{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T23:29:45Z","timestamp":1768778985957,"version":"3.49.0"},"reference-count":80,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Accurate representation of clinical sex and gender identity in interoperable clinical systems is a major challenge for organizations intent on improving outcomes for sex- and gender-marginalized people. Improved data collection has been hindered by the historical approach that presumed a single, often binary, datum was sufficient. We describe the Health Level Seven International (HL7) Gender Harmony logical model that proposes an improved approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>The proposed solution was developed via an American National Standards Institute (ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is an HL7 International-balloted consensus on the subject of representing sex and representing gender in clinical systems based on work of the gender harmony project led by the HL7 Vocabulary Work Group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The Gender Harmony Model is a logical model that provides a standardized approach that is both backwards-compatible and an improvement to the meaningful capture of gender identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and pronouns that are affirmative and inclusive of gender-marginalized people.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Most clinical systems and current standards in health care do not meaningfully address, nor do they consistently represent, sex and gender diversity, which has impeded interoperability and led to suboptimal health care. The Gender Harmony Project was formed to create more inclusive health information exchange standards to enable a safer, higher-quality, and embracing healthcare experience. The Gender Harmony Model provides the informative guidance for standards developers to implement a more thorough technical design that improves the narrow binary design used in many legacy clinical systems.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocab196","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T11:36:27Z","timestamp":1631100987000},"page":"354-363","source":"Crossref","is-referenced-by-count":28,"title":["Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2937-0342","authenticated-orcid":false,"given":"Robert C","family":"McClure","sequence":"first","affiliation":[{"name":"MD Partners, Inc., Lafayette, Colorado, USA"}]},{"given":"Caroline L","family":"Macumber","sequence":"additional","affiliation":[{"name":"Clinical Architecture, Carmel, Indiana, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8397-8810","authenticated-orcid":false,"given":"Clair","family":"Kronk","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}]},{"given":"Chris","family":"Grasso","sequence":"additional","affiliation":[{"name":"Fenway Health, Boston, Massachusetts, USA"}]},{"given":"Robert J","family":"Horn","sequence":"additional","affiliation":[{"name":"Fairhaven Technology, Maynard, Massachusetts, USA"}]},{"given":"Roz","family":"Queen","sequence":"additional","affiliation":[{"name":"School of Health Information\u2002Science, University of Victoria, Victoria, BC, Canada"}]},{"given":"Steven","family":"Posnack","sequence":"additional","affiliation":[{"name":"US Department of Health and Human Services, Office of the National Coordinator for Health IT, Washington, District of Columbia, USA"}]},{"given":"Kelly","family":"Davison","sequence":"additional","affiliation":[{"name":"Canada Health Infoway, Toronto, ON, Canada"},{"name":"School of Health Information Science, University of Victoria, Victoria, BC, Canada"}]}],"member":"286","published-online":{"date-parts":[[2021,10,6]]},"reference":[{"issue":"1","key":"2022011313554443700_ocab196-B1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1089\/trgh.2017.0004","article-title":"Review of the transgender literature: where do we go from here?","volume":"2","author":"Wanta","year":"2017","journal-title":"Transgend Health"},{"issue":"4","key":"2022011313554443700_ocab196-B2","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/BF01542194","article-title":"Comparison of attitudes toward transexuality and homosexuality","volume":"12","author":"Leitenberg","year":"1983","journal-title":"Arch Sex Behav"},{"issue":"2","key":"2022011313554443700_ocab196-B3","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1093\/poq\/nfy009","article-title":"Explaining public opinion toward transgender people, rights, and candidates","volume":"82","author":"Jones","year":"2018","journal-title":"Public Opin Q"},{"key":"2022011313554443700_ocab196-B4","author":"Truitt","year":"2016"},{"key":"2022011313554443700_ocab196-B5","volume-title":"A Survey of LGBT Americans","year":"2013"},{"issue":"21","key":"2022011313554443700_ocab196-B6","doi-asserted-by":"crossref","first-page":"e116","DOI":"10.1056\/NEJMp2024745","article-title":"Two steps back \u2014 rescinding transgender health protections in risky times","volume":"383","author":"Malina","year":"2020","journal-title":"N Engl J Med"},{"key":"2022011313554443700_ocab196-B7","author":"James","year":"2016"},{"key":"2022011313554443700_ocab196-B8","author":"M\u00e9ndez","year":"2013"},{"key":"2022011313554443700_ocab196-B9","first-page":"40","article-title":"Unfit for parenthood? 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