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The Gender Harmony Implementation Guides, balloted Sept 2022 are final and have been published! 

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Note to Off-Cycle September 2022 Balloters: For some guidance on how to use the JIRA balloting process for the GH Cross-paradigm IG, please see the slides presented during the Sept WGM BoF session located here. If you have any issues with balloting against the GH Cross-paradigm IG, please contact

the GH project team at

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Gender Harmony Meeting Calls

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This is project born of the ongoing frustration the ideas encompassed by "sex" and "gender" have never been easy to capture consistently within health models. Those terminologists among us have always said this topic was the quintessential example that proves "terminology is hard." This project is going to try use some tried and true approaches to how we model information (data elements, value sets, code systems) and use them to define/harmonize some aspects, likely not all, for representing sex/gender. This project will result in a balloted informational document that will define use-context collections that also include appropriate value sets. These artifacts can then be associated with model elements using binding parameters that are informed by the metadata the project will identify with each use context. 

The project must take into account actual user needs and include end user communities, including the international community. Communities such as DaVinci, HSPC/CIIC, Argonaut, IPS, pharmacy, the LGBTQ community and many others. Importantly we must walk that fine line of allowing multiple approaches to very similar things without requiring harmonization from the outset, yet we will harmonize if at all possible.   

We expect that once completed, the set of use-contexts, currently called sex-gender types, can be used to clarify that certain existing model implementations actually intend users to assume one sex or gender entry actually represent multiple distinct sex-gender types that can in fact have different values that use the same code. For example, a single "sex" field that at data entry time is perceived to mean "current gender identity" but is then subsequently used to represent "current phenotypic organ clinical sex." In that case the initial choice of "M" may in fact properly be represented as "F" for the latter use.

Link to the Vocab Q4 minutes where this was discussed

Please participate in Gender Identity!

Phase 1 - January 2021 HL7 Gender Harmony PASSED Ballot and is published!

Phase 2 - Off-cycle September 2022 Cross-paradigm BALLOT

The Informative Specification is owned by the Terminology Infrastructure WG.

The CDA specification is owned by Structured Documents WG.

The V2 specification (as defined in Thank you to the many people who participated in the phase 1 ballot. We now need you to participate in our ballot that defines how to exchange GH-elements in V2 ( V2.9.1) , CDA, and FHIR (R5.). 

Ballot Issue resolution and voting meetings are listed HERE

The following WGs are helping

Patient Administration (responsible for the Patient Resource and other related resources, and V2.)

is owned by the V2 Management Group.

The FHIR R5 artifacts defined via this project are owned by the Patient Administration WG 

The following addition WGs are helping

  • O&O (Responsible for Observation and V2)
  • FM (Financial related) Structured Documents (C-CDA)
  • Patient Enpowerment
  • Cross-workgroup Projects (US Core)

Final publication of the phase 1 specification is available here:

JAMIA article on project:

Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation

Survey is now closed - thanks to all who participated.

Dashboard link:

Phase 2 - changes in V2, CDA, FHIR products to support GH

Main GH

This is our focus currently and will result in a cross-paradigm FHIR publication ballot that discusses each product family.

As of Jan 2022, targeting SEPTEMBER 2022 BALLOT CYCLE for the GH ballot.

We will be defining FHIR resource changes needed to support GH to be included in the R5 MAY 2022 ballot.


Url to download zip:

Please participate!

You do not need to be an HL7 member to participate, but to leave comments and really get the most out of your participation, you will need an HL7 Confluence Login. To get one please Request an Account.

Like many of the HL7 projects, this project has matured and adapted over time, making some of the pages outdated. We recommend new participants engage by:

  1. Joining the bi-weekly calls
  2. Reviewing the Context Definition Page to review the context definitions created by this project
  3. For background information and/or to review information intially submitted by international project participants, see the Implementations and SDO Use Case page
  4. Leaving comments on any of the related pages
  5. Contacting project leads Rob McClure and Caroline Macumber with any other comments/questions or concerns

We need USE CASES for examples of situations where non-typical patient sex or gender has an impact on clinical care. See slide 2 in this presentation as a general example but we need input on specific machines, lab tests, etc. that are impacted and how to implement in a non disruptive way.

Gender Harmony Meeting Calls

Every other Monday 4pm ET for 90 min using

Join Zoom Meeting - | Meeting ID: 718 380 6281  Password: 370553

Dial-in: +1 646 558 8656 US (New York)

Find your local number:

View all call details at

Project ID 1533

TSC Approval 2019-07-08

Project Naming

Some folks suggested we try a different name to ensure communication makes it through e-mail filters.  Please list any suggested project names here:

DIGS - Discrete Interoperability for Gender and Sex

New DIGSY - New Discrete Interoperability for Gender and Sex, yo.

Short URL for project:

LOINC definitions of Sex and Gender

WHO on Gender

German HL7 page on Geschlecht (Gender)

Health Standards Collaborative Approaches to Terminology for Gender and Sex

Canada Health Infoway Sex and Gender Working Group