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We Council have identified a bit of a blocker when developing their data feed for RelatedPersons. The issue arises when they have multiple patients who all have a relationship with the same person … for example:
Mavis has a Daughter Sarah, who is her Main Carer and NoK
David is married to Sarah, is wife is his NoK
Claire is Sarah’s Daughter, her mother is an Emergency Contact
In order to model this in FHIR, we would need to create 3 instances of a RelatedPerson, each referencing one of the 3 Patients, with the details of the specific relations and roles between the two individuals (see attached)
The issue relates to adding a local identifier for the RelatedPersons. Currently, the default settings in the Connect FHIR Appliance will prevent providers from being able to create multiple instances of the same resource with the same Identifier, and hence will respond with a 500 internal server error (due to a database constraint violation error) when attempting to create the second and third RelatedPerson instances.
That validation makes sense on the likes of Patient, SocialCareServices and SocialCareAssesment, as we would not expect to see two resource instances with the same business identifier in the same appliance. However, I don’t believe it shouldn’t apply to RelatedPerson identifiers, which relate to the actual person, not the specific instance of the RelatedPerson resource (which detail the roles and relationship to a specific patient). Even the current version of the FHIR Implementation Guide has a note to this effect.
"RelatedPerson identifiers might not be unique across instances within a system, as a single human individual may be represented as many different RelatedPerson resources with different roles, periods, or relationships."
