Warning When Gender Identity Extension is validated

[raghunathsandilya]

We are trying to validate the Patient resource against fhir.us.uds-plus IG.

Getting
Patient.extension[4].value.ofType(CodeableConcept): None of the codings provided are in the value set 'Uds Plus Gender Identity Codes' (http://hl7.org/fhir/us/uds-plus/ValueSet/uds-plus-gender-identity-codes|1.0.0), and a coding should come from this value set unless it has no suitable code (note that the validator cannot judge what is suitable) (codes = http://terminology.hl7.org/CodeSystem/v3-NullFlavor#ASKU) on line 67

for

{ "valueCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor", "code": "ASKU", "display": "asked but unknown" } ] }, "url": "http://hl7.org/fhir/us/uds-plus/StructureDefinition/uds-plus-gender-identity-extension" }

As fhir.us.uds-plus IG is derived from US Core IG. And the NullFlavor code 'ASKU' is valid as per US CORE Profile extensions. We are expecting the warning shouldn't be shown.

Can you please let us know why it is being showed as a warning?

[dehall]

Hi @raghunathsandilya , I'm not sure I have the latest version of the UDS+ IG, but based on what I'm seeing I believe this is a bug in the definition of that ValueSet in the IG. That ValueSet looks like it should contain the code "NASK" ("not asked") as well as all the codes from the "Gender Identity" valueset: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1021.32/expansion/Latest
If you try with the NASK code it should validate without any warnings, but if you use any of the other codes from that value set (which includes ASKU) it returns the same warning.

In the version of the IG that I have, I see this snippet in the definition of the ValueSet:

"compose": {
    "include": [
      {
        "system": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.32"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
        "concept": [
          {
            "code": "NASK",
            "display": "Not Asked"
          }
        ]
      }
    ]
  }

Compare that to a similar value set definition from US Core, note that the references are in the field valueSet rather than system:

"compose": {
    "include": [
        { "valueSet": ["http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1"]},
        { "valueSet": ["http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.103"]}
    ]}

This should probably be reported to the IG developers but I'm not sure who that is. Do you have a contact that you could share this info with?