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Two independent autopsies of bone evidence disagree on how the material should be sexed. They agree that the individual was likely a murder victim who had disappeared, and that proper appropriate sexing will be essential in identifying the individual.


Pre-Gender Harmony:

  1. Autopsist 1 enters an Administrative Sex.
  2. Autopsist 2 changes the Administrative Sex after disagreeing.
  3. If Autopsist 1's result was correct, then the patient matching algorithm will fail.

Post-Gender Harmony:

  1. Autopsist 1 associates a Sex For Clinical Use with the autopsy results (recorded as an Observation), noting how sexing was performed.
  2. Autopsist 2 associates a second Sex For Clinical Use datum with the autopsy results (recorded as an Observation), noting how sexing was performed.
  3. With both recorded with notes on why the sexing was performed in a particular manner, patient identifying algorithms can work could search more effectively with a broader search space.

Alternative and/or related Workflow(s):

Workflow if bone evidence is submitted for X-ray/CAT scan:

  1. "Unknown" would likely be entered for Gender Identity.
  2. SFCU would likely be missing.
  3. Resulting image objects will have the aforementioned values.
  4. If a report is generated, a complete discussion will likely be produced, with further information about suggested values based on observations.
  5. If there is a future disagreement about interpretation of observations, there may be another report generated with that information.

Alignment and/or Misalignment with Gender Harmony Model:

The primary workflow involves multiple information components which cannot be represented adequately outside of the Gender Harmony Model.

The alternative workflow presented can function within DICOM by coercing the SFCU into Patient Sex (0010,0040) (as missing). The Gender Identity (unknown) will be lost in the conversion as it currently stands.

Current Standard Support:


V3 Resource:
  •  HL7 FHIR
FHIR Resource:
  •  DICOM
DICOM Resource: DICOM would likely not be involved in the primary workflow. However, in the alternative workflow, SFCU would likely be coerced into Patient Sex and Gender Identity would be lost in conversion, unless there is updating of systems.
  •  NCPDP
NCPDP Resource:
  •  X12