HL7 Cross Paradigm Implementation Guide: Gender Harmony - Sex and Gender Representation, Edition 1
1.0.0 - release
HL7 Cross Paradigm Implementation Guide: Gender Harmony - Sex and Gender Representation, Edition 1
1.0.0 - release
HL7 Cross Paradigm Implementation Guide: Gender Harmony - Sex and Gender Representation, Edition 1, published by HL7 Terminology Infrastruture Work Group. This is not an authorized publication; it is the continuous build for version 1.0.0. This version is based on the current content of https://github.com/HL7/fhir-gender-harmony/ and changes regularly. See the Directory of published versions
The Health Maintenance Lab use case narrative was constructed to demonstrate the workflow of a transgender female patient who presents to her clinic needing an update of her demographic name, gender, and pronouns. The following is a FHIR example for the updating of the patient’s name, gender identity, and pronouns:
{
"Patient": {
"id": {
"_value": "example"
},
"extension": [
{
"extension": [
{
"valueCodeableConcept": {
"coding": {
"system": {
"_value": "http://snomed.info/sct"
},
"code": {
"_value": "446141000124107"
},
"display": {
"_value": "Identifies as female gender (finding)"
}
}
},
"_url": "value"
},
{
"valuePeriod": {
"start": {
"_value": "2022-08-01"
}
},
"_url": "period"
},
{
"valueCodeableConcept": {
"coding": {
"system": {
"_value": "http://snomed.info/sct"
},
"code": {
"_value": "446151000124109"
},
"display": {
"_value": "Identifies as male gender (finding)"
}
}
},
"_url": "value"
},
{
"valuePeriod": {
"end": {
"_value": "2022-07-31"
}
},
"_url": "period"
}
],
"_url": "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity"
},
{
"extension": [
{
"valueCodeableConcept": {
"coding": {
"system": {
"_value": "http://loinc.org"
},
"code": {
"_value": "LA29518-0"
},
"display": {
"_value": "he/him/his/his/himself"
}
}
},
"_url": "value"
},
{
"valuePeriod": {
"end": {
"_value": "2022-07-31"
}
},
"_url": "period"
},
{
"valueCodeableConcept": {
"coding": {
"system": {
"_value": "http://loinc.org"
},
"code": {
"_value": "LA29519-8"
},
"display": {
"_value": "she/her/her/hers/herself"
}
}
},
"_url": "value"
},
{
"valuePeriod": {
"start": {
"_value": "2022-08-01"
}
},
"_url": "period"
}
],
"_url": "http://hl7.org/fhir/StructureDefinition/individual-pronouns"
}
],
"identifier": {
"use": {
"_value": "usual"
},
"type": {
"coding": {
"system": {
"_value": "http://terminology.hl7.org/CodeSystem/v2-0203"
},
"code": {
"_value": "MR"
}
}
},
"system": {
"_value": "urn:oid:1.2.36.146.595.217.0.1"
},
"value": {
"_value": "patientID1"
},
"period": {
"start": {
"_value": "2001-05-06"
}
}
},
"active": {
"_value": "true"
},
"name": [
{
"use": {
"_value": "usual"
},
"family": {
"_value": "Smith"
},
"given": {
"_value": "Jack"
},
"period": {
"end": {
"_value": "2022-07-31"
}
}
},
{
"use": {
"_value": "usual"
},
"family": {
"_value": "Smith"
},
"given": {
"_value": "Julie"
},
"period": {
"start": {
"_value": "2022-08-01"
}
}
},
{
"use": {
"_value": "nickname"
},
"given": {
"_value": "Jack"
},
"period": {
"end": {
"_value": "2022-07-31"
}
}
},
{
"use": {
"_value": "nickname"
},
"given": {
"_value": "Julie"
},
"period": {
"start": {
"_value": "2022-08-01"
}
}
}
],
"_xmlns": "http://hl7.org/fhir"
}
}
Following the update of information, the patient is notified of the need for a health screening appointment. During the meeting with her physician, the examination of the patient’s prostate noted the presence of nodules. Due to this finding, a PSA is ordered for the patient using the Sex for Clinical Use as male with a note that the patient has a prostate. The following is a FHIR example for the service request for a PSA:
{
"ServiceRequest": {
"id": {
"_value": "PSA"
},
"extension": [
{
"extension": [
{
"valueCodeableConcept": {
"coding": {
"system": {
"_value": "http://terminology.hl7.org/CodeSystem/sex-for-clinical-use"
},
"code": {
"_value": "Male"
},
"display": {
"_value": "Specified sex for clinical use"
}
}
},
"_url": "value"
},
{
"valueString": {
"_value": "Patient has a prostate."
},
"_url": "comment"
}
],
"_url": "http://hl7.org/fhir/StructureDefinition/patient-sexForClinicalUse"
}
],
"identifier": {
"type": {
"coding": {
"system": {
"_value": "http://terminology.hl7.org/CodeSystem/v2-0203"
},
"code": {
"_value": "PLAC"
}
},
"text": {
"_value": "Placer"
}
},
"system": {
"_value": "urn:oid:1.3.4.5.6.7"
},
"value": {
"_value": "2345234234234"
}
},
"status": {
"_value": "active"
},
"intent": {
"_value": "original-order"
},
"code": {
"coding": {
"system": {
"_value": "http://loinc.org"
},
"code": {
"_value": "2857-1"
},
"display": {
"_value": "Prostate specific Ag [Mass/volume] in Serum or Plasma"
}
},
"text": {
"_value": "Prostate specific Ag [Mass/Vol]"
}
},
"subject": {
"reference": {
"_value": "Patient/patientID1"
},
"display": {
"_value": "Julie Smith"
}
},
"encounter": {
"reference": {
"_value": "Encounter/example"
}
},
"occurrenceDateTime": {
"_value": "2022-08-15T18:01:00+01:00"
},
"requester": {
"reference": {
"_value": "Practitioner/example"
}
},
"performer": {
"reference": {
"_value": "Practitioner/f005"
}
},
"reasonCode": {
"coding": {
"system": {
"_value": "http://hl7.org/fhir/sid/icd-10-cm"
},
"code": {
"_value": "N40.2"
},
"display": {
"_value": "Nodular prostate without lower urinary tract symptoms"
}
}
},
"_xmlns": "http://hl7.org/fhir"
}
}
The PSA is performed and resulted. The following is a FHIR example for the observation of the PSA result:
{
"Observation": {
"id": {
"_value": "f001"
},
"identifier": {
"use": {
"_value": "official"
},
"system": {
"_value": "http://www.bmc.nl/zorgportal/identifiers/observations"
},
"value": {
"_value": "6323"
}
},
"status": {
"_value": "final"
},
"code": {
"coding": {
"system": {
"_value": "http://loinc.org"
},
"code": {
"_value": "2857-1"
},
"display": {
"_value": "Prostate specific Ag [Mass/volume] in Serum or Plasma"
}
}
},
"subject": {
"reference": {
"_value": "Patient/patientID1"
},
"display": {
"_value": "Julie Smith"
}
},
"issued": {
"_value": "2022-08-15T17:45:00+01:00"
},
"performer": {
"reference": {
"_value": "Practitioner/f005"
},
"display": {
"_value": "D. Jones"
}
},
"valueQuantity": {
"value": {
"_value": "3.0"
},
"unit": {
"_value": "ng/ml"
},
"system": {
"_value": "http://unitsofmeasure.org"
},
"code": {
"_value": "ng/ml"
}
},
"interpretation": {
"coding": {
"system": {
"_value": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
},
"code": {
"_value": "N"
},
"display": {
"_value": "Normal"
}
}
},
"note": {
"text": {
"_value": "Patients on testosterone suppressing medications, the upper limit of normal for the PSA should be reduced to 1.0 ng/ml."
}
},
"referenceRange": {
"low": {
"value": {
"_value": "0"
},
"unit": {
"_value": "ng/ml"
},
"system": {
"_value": "http://unitsofmeasure.org"
},
"code": {
"_value": "ng/ml"
}
},
"high": {
"value": {
"_value": "4.0"
},
"unit": {
"_value": "ng/ml"
},
"system": {
"_value": "http://unitsofmeasure.org"
},
"code": {
"_value": "ng/ml"
}
}
},
"_xmlns": "http://hl7.org/fhir"
}
}
IG © 2022+ HL7 Terminology Infrastruture Work Group. Package hl7.xprod.uv.gender-harmony#1.0.0 based on FHIR 5.0.0. Generated 2023-11-06
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