sex or gender concept that is relevant for their use case, and create a use-case specific property or extension to represent that specific concept. For example, if the sex assigned at birth is an important concept in a specific jurisdiction, that jurisdiction can create an realm-specific extension for that concept. In cases where a specific property or extension is not practical, or there is a need to represent a historical field that is not well defined, there is a standard recordedSexOrGender extension that may be used."

      Suggest the following:

      1) include additional text to provide guidance on when to use patient.gender vs RSG to represent administrative gender. 

      2) fix typos in the RSG section "clincal" to "clinical", and "can create an realm-specific" to "can create a realm-specific"

       

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            cmacumber Caroline Macumber
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