Linking mother and newborn babies

Development
1

We are interested in exploring the best way to record the mother / baby relationship as it pertains to an actual delivery visit / encounter.

Tracking the Mother / Child linkage via a Relationship is clearly part of this, but this does not explicitly associate both of these patients together in the context of a specific delivery.

In OpenMRS, some of the current mechanisms that I am aware of could involve:

  • Coordinate the birthdate or specific visit/encounter dates of the Child in the relationship with specific visit/encounter dates of the mother in the relationship

  • Capture observations in one patient’s encounter that record a reference to the other patient (eg. capture child patient uuid in value_complex or value_text of an obs in the mother’s encounter)

In FHIR, this seems to be something that is handled via the Encounter.partOf element. This is described also in the Patient resource.

In OpenMRS, the only mechanism we have to represent Encounter.partOf is via the Visit → Encounter relationship, and here the Visit is associated with only 1 Patient we require all such Encounters to belong to the same Patient. There has been some previous discussion (eg. by @burke here) that Episodes of Care may also support linking Encounters in the future, though it isn’t clear to me that these could be for different Patients.

I’m interested if anyone has particular thoughts about the best way to either a) accomplish this with existing OpenMRS constructs, or b) evolve OpenMRS core and/or modules to support this in a particular way.

Thanks! Mike

@mogoodrich FYI

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As a follow-up, we had a short discussion around this today, and one design we are considering would be to expand the core OpenMRS Encounter:

class Encounter {
  ...
  Encounter partOf; // Optional property, could be for a different patient
  ...
}

Happy to discuss additional ideas, potentially at the platform call this week? @burke / @dkayiwa / @ibacher ?

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For the record, we discussed this last week and decided that, since Encounter.partOf is a strict hierarchy with only one allowed per encounter and we would want to link encounters for other reasons, we probably don’t want to use the OpenMRS encounter.part_of for this purpose. But, given FHIR specifically points out the use case in the description of Encounter.partOf:

This is also used for associating a child’s encounter back to the mother’s encounter.

and FHIR’s description of approaches to track mother & newborn relationships, a decent option would be to add partOf to OpenMRS’ visit (which is considered an Encounter by FHIR), meaning we would use visit.part_of to link a child’s visit to its mother’s visit, providing an explicit link at the time of childbirth between mother and child.

Note that this means we should document that visit.partOf should not be assumed to point to a visit for the same person. In fact, our initial use case would always link visits of two different persons (child to mother). It would probably be good to avoid assuming Encounter.partOf (within OpenMRS) will always link encounters for the same person (although, at this point, it seems more likely to be the case).