What does this mean? Can this be applied universally with realm-specific subtypes?
- ONC USCDI includes “Birth Sex” which has no official definition.
- It should be coded with M and F from V3_AdministrativeGender code system, plus UNK (unknown) from the V3 NullFlavor code system.
- The 2015 regulation says this is represented (https://www.healthit.gov/sites/default/files/170299_f_29_hl7_v3_agender_and_nullflavor.pdf) by the V3 AdministrativeGender value set used in C-CDA (2.16.840.1.113883.1.11.1) here https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.1.11.1/expansion. That value set includes all codes from the V3 AdministrativeGender code system, which includes M, F and UN (Undifferentiated). So the value set to be used per the original regulation includes the code UN even though it also says, only use M, F, UNK.
- There are at least two identical value sets based on the regulatory specification, likely created because the one listed in the regulation seems to be incorrect in that it includes UN.
- Argonaut
- Name: USRealm Birth Sex value set
- Found: http://build.fhir.org/ig/argonautproject/data-query/ValueSet-usrealm-birthsex.html.
- Defining url: http://fhir.org/guides/argonaut/ValueSet/usrealm-birthsex
- Used in Argonaut Patient Profile
- Bound REQUIRED to
- Element birthsex extension (also required)
- that has definition “A code classifying the person's sex assigned at birth as specified by the Office of the National Coordinator for Health IT (ONC)”
- US Core
- Name: US_Core_Birth_Sex_Value_Set (initial version (r2) had no “_” in the name)
- Found: http://hl7.org/fhir/us/core/2019Jan/ValueSet-us-core-birthsex.html.
- Defining url: http://hl7.org/fhir/us/core/ValueSet/us-core-birthsex
- Used in US Core Patient Profile
- Bound REQUIRED to
- Element birthsex extension (also required)
- No definition given
- Neither has above value sets have an OID - yet.
- Questions?
- Can these two value sets that have exactly the same CLD (content definition) be harmonized?
- Define the acceptable metadata - Name, OID, scope/context of use
- Can they change over time? Ie: can we add other values as needed by defining other versions of the same value set?
- Is X (intersex) = UN (undifferentiated)?
- Can Other be used instead?
- Some (Rob M) believe that Other as a meaningful code is not the same as OTH a null value
- Note that FHIR uses a FHIR-defined code system (and value set) AdministrativeGender for the base patient profile element gender. Both the Argonaut and US Core patient profiles include gender element in addition to birthsex.