I believe we allowed
obs for a person because PIH had a use case where they could get lab results reported for a person prior to registering the person as a patient in their system. Or maybe it was b/c PIH wanted to collect observations on non-patients. I recall PIH driving the data model change, but not the specifics.
We’ve wanted to have encounters for groups of patients (cohort encounters), which would align with FHIR, but haven’t had anyone to drive that change (still trying to get cohort enhancements into core to align with FHIR and serve as a foundation for our needs for lists & groups of patients).
When design issues come up like this, we look to FHIR, since our goal is to eventually converge with FHIR’s model. While FHIR’s
Observation.subject links to a
Patient doesn’t require a medical record like ours does. So, it’s technically possible. Though, if we did make changes, I would insist on not doubling-down on our mistake of assuming patient & person are the same (share a UUID).
My biggest concern would be the affect on all the existing code (modules, applications, API clients) that assume encounters are for patients. And to align with FHIR, we actually wouldn’t be making encounter for persons; rather, relaxing the registration requirement for patients… which might be a bigger can of worms.