Stream: implementers
Topic: FamilyMemberHistory
Jeremy Walton (Jun 24 2016 at 01:03):
How do you link a FamilyMemberHistory to a patient?
Jeremy Walton (Jun 24 2016 at 01:07):
i.e. Patient Bob (reference: Patient/1) has a father named Jake (reference Patient/2) So I want to link them on Bob's FamilyMemberHistory to say all of this patient's FamilyMemberHistory and Conditions are now apart of Bob's FamilyMemberHistory as well? Without having to recreate all of the conditions from that record?
Abbie Watson (Jun 24 2016 at 01:19):
We've been thinking about this problem also. We're considering extending either a DocumentManifest or List resource and creating a FamilyTree object.
Jeremy Walton (Jun 24 2016 at 01:25):
So currently there is no way to represent this?
Abbie Watson (Jun 24 2016 at 01:26):
Well, there's the FamilyMemberHistory.patient field of course. But you're asking about how to combine resources into a more complex data structure. List, Group, and DocumentManifest are the available resources for that sort of thing.
Jeremy Walton (Jun 24 2016 at 01:30):
I'm not sure it needs to be List resource as its just a link between 2 patients who have a relationship. For example, we store this relationship and several of our clients save a few gigs of disk space not having to duplicate this information. Clients also like to record if they are or are not biologically related.
Abbie Watson (Jun 24 2016 at 01:36):
Presumably, as soon as mother, brother, sister, etc are added in it could be more than 2; hence a List. Keep in mind that a Tree can be serialized into a List; and a List deserialized into a Tree. Unfortunately, there's not a FamilyTree object yet. I'm sure there will be sooner or later.
Brian Postlethwaite (Jun 24 2016 at 01:38):
This information would also need to be considered in terms of security and exposure/disclosure if sharing.
Jeremy Walton (Jun 24 2016 at 01:41):
Isn't that up to the implementation? I was under the impression security was outside of the FHIR spec.
Brian Postlethwaite (Jun 24 2016 at 02:19):
That's correct, it's easier to partition if the data is seperate, then there is no need to work out how much is available to who.
Brian Postlethwaite (Jun 24 2016 at 02:19):
Just a consideration to consider, not something that needs to be in the spec.
Jeremy Walton (Jun 24 2016 at 02:20):
The Data is still separate, it would just have links, similar to Patient.links
Brian Postlethwaite (Jun 24 2016 at 02:21):
ok.
Jeremy Walton (Jun 24 2016 at 02:22):
I kinda like Patient.relations, because a relation doesn't have to be a biological family member.
Jeremy Walton (Jun 24 2016 at 02:22):
I wonder if you relate animals together, is that a security concern?
Abbie Watson (Jun 24 2016 at 02:23):
This could also be done with an extension to Patient. Patient.familyHistory[] perhaps?
Brian Postlethwaite (Jun 24 2016 at 02:23):
You would also want links to the RelatedPerson records too
Jeremy Walton (Jun 24 2016 at 02:24):
Probably, I personally wouldn't find any use for it, but I could see others.
Brian Postlethwaite (Jun 24 2016 at 02:28):
Is there a tracker for this yet?
Jeremy Walton (Jun 24 2016 at 02:28):
@Abigail Watson I was never clear on how to create extensions, do people normally create variables as "_familyHistory"? Is there a naming convention used so as to not conflict at a later time? I would hate to use a variable name that could be added to the official spec at a later time, thereby producing conflicts.
Brian Postlethwaite (Jun 24 2016 at 02:28):
Or are we just considering extensions at this point.
Brian Postlethwaite (Jun 24 2016 at 02:30):
@Jeremy Walton , you might want to review http://hl7-fhir.github.io/extensibility.html which has the details of doing extensions (yes this is the latest version, but probably hasn't changed much) The extensions can't clash, as the are serialized differently and have different coding techniques.
Jeremy Walton (Jun 24 2016 at 02:31):
@Brian Postlethwaite I guess an extension, if i can do it in a non conflicting way. This would save me from auto creating a huge amount of familymemberhistory resources
Abbie Watson (Jun 24 2016 at 02:31):
Honestly, I'm just now figuring out extensions myself.
Brian Postlethwaite (Jun 24 2016 at 02:31):
Hope that link helps then.
Lloyd McKenzie (Jun 24 2016 at 03:04):
There are several extensions that help to support this. There are extensions to allow you to link FamilyMemberHistories together to identify the mother, father and twin relationships (as needed to support genetic analysis). There's also an extension that allows you to link a FamilyMemberHistory to the Patient record for that family member.
Brian Postlethwaite (Jun 24 2016 at 04:22):
Is this the extension you are referring to @Lloyd McKenzie http://hl7.org/fhir/DSTU2/extension-familymemberhistory-patient-record.html
Lloyd McKenzie (Jun 24 2016 at 04:45):
Yes. As well as http://www.hl7.org/fhir/extension-family-member-history-genetics-parent.html
Pravina Munghate (Jul 13 2016 at 19:39):
Hi ,
We are trying to capture family member history for a pregnant patient from both maternal & father's family side as a part of booking appointment. It doesn't need to point to any specific member from each side of the family.
https://www.hl7.org/fhir/familymemberhistory-definitions.html#FamilyMemberHistory.relationship
Relationship codes listed above doesn't include codes which would indicate maternal family or father's family, there is just one generic code - family.
Suggestions on how to indicate distinctly family side through relationship is much appreciated.
Many thanks !
-Pravina
Lloyd McKenzie (Jul 13 2016 at 20:19):
Well, you could use the extensions in the genetic family history profile to track full lineage. We do have distinct maternal and paternal codes for most relationships - e.g. maternal aunt, paternal grandfather, etc. So far, no one has had a use-case for distinguishing maternal/paternal without having more detail about the nature of the relationship. If you really do need this level of granularity, you can submit a change request for us to add it to the code system. And of course, you're also free to use a local code.
Abbie Watson (Aug 01 2016 at 22:54):
So, finally got my first extension written. Wasn't too difficult. Spent more time fussing with our schema package than extending the resource itself. Don't worry about the underscore... feel free to keep things semantic and readable. But do structure the field as an object, and add a url sub-field that contains a pointer to the extension definition. That's how they're avoiding conflicts.
Richard Townley-O'Neill (Aug 25 2016 at 05:22):
There is a gap in the entry for the FamilyMemberHistory resource at http://hl7-fhir.github.io/familymemberhistory.html . It opens with "This resource records significant health events and conditions ..." but there is nothing useful said about events later on, just about conditions.
Lloyd McKenzie (Aug 26 2016 at 02:35):
@Richard Townley-O'Neill Can you submit a change request?
Richard Townley-O'Neill (Aug 26 2016 at 06:17):
@Lloyd McKenzie Where do I find how to do that?
Lloyd McKenzie (Aug 26 2016 at 06:26):
@Richard Townley-O'Neill At the bottom of every page in the spec there's a "propose a change" link. You'll need to register which involves a human looking at your submission and trying to verify that you're not a bot after which you'll receive an activation email (if you don't have it within 24 hours, check your spam folder). From that point forward, you'll be able to propose changes and also monitor what happens to them as they wind their way toward being applied.
Jayashree Surnar (Jul 07 2017 at 05:40):
can anybody explain this scenario how to impl this:
Reviewed, None Identified for a Family Member
When an individual family member's history is not available, FamilyMemberHistory.dataAbsentReason can be used to indicate why that family member's history is not available (e.g. subject unknown).here what's the subject(is it FamilyMember's condition/problem/disease or anything else?)?
Lloyd McKenzie (Jul 07 2017 at 15:00):
It lets you explicitly say that the fact that there's no conditions or other information for a particular relative doesn't mean that the history is incomplete, it just means that there's nothing interesting about that relative to state from a family history perspective
Michelle (Moseman) Miller (Jul 07 2017 at 15:31):
@Jayashree Surnar Assuming you are asking about what the dataAbsentReason code of "subject-unknown" means, it means that the Patient does not know the subject (i.e. family member), which might be the case when the subject (i.e. family member) is the biological parent of an adopted patient
Jayashree Surnar (Jul 10 2017 at 04:01):
Thank you @Michelle (Moseman) Miller , @Lloyd McKenzie
Jose Costa Teixeira (Dec 28 2020 at 17:49):
Can't FamilyMemberHistory be used for the patient?
Lloyd McKenzie (Dec 28 2020 at 18:45):
Don't understand the question @Jose Costa Teixeira
Jose Costa Teixeira (Dec 28 2020 at 18:50):
if I want to report something about the history of the patient (in a very summary form), would I use FamilyMemberHistory? e.g. "had some migraine-related vertigo some years ago..."
Jose Costa Teixeira (Dec 28 2020 at 18:50):
I'm trying to understand the triangle Patient - RelatedPerson - FamilyMemberHistory
Jose Costa Teixeira (Dec 28 2020 at 18:50):
(and how other resources would or not overlap with these)
Lloyd McKenzie (Dec 28 2020 at 19:12):
FamilyMemberHistory is about capturing family history. It's not generally about the patient's own history - that would be in Condition, Observations or, when captured as a clinical note, DocumentReference.
Jose Costa Teixeira (Dec 28 2020 at 19:16):
can't we use those Conditions, Obsevations, etc pointing to the RelatedPerson to capture family member history?
Yunwei Wang (Dec 28 2020 at 20:15):
As my understanding, RelatedPerson is an actor in the clinical workflow who attribute information. Such as Condition.recorder
FamilyMemberHistory is for information about this "family member". Or say, the family member is the subject in the clinical workflow.
Jose Costa Teixeira (Dec 28 2020 at 20:17):
I did not read RelatedPerson as only an actor. Couldn't it be also a relative?
Yunwei Wang (Dec 28 2020 at 20:19):
It hinted here
Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
and here
A RelatedPerson resource is primarily used for attribution of information, since RelatedPersons are often a source of information about the patient.
Yunwei Wang (Dec 28 2020 at 20:22):
I randomly checked some of reference of RelatedPerson. They all match actor pattern, such as MedicationRequest.performer, Group.managingEntity, Condition.recorder, etc.
Jose Costa Teixeira (Dec 28 2020 at 20:26):
interesting. What happens when we need to say "Patient's mother says that the patient had vertigo several years ago. By the way, she also says she had it as well at the same age"
Jose Costa Teixeira (Dec 28 2020 at 20:29):
do we have the mother as a related person and as a family member?
Lloyd McKenzie (Dec 28 2020 at 20:32):
RelatedPerson is someone who is acting on the basis of their personal relationship (whether that's family member, neighbor, friend, etc.)
Yunwei Wang (Dec 28 2020 at 20:33):
I think, it would be
Condition "vertigo" has Patient (p1) as target and RelatedPersion (mother) as asserter.
FamilyMemberHistory "vertigo" has monther's info and Patient (p1) as patient
Lloyd McKenzie (Dec 28 2020 at 20:33):
You can link a FamilyMemberHistory to a RelatedPreson if you happen to have a RelatedPerson record for them.
Last updated: Apr 12 2022 at 19:14 UTC
