hardDesignConceptMidSeniorStaff
How would you model sex and gender in a patient record?
6 min readUpdated 2026-08-15
Answer
Short answer
Not as one field. Administrative sex, recorded sex at birth, gender identity, name and pronouns to use, and the sex parameter a clinical calculation needs are separate elements with separate provenance and separate consumers, and each has to be able to change without rewriting the others.
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Likely follow-ups
- A reference range is computed from the wrong parameter and a result is reported as normal. Where in your design was that decision made?
- How would you decide which screening recalls a patient is due, without inferring anatomy from any sex field?
- Which of these elements should flow to an external organisation by default, and which should not?
- What has to happen to historic orders, results and letters when a patient's recorded gender changes?
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