Stream: implementers
Topic: RelatedPerson
Pravina Munghate (Apr 13 2016 at 21:22):
Hi All, We have a requirement where we want to record Next-of-kin for a patient and at the same time we want to record relationship of the patient with Next-of-kin (Partner / Sibling/ Parent etc). Effectively there are 2 relationships with the same person. RelatedPerson supports only 1 relationship at a time. Does this mean we will need to have 2 separate records , each with different relationship with the patient ? or is there an alternative way to represent multiple relationships with the same person ? Thanks !
Lloyd McKenzie (Apr 13 2016 at 21:27):
Not quite following. Next of kin would normally be captured in Patient.contact. And there you can capture the relationship of the NOK to the patient. What additional relationship are you wanting to capture?
Lloyd McKenzie (Apr 13 2016 at 21:28):
Ah, just looked at the topic title. RelatedPerson is *not* for capturing next of kin relationships.
Lloyd McKenzie (Apr 13 2016 at 21:29):
Its purpose is to capture the records of people who might be actors or targets of healthcare activities. E.g. participants in a care plan, reporters of allergies, targets of information distribution or training, etc.
Lloyd McKenzie (Apr 13 2016 at 21:30):
It's certainly possible that someone might show up in both places - as a Patient.contact (NoK) and as a RelatedPerson (someone who will act or be acted upon based on their personal relationship with the patient as opposed to based on their professional capacity).
Brian Postlethwaite (Apr 15 2016 at 04:34):
Not sure I'm 100% sure on the context here, but the relationship is 1 way.
Use case: Patient = Sally.daughter and RelatedPerson=Steven.Daddy (relationship=father)
With this example you can decribe 't describe the relationship of sally to steven (daughter)
Brian Postlethwaite (Apr 15 2016 at 04:47):
When these roles reverse and in our example Steven.Daddy becomes the Patient, and Sally becomes the RelatedPerson, then the relationship here would be daughter.
And just to complete the picture, you could create 2 Person resources that link the Patient and related person for the same individual together.
Aleksandra Pavlyshina (Aug 29 2016 at 14:37):
Hi All, in our care management application, we need to specify that a person is an attorney (Power of Attorney) for the patient. I believe that this should be specified in CareTeam.participant.role binding, also possible but IMO less likely places are Patient.contact.relashionshipbinding and RelatedPerson.relashionship binding, but none of them has this value in bound value sets (though they are extensible/example so it's possible to add the necessary value). Please advise what approach will be correct in this situation?
Igor Sirkovich (Aug 29 2016 at 18:30):
Hi Alexandra, RoleCode code system (http://hl7-fhir.github.io/v3/RoleCode/cs.html) has codes POWATT, DPOWATT, HPOWATT and SPOWATT for various types of Power of Attorney. A subset of this code system is used for RelatedPerson.relationship (http://hl7-fhir.github.io/valueset-relatedperson-relationshiptype.html), but for some reason, this subset includes only codes under _PersonalRelationshipRoleType and doesn't include codes under _AffiliationRoleType. Anyway, as you've mentioned, this is extensible and I believe you are free to add the necessary codes from RoleCode for your project (we did so in Ontario). I've added a tracker item to add these codes to http://hl7-fhir.github.io/valueset-relatedperson-relationshiptype.html.
Brian Postlethwaite (Aug 30 2016 at 03:01):
I think the RelatedPerson is the appropriate resource for this, and the suggestion to open the binding to those values makes sense (I'll look forward to reviewing the ballot item/tracker for it)
Aleksandra Pavlyshina (Aug 30 2016 at 11:41):
The problem here is that RelatedPerson.relationship is 0..1, so we cannot indicate both personal relationship and role (caregiver, primary caregiver, emergency contact, power of attorney). In our application, we record family community capturing Relationship and then indicating that this person is:
Caregiverwith possible option 'Primary'Emergency Contactwith possible option 'Primary'-
Power of Attorney
I thought to capture them to RelatedPerson and then: -
Caregiver - will be
CareTeam.participant.role= Caregiver (person) SCTID: 133932002 - Caregiver Primary - will be
CareTeam.participant.role= Primary carer (person) SCTID: 407543004 - Emergency Contact - data about this person will be duplicated in
Patient.contactwithrelationship= c (Emergency Contact) - Emergency Contact Primary - possibly Extension (similar to Indicator of primary specialty) on
Patient.contactwhere relationship has type 'c' (Emergency Contact) - Power of Attorney - possibly
CareTeam.participant.role= POWATT ('power of attorney' from the code system http://hl7.org/fhir/v3/RoleCode)
The other option is to create severalRelatedPersonresources for one family member to capture that this person is e.g. a sister, a primary caregiver, an emergency contact and an attorney for the patient at once. So, I'm struggling which approach is better here. Probably personal relashionship is less important than POA, Emergency Contact or Primary Caregiver, and it is more likely to quiery a POA for a given patient than for their sister...
Aleksandra Pavlyshina (Aug 30 2016 at 16:09):
It turned out that we capture if the family member being added has 'Power of Attorney', but that is different than being an actual attorney. And in other place of application we capture actual attorneys of a patient. So now I need to figure out how to represent both POA and actual attorneys...
And for actual attorneys we need to capture:
- name,
- firm (name of the business the attorney works for (such as a sole proprietorship, partnership or corporation)),
- address,
- telecom,
- and indicate that the attorney is associated with the creation/management of specified type(s) of document (
Living Will,Advance Directive,DNR,POST / POLST), for the patient.
Lloyd McKenzie (Aug 30 2016 at 16:18):
Agree that capturing the role of different participants is best done using CareTeam. RelatedPerson is used in contexts where you want to capture "who did what". CareTeam is where you capture the different roles people have in the delivery of care to the Patient. Attorney and "power of attorney" are definitely different role codes. If you're missing one for Attorney, you can make one up for now, but I'd certainly encourage you to submit a change request to get that concept added if it doesn't exist.
John Moehrke (Aug 30 2016 at 17:00):
@Aleksandra Pavlyshina Look at Contract. I think some of this is intended to be specified in a Contract (or contract like) object that points at the attorney and also points at the patient. Rather than the patient pointing at everything else.
Brian Postlethwaite (Aug 30 2016 at 20:39):
Can you please log a tracker issue for this, nd Pa will clarify and get back to you on it.
The request seems quite reasonable to want to specify a list of relationship types for a single person.
Aleksandra Pavlyshina (Aug 31 2016 at 16:13):
@John Moehrke In our application, we also need to upload documents like Living Will, Advance Directive, DNR, POST / POLST from patient if any. I thought to use DocumentReference for those, but do you recommend to use Contract instead? Will it be correct in that case to represent an attorney as a RelatedPerson resource with a firm added as an extension.reference to Organization, and RelatedPerson.relationship = 'Attorney', and point to that attorney from Contract?
John Moehrke (Aug 31 2016 at 16:25):
Experience will ultimately bring the answer. Yes an imported document would be best managed with a DocumentReference. That DocumentReference can be pointed to from either Contract or Consent; as the evidence of what the patient saw and acted upon. The Consent resource is intended to support these specific types of use-cases, but so far has only been modeled for Privacy Consent. Thus the committee needs comments in the current ballot to help them understand your perceived needs for these other types of Consent. We were using Contract, but it became cumbersome; technically, administratively, and emotionally. It still exists as a more general-purpose Contract. We also need comments on this. As to recording the attorney for a Privacy Consent, this was not seen in use today so it was not included in the model. It is not clear why that is needed in a coded form, it clearly would be indicated in the human readable document.
Aleksandra Pavlyshina (Sep 21 2016 at 18:08):
Added [#12141] Summary: Add a code for 'Attorney' to relationship and participant.role value sets
Last updated: Apr 12 2022 at 19:14 UTC
