Stream: implementers
Topic: Patient Or RelatedPerson Or ?
Shovan Roy (Jun 19 2019 at 04:16):
Hi All,
May request you to suggest which resource I can use to pre-register someone in the FHIR server so that once the Patient context is created the registered person can access the patient's record?
For an example, in FHIR server I would like to register a person as a representative of a 'to be' born baby. Once the Baby is born, that registered representative can access the record. I was thinking of using RelatedPerson along with Consent. But I can't use RelatedPerson coz it has a mandatory Patient reference. Since the baby hasn't born during the registration, I don't have a Patient reference created.
Is this advisable to register that person (representative) as 'Administrative' Patient? please note this person (representative) may or not have have a health record at all. Suggestion ?
Lloyd McKenzie (Jun 19 2019 at 05:56):
If you're tracking the unborn baby as someone who will eventually have a record, then you effectively have a record already. So yes, creating a Patient instance for them is appropriate. (Having or not having a Patient record for a fetus is an administrative decision driven by organizational policy as well as exactly what information you're capturing. The alternative is BodyStructure, but that wouldn't work for your use case.)
Shovan Roy (Jun 19 2019 at 06:39):
thanks @Lloyd McKenzie .. I'have already flagged that with the Policy team about the pre-creating a Patient for the to be born baby. However there are multiple complexities coming up in terms of followings:
What if the there are twins?
What if the representative is an organization ?
As per my understanding RelatedPerson works really well in these cases but the as I mentioned, the patient reference in RelatedPerson is mandatory and if the policy doesn't permit to pre-create a patient then the model doesn't work.
looping in @Nichol Hill
Lloyd McKenzie (Jun 19 2019 at 14:02):
I had raised the question a year or more ago about the personal relationship being something like 'ward of the state', but I don't recall how this was addressed. @Brian Postlethwaite?
In the case of twins, you'd probably auto-propagate the representatives to the second Patient as soon as you know that there's an extra fetus - which might not be until time of birth, but is typically sooner.
John Moehrke (Jun 19 2019 at 16:16):
The privacy policy authorizing this access to that patient is supported in the Consent resource as a grantee. This would be done with a Consent.provision.type of permit, with a Consent.provision.actor identifying the grantor as a a GRANTEE, or GUARD, or AGNT, or other... depending on the actual relationship of the authorization. Clearly I am not fully specifying the Consent resource, just the key for grantee.
John Moehrke (Jun 19 2019 at 16:21):
GF#22717 created to request the example be made more complete and clear -- @David Pyke
Shovan Roy (Jun 19 2019 at 22:56):
Thanks @Lloyd McKenzie , while waiting on @Brian Postlethwaite feedback. I was also thinking of an alternative solution to create a RelatedPerson for the representative with 'to be born' baby Patient as a 'contained' resource. This Patient will not have any details (may be only a name 'fetus of $mother') In that way the context of the 'to be born' baby Patient will be bounded with the RelatedPerson I believe. Once the Baby is born, then we will Create a Patient instance/s and remove the Contained reference. @Lloyd McKenzie , @Brian Postlethwaite , is there a possibility to make patient reference as optional in RelatedPerson in future releases to ensure that the RelatedPerson can exist even before the Patient context has been created.
thanks @John Moehrke , yes in my model I'm using Consent for this purpose. I'm planning to use 'Consent.patient' refer to the baby once born (in this case). Consent.provision.actor.reference to refer to the RelatedPerson who has consented. Basically the RelatedPerson. Consent.provision.actor.role to define the role of the RelatedPerson in this context and Consent.provision.type to check if the consent is in operating state.
Lloyd McKenzie (Jun 19 2019 at 22:57):
That could work. However, what's the point of creating a resource that has authority to access a patient compartment if the patient isn't defined?
Shovan Roy (Jun 20 2019 at 03:17):
We need a mechanism to pre-register the representative and their consent so that administrative validation can be performed before we store the data of the newborn.
Lloyd McKenzie (Jun 20 2019 at 03:25):
Right. But if you're registering a representative, you have some concept that they're a representative of something - otherwise there's nothing to tie the registration to.
Brian Postlethwaite (Jun 20 2019 at 06:52):
It's a Patient under the hood, if they want to call it something else, or filter it out of other things, then that's fine too.
Like Lloyd says, that's what everything is linking back to, and you're just going to make life hard for everyone doing otherwise.
Brian Postlethwaite (Jun 20 2019 at 06:54):
making the patient optional in RelatedPerson seems wrong, as that's the whole point, its a person that's related to a patient.
Brian Postlethwaite (Jun 20 2019 at 06:56):
The spec clearly shows those maternity resource relationships through an example
http://hl7.org/fhir/patient.html#maternity
Also including how encounters would be structured for the delivery
Brian Postlethwaite (Jun 20 2019 at 06:57):
The mother of the child is going to be both a Patient, and a RelatedPerson. The baby/fetus is just going to be a Patient.
People/Organizations would get access to the record(s) through a Consent resource as you've noted above.
Nichol Hill (Jun 20 2019 at 22:54):
While not part of out immidate use case this raises the question of how you record details of person that has a relationship with something other than a patient. I..e recording a relationship with a provider or an orginisation (i.e. friend of a hospital).
Shovan Roy (Jun 21 2019 at 03:32):
Thanks @Brian Postlethwaite , @Lloyd McKenzie . I'm still working with project's policy team to decide if I'm allowed to create a Patient for the baby to be born. To balance out the policy and FHIR resource requirement, I'm thinking of using a contained Patient in RelatedPerson till time baby is born or an outcome of birth happens. Patient reference in RelatedPerson will be changed based on the outcome of the birth.
However there are other still some unclear situations. Please see the above comment from Nichol
Brian Postlethwaite (Jun 21 2019 at 03:33):
No idea what a relationship with an organization would even mean.
Brian Postlethwaite (Jun 21 2019 at 03:34):
@Lloyd McKenzie how did the employment stuff end up getting modelled, was that with Observations? I don't recall. As that would be similar to the answer for this (maybe)
Richard Townley-O'Neill (Jun 21 2019 at 04:52):
@Shovan Roy
I'm still working with project's policy team to decide if I'm allowed to create a Patient for the baby to be born.
Look for a way to indicate to the stakeholders which Patient resources are "business patients" and which are "implementation machinery patients". Preferably something in your presentations to clearly distinguish between business concepts and implementation machinery.
Richard Townley-O'Neill (Jun 21 2019 at 04:54):
At worst you could add an extension to Patient to say something like "not recognised as a patient by so and so policy or organisation".
:frown:
Shovan Roy (Jun 21 2019 at 04:55):
thanks @Richard Townley-O'Neill , I like the idea of 'implementation machinery patients"..
Lloyd McKenzie (Jun 22 2019 at 02:28):
@Brian Postlethwaite It's possible for a patient's guardian to be "The province of Alberta". How would that be captured? I thought I'd submitted a tracker related to this, but I can't find it. We support it as a Patient.contact. However, how would someone sign a consent "on behalf of the province of Alberta" or something like that?
Brian Postlethwaite (Jul 15 2019 at 05:14):
@Lloyd McKenzie The patient.contact can include the organization, and for that case I would expect is important to follow the patient instance around everywhere.
As for the RelatedPerson, that tracker may still be open. I'll take a look for it.
Last updated: Apr 12 2022 at 19:14 UTC
