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

Standards History

History of Sex and Gender in HL7 Standards

HL7v2 History

1. In HL7v2 2.3.1:
   • The PID-8 field was labeled as “Sex”
   • The field definition was “This field contains the patient’s sex”.
   • Table 0001 was introduced with values for F, M, O, and U. This table did not have a formal Value Set definition, or include definitions for the codes.
2. In HL7 v2.4:
   • The name of the PID-8 field was updated to be “Administrative Sex”.
   • The field definition remained “This field contains the patient’s sex”.
   • Table 0001 was updated to include A-Ambiguous and N-Not applicable, but the table still had no formal Value Set definition.
3. In HL7 v2.7:
   • Chapter 2C was introduced for Code Tables, but no substantive changes were made to the sex codes or their definitions.
4. In HL7 v2.9:
   • The 0001 table was updated to identify a Concept Domain, Code System, and Value Set.
   • The Value Set was given a definition of “Concepts specifying a patient’s sex for administrative purposes.”
   • A new code was added for X-Non-Binary. This code included a usage note indicating that it was for jurisdictional use, and was driven by reporting requirements of some states in the US. This was intentionally a stop-gap measure. The HL7 meeting which added X-Non-Binary to table 0001 was the same meeting that initiated the Gender Harmony Project!

HL7v3 History

1. HL7v3 adopted Administrative Gender as a concept.

FHIR History

1. In FHIR DSTU1
   • A Patient.gender property was included with a definition, requirements, and comments.
   • Patient.gender was mapped to PID-8 in the Mappings for HL7v2.
2. In FHIR DSTU2:
   • Additional Patient.gender comments were added suggesting the use of Observations (when available) rather than Patient.gender for clinical decision support.
3. In FHIR STU3:
   • The Patient Gender section was added with some guidance on representing patient gender.
4. In FHIR R4:
   • The Patient Gender section was updated and renamed to include more guidance based on an increased volume of feedback from the community.
   • The patient-genderIdentity extension was added to the core FHIR spec.
5. In FHIR R5:
   • The Patient Sex and Gender section was updated to align with the Gender Harmony project.
   • The patient-genderIdentity extension was retired in favor of the individual-genderIdentity extension to account for Practitioner and other individuals.
   • The patient-sexParameterForClinicalUse extension was added.
   • The individual-pronouns extension was added.
   • The individual-recordedSexOrGender extension was added.