Closed RichardTON closed 2 years ago
On balance given the likely extent of work required, particularly on the options for terminology, it was decided with @oridashi (Brett) to remove this extension for now. This has been done in PR #611 (see commit 2ba705ca89d18e3d7fc879a4ce81b27598715d5a) and includes the added informative text:
The core extension Gender Identity is not yet supported in AU Base Patient as the terminology is considered inappropriate for use in Australia.
Related ballot feedback is below.
https://jira.hl7australia.com/browse/FHIRIG-186 Gender identity should be added to StructureDefinition-au-patient http://hl7.org.au/fhir/2021Aug/StructureDefinition-au-patient.html
A data element to capture the patient's gender identity should be added.
It is suggested that this be addressed through addition of an CodeableConcept extension and extensibly binding it to a new (HL7 AU maintained) value set. This value set should select codes from an HL7 AU maintained code system (also to be added) which includes codes aligned with the Australian Bureau of Statistics (ABS) Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables (https://www.abs.gov.au/statistics/standards/standard-sex-gender-variations-sex-characteristics-and-sexual-orientation-variables/latest-release) values for gender identity i.e. Male, Female, Non-binary, Different Term, Prefer Not To Answer, Not stated or inadequately described.
If appropriate the HL7 International gender-identity extension (https://www.hl7.org/fhir/extension-patient-genderidentity.html) could be considered for adoption. Reporter:Reuben Daniels Email:reuben@saludax.com
https://jira.hl7australia.com/browse/FHIRIG-187 Gender should be added to StructureDefinition-au-relatedperson http://hl7.org.au/fhir/2021Aug/StructureDefinition-au-relatedperson.html
Similar comment as for FHIRIG-186. The same suggested extension, value set and code system proposed may be reused. Reporter:Reuben Daniels Email:reuben@saludax.com
this is included for future work; and assessing the harmony project outputs
Outcome from meeting on Gender Identity 11 AUG 2022 to discuss proposals documented on https://confluence.hl7australia.com/display/PA/Gender+Identity is documented here https://confluence.hl7australia.com/pages/viewpage.action?pageId=116461176:
Initial value set to consist of
code | display | system |
---|---|---|
446151000124109 | Identifies as male gender | http://snomed.info/sct |
446141000124107 | Identifies as female gender | http://snomed.info/sct |
33791000087105 | Identifies as nonbinary gender | http://snomed.info/sct |
unknown | Unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason |
asked-declined | Asked But Declined | http://terminology.hl7.org/CodeSystem/data-absent-reason |
Value set published, see https://healthterminologies.gov.au/fhir/ValueSet/gender-identity-response-1
This is a core extension with it's own definition so implementing behaviour supporting extensible binding will need to be done with this in mind.
Options include in AU Base Patient add the core genderIdentity extension and:
Invariant on Patient
<constraint>
<key value="inv-pat-1" />
<severity value="warning" />
<human value="Gender identity SHALL be a member of the Gender Identity Response value set if any of the codes within that value set can apply" />
<expression value="extension('http://hl7.org/fhir/StructureDefinition/patient-genderIdentity').empty() or extension('http://hl7.org/fhir/StructureDefinition/patient-genderIdentity').valueCodeableConcept.memberOf('https://healthterminologies.gov.au/fhir/ValueSet/gender-identity-response-1')" />
<source value="http://hl7.org.au/fhir/StructureDefinition/au-patient" />
</constraint>
Decompose the extension:genderIdentity slice to value[x] / valueCodableConcept
<element id="Patient.extension:genderIdentity.valueCodeableConcept">
<path value="Patient.extension.valueCodeableConcept" />
<type>
<code value="CodeableConcept" />
</type>
<binding>
<strength value="extensible" />
<valueSet value="https://healthterminologies.gov.au/fhir/ValueSet/gender-identity-response-1" />
</binding>
</element>
Noting that with any of the approached the example binding gets rendered in views (Diff, Snapshot etc.) and there doesn't appear to be a way to turn that off .
The binding option is preferred, the extension:genderIdentity slice has been decomposed to value[x] / valueCodableConcept to add a binding.
PR forthcoming - content reviewed and okayed by @oridashi and @davidmckillop.
AU Base Patient uses the FHIR Core Gender Identity extension. As AU Base Patient uses this, Patient needs to provide usage notes to clarify Gender Identity's usage in an Australian context and a preferred binding, rather than the example binding.