Adopt the HL7 Gender Harmony Gender Identity data element and its corresponding FHIR extension (Individual Gender Identity) from the FHIR Extensions Pack as follows:

1. Terminology

• Add the following concept to the Gender Identity Response value set to support a value that indicates that the workflow did not support obtaining a gender identity value to include:  

• code: not-asked
• code system: http://terminology.hl7.org/CodeSystem/data-absent-reason
• display: Not Asked

2. Include the GI FHIR extension (Individual Gender Identity) as follows

• Add the extension to the AU Base Patient, AU Base RelatedPerson and AU Base Practitioner AU Base profiles with 0..* cardinality.
• Apply AU terminology constraints, i.e. extensible binding to the updated (see 1 above) Gender Identity Response value set as agreed in https://github.com/hl7au/au-fhir-base/issues/599 and balloted in AU Base v4.1.0.
• Add profile specific implementation guidance to the profile pages leveraging existing AU Base Patient guidance
• IMPORTANT NOTE for AU Base Patient: proposal is to DEPRECATE use of the existing genderIdentity extension and replace it with the Individual Gender Identity extension.

3. Search Parameters

• Replace patient-gender-identity with a search parameter for GH Individual Gender Identity, i.e. update code, base, expression.
• Add proposed new search parameter:

<?xml version="1.0" encoding="utf-8"?>

<SearchParameter xmlns="http://hl7.org/fhir">

    <id value="gender-identity" />

    <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">

        <valueInteger value="0"/>

    </extension>

    <!-- This search parameter is for R4 & R5 use. -->

    <url value="http://hl7.org.au/fhir/SearchParameter/gender-identity" />

    <name value="GenderIdentity" />

    <status value="draft" />

    <description value="This search parameter returns resources with the Individual Gender Identity extension matching the specified code." />

    <code value="gender-identity"/>

    <base value="Patient"/>

    <base value="RelatedPerson"/>

    <base value="Person"/>

    <base value="Practitioner"/>

    <base value="PractitionerRole"/>

    <type value="token"/>

    <expression value="Patient.extension('http://hl7.org/fhir/StructureDefinition/individual-genderIdentity').value | RelatedPerson.extension('http://hl7.org/fhir/StructureDefinition/individual-genderIdentity').value" | Practitioner.extension('http://hl7.org/fhir/StructureDefinition/individual-genderIdentity').value" | Practitioner.extension('http://hl7.org/fhir/StructureDefinition/individual-genderIdentity').value" | PractitionerRole.extension('http://hl7.org/fhir/StructureDefinition/individual-genderIdentity').value"/>

    <multipleOr value="true">

        <extension url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">

            <valueCode value="MAY"/>

        </extension>

    </multipleOr>

    <multipleAnd value="true">

        <extension url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">

            <valueCode value="MAY"/>

        </extension>

    </multipleAnd>

</SearchParameter>

4. Update the patient-example-sex-and-gender, example relatedperson-example-sex-and-gender, example practitioner-example-sex-and-gender examples to demonstrate use of the GH GI data element.