How to map multiple dependents / beneficiaries in FHIR?


#1

I have multiple Patients in my system. Some are naturally dependents of other Patients in the eyes of Health Insurance Providers. Let’s say a dad has four dependent children and they’re all patients. How would I map this relationship in FHIR?

The Patient.link field is only meant for patients who duplicate this patient? https://www.hl7.org/fhir/patient-definitions.html#Patient.link (even though the RelatedPerson docs seem to dispute that)

Coverage only has one beneficiary/dependent slot, not multiple.

Patient.contact doesn’t have a way to link two actual patients together.


#2

In information about Dad, he would be recorded as a Patient resource. Each of his children would be a RelatedPerson resource that points to Dad as the patient.
In Information about Child1, s/he would be a Patient with Dad and the 3 siblings as RelatedPerson resources that point to Child1 as the patient.


#3

I see, thanks @RichardT. The docs for link were confusing https://www.hl7.org/fhir/patient-definitions.html#Patient.link, “Link to another patient resource that concerns the same actual patient.” But I think this makes sense if the RelatedPerson is about the same Patient, but RelatedPerson.patient refers to the other party. As in it’s Patient (dad) .link (RelatedPerson) .patient (child)

Your second point about Child1, is this this just to close the reference loop and make a 2-way pointer? If I only need to traverse from Dad > Child, could I skip the second RelatedPerson group?


#4

Not quite. Don’t use Patient.link at all. Do the following:

Patient.id=11111
Patient.name=“Dad”

RelatedPerson.id=22222
RelatedPerson.patient=11111
RelatedPerson.name=“Child1”

RelatedPerson.id=33333
RelatedPerson.patient=11111
RelatedPerson.name=“Child2”

etc.

Yes you can skip my second point: you only need it if you need to record patient information about Child1.


#5

The children are full patients in my system, and I want to be able to traverse from Dad to children. It looks like you’re only saying there is a relationship, not that there are actual child patient records? Or is 22222 also the ID of the child patient?


#6

From an insurance perspective there would also be a Coverage resource for each combination of Beneficiary (Patient) and insurer, so in your example there would be 5 Coverage resources all with Dad as the Subscriber and then with Dad, Child1, …, Child4 as the beneficiary. You would only know the children are related as they have the same subscriber.


#7

You’ll end up with a Patient for dad and for each child. You’ll have a Coverage for each as well. And you may have RelatedPerson instances for each child pointing to the Parent. You might have RelatedPerson instances attached to the father for each child, though in general the children wouldn’t be “Actors” on the father’s record - at least not until they reached the age of majority.