VA MHV FamilyMemberHistory - MyHealtheVet use of PGHD v0.2.10-beta

MyHealtheVet use of PGHD
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MyHealtheVet use of PGHD - Local Development build (v0.2.10-beta) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: VA MHV FamilyMemberHistory ( Experimental )

Official URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/VA.MHV.familymemberhistory				Version: 0.2.10-beta
Standards status: Informative				Computable Name: MHVfamilymemberhistory

A profile on the FamilyMemberHistory that declares how MHV will Create in PGHD for an family member history record.

Proposed mapping not yet approved for implementation

Given that MyHealtheVet has access to medical record (Vista and Cerner) of FamilyMemberHistory, there should be logic keeping a patient from entering a duplicate details.

For each relative of the Patient there will be a FamilyMemberHistory instance
- Thus a query of the FamilyMemberHistory instances for a given Patient will give you all the relatives for which medical history is known.
- Each FamilyMemberHistory record would be updated when new medical conditions/problems are learned
- Thus FamilyMemberHistory needs to have support for Create/Read/Update/Delete
once created will or might have an id, versionId, lastUpdated, text, and identifier
must be marked with MHV app tag
must point at the patient
must indicate the date this record is being recorded into PGHD
should have a name of the family member
must have the relationship this family member has with the Patient
should have the sex/gender (birth sex) of this family member
should have the age or date-of-birth
- should use a valueSet for date ranges on decades
- indicate estimatedAge if the age is estimated
should have indication when patient has died with the age of death or date
- should use a valueSet for date ranges on decades
may have extension indication of twin (multiple-birth) using
may have extension indicate Race
may have extension indicate Ethnicity
may have extension indicate Adopted
should have 0..* conditions
- condition.code should be from a given valueSet
- condition.outcome should indicate the outcome of this condition
- condition.onset[x] should indicate when this condition first manifested
- condition.note may include a freetext note
should have a note

Usage

The Family Member History enables recording into a Patient’s chart relevant medical history of that Patient’s family members. Given a Patient, there will be some number of Family Member History resource that indicate various relatives. Each Family Member History resource contains the list of medical conditions that family member had or has. Thus the Family Member History resource is about the Patient potential to have similar medical conditions due to genetics or social environment.

Minimal Viable

create, read, update, and delete of FamilyMemberHistory FHIR core resource
must point at the patient
must indicate the date being recorded
should have the family member’s name or some alias
must have relationship between family member and patient
should have sex of the family member (birth sex)
should indicate if the family member is deceased
will have zero or more medical conditions using SNOMED-CT codes
- allow free-text entered conditions for those not listed
should have a note

Coordination with current MyHealtheVet Family Health History

Existing (old) Family Health History in MyHealtheVet

All elements map directoy to FHIR elements
- See defined mapping from old to PGHD
- old conditions need to be mapped to proper Conditions vocabulary
No need for extensions

Existing Relationship to FHIR relationship and gender

MHV Relationship	FHIR relationship
Self	N/A -> Conditions
Mother	#MTR “mother”
Father	#FTH “father”
Grandfather - Mother’s Side	#MGRFTH “maternal grandfather”
Grandmother - Mother’s Side	#MGRMTH “maternal grandmother”
Grandfather - Father’s Side	#PGRFTH “paternal grandfather”
Grandmother - Father’s Side	#PGRMTH “paternal grandmother”
Uncle - Mother’s Side	#MUNCLE “maternal uncle”
Aunt - Mother’s Side	#MAUNT “maternal aunt”
Uncle - Father’s Side	#PUNCLE “paternal uncle”
Aunt - Father’s Side	#PAUNT “paternal aunt”
Sister	#SIS “sister”
Brother	#BRO “brother”
Daughter	#DAUC “daughter”
Son	#SONC “son”
Half Sister	#HSIS “half-sister”
Half Brother	#HBRO “half-brother”
Male Cousin	#COUSN “cousin”
Female Cousin	#COUSN “cousin”
Nephew	#NEPHEW “nephew”
Niece	#NIECE “niece”
N/A	#SIGOTHR “significant other”

MHV Relationship

FHIR relationship

Self

N/A -> Conditions

Mother

#MTR “mother”

Father

#FTH “father”

Grandfather - Mother’s Side

#MGRFTH “maternal grandfather”

Grandmother - Mother’s Side

#MGRMTH “maternal grandmother”

Grandfather - Father’s Side

#PGRFTH “paternal grandfather”

Grandmother - Father’s Side

#PGRMTH “paternal grandmother”

Uncle - Mother’s Side

#MUNCLE “maternal uncle”

Aunt - Mother’s Side

#MAUNT “maternal aunt”

Uncle - Father’s Side

#PUNCLE “paternal uncle”

Aunt - Father’s Side

#PAUNT “paternal aunt”

Sister

#SIS “sister”

Brother

#BRO “brother”

Daughter

#DAUC “daughter”

Son

#SONC “son”

Half Sister

#HSIS “half-sister”

Half Brother

#HBRO “half-brother”

Male Cousin

#COUSN “cousin”

Female Cousin

#COUSN “cousin”

Nephew

#NEPHEW “nephew”

Niece

#NIECE “niece”

N/A

#SIGOTHR “significant other”

Note: There are more codes, specifically such as codes for adoptions on all of these.

Support for only export the existing data into PGHD

This option has minimal changes to the current User Interface of MyHealtheVet. The change would enable the Veteran to “Export your existing Family Health History to PGHD”. For this option there is NO new User Interface.

The MVP of this would not enable the Veteran to see the data in PGHD, but where MyHealtheVet is the only application writing Family Member History into PGHD, the data there should be the same as already being displayed in MyHealthevet. There is risk that some application may be approved that does enable the Veteran to add or change, such as HealthHub or some third-party application.

The MVP would need to enable the Veteran to “Update” the data previously exported. Likely the MyHealtheVet would know that data had been exported, and thus after the Veteran has changed the Family Health History, would automatically change the PGHD equally. This ability to can be based on a query of PGHD for existing FamilyMemberHistory resources that would indicate a previously export, or we could record a Consent resource into PGHD to indicte agreement. NOTE: There would be failure-modes where the eVault and PGHD might get out-of-date.

WARNING: the existing Family Health History User Interface (and database) can not support the fidelity of the FHIR Family Member History resource. So it is not advisable to make the existing user interface bi-directional. Meaning the current User Interface can not show the data as it appears in PGHD.

WARNING: the current Family Health History set of conditions (checkboxes) need to be mapped to SNOMED-CT specific codes. Where this mapping can be done strictly, there should be no problem. However it is unclear at this time if this mapping can be done with clinical accuracy. Note that when mapped, the FHIR specification allows for recording both the proper SNOMED-CT code and also the historic MyHealtheVet condition code.

WARNING: This would become very problematic when there are other applications, such as Health Hub, that also write FamilyMemberHistory data into PGHD, as those changes will not be reflected at MHV.

I do not recommend this as the MVP. Too much difference in the set of Conditions and loss of visibility of changes that might happen to the data in PGHD.

Similar UI

This option uses a similar UI to the current Family Member History, much like we did for Vitals. The user interface would be replicated and improved as minimal as possible. Likely the one big change to the UI would be moving away from the current long list of checkboxes for conditions to something that could support the much larger number of conditions allowed by SNOMED-CT (over 25,000 items).

Export to start

Given some Veterans have recorded Family Health History, there could be an ability to export this data to start a new Family Member History. That is to say when a Veteran first uses the PGHD Family Member History, they are propted to initialize with the existing Family Health History data. This would only be offered the first time. This export would still have the SNOMED-CT code translation problem mentioned above.

Import just the Family Members structure, not the conditions each member has.
Import also the Conditions, but import them purely as displaynames with no attempt to convert to SNOMED-CT.
Import the Conditions and convert them to a SNOMED-CT mapped term. This will require a clinically relevant mapping approved by medical professionals.

Note: The old MHV Family Health History can not handle FHIR managed data. This is because the FHIR FamilyMemberHistory resource is more specific, and carry many more details. Thus one would not give a Veteran the impression that the old MHV Family Health History is showing the data in PGHD to prevent the Veteran from presuming that it does, and complaining that data has been lost.

BlueButton

It might be helpful to export PGHD information including FamilyMemberHistory into the BlueButton report. The current Family Health History export into the BlueButton report is similar to how this would look for FamilyMemberHistory data from PGHD. This text export is also similar to the current VCM way of handling the FamilyMemberHistory in PGHD.

Selecting Conditions

The CDC prototype proposed that the 93 Condition codes would be grouped into categories that would be the first level the user would select from. Each group has an “other”, and the list of 17 groups allows for unknonw, and also user entered code. It is not obvious that SNOMED-CT was common use at the time this CDC Prototype was developed.

CDC Prototype Condition Groups

Cancer -> 24
Clotting Disorder -> 4
Dementia/Alzheimers
Diabetes -> 10
Gastrointestinal Disorder -> 8
Heart Disease -> 5
High Cholesterol -> 2
Hypertension
Kidney Disease -> 7
Lung Disease -> 8
Osteoporosis
Psychological Disorder -> 15
Septicemia
Stroke/Brain Attack
Sudden Death -> 4
Unknown
(user entered)

This grouping does not exist formally. This grouping would be nice, but it seems inappropriate that MyHealtheVet is looked to to provide this kind of clinical knowledge breakdown. Thus this seems a good opportunity for multiple ValueSets. With the top level valueSet being the groups, and a valueSet for each of those groups. Thus the management of the groups and the members in that group can be managed dynamically and not be fixed in application logic.

See the SNOMED-CT subset for conditions.

25,000+ codes, and changes often. Not lay person friendly terms.
has 241 groups, but not lay person friendly groups

Recommendation to me is to use the USA Edition of CMT release ( 25,604 codes). Noted is that the SNOMED-CT terms do have a “lay person” display name for the code. Not sure how to get to them yet. Mapping from MyHealtheVet current Conditions to SNOMED-CT

Free-text Conditions

The User Interface must allow the Veteran to type in a Condition. This would enable conditions that are not part of the sub-set or grouping. When a Veteran types in a Condition,

MHV should look in SNOMED-CT for a match.
When exactly one match is returned, the Veteran should be given the choice to keep that selected code.
Multiple values might be found, for which the Veteran should then be given the choice to pick from multiple values.
The Veteran should always be allowed to record the text they typed in without a code (FamilyMemberHistory.condition.code.text).

Additional features beyond MVP

should have date-of-birth or age of the family member
may have extension indication of twin (multiple-birth) using
may have extension indicate Race
may have extension indicate Ethnicity
may have extension indicate Adopted
for each condition
- condition.outcome should indicate the outcome of this condition
- condition.onset[x] should indicate when this condition first manifested
- condition.note may include a freetext note
allow Veteran to enter their own Conditions (from their perspective)

Background

This is the notes for the VA.MHV.familymemberhistory Profile

The specification here is

inspired by CDC prototype
Impact assessment of CDC family health assessment
could derive off of QI-Core FamilyMemberHistory profile, but it is not clear that gives us anything useful
There is no profile of FamilyMemberHistory in us-core
USCDI v2 added Health Conserns and hint that family member is included.
USCDI v3 seems to be similar
Level 2 has it clear Family Health History
Cerner Millennium R4 has support for FamilyMemberHistory
- extension for patient-Adopted (Boolean)

Some discussion notes

could indication of twin (multiple-birth) using http://hl7.org/fhir/R4/extension-family-member-history-genetics-sibling
- not clear this is the best match, as this requires a link to the ‘other’ sibling
- where as the CDC prototype just wanted to know if this member was a MultiBirth
could indicate Race and Ethnicity using http://hl7.org/fhir/R4/extension-family-member-history-genetics-observation
- not clear these are useful as they require the family-member to also be a Patient
- these observations likely are contained so as to not confuse with a real patient
age in decades – no known valueSet for this, but it sure seems useful

XKCD on Family History – https://xkcd.com/2620/

Profile

Usage:

Examples for this Resource Profile: Johannes Yakub Schmidt, Katherine Irene Schmidt, John Jacob Schmidt, John Jacob Schmidt and Jania Louise Schmidt

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from FamilyMemberHistory

Name	Flags	Card.	Type	Description & Constraints
FamilyMemberHistory		0..*	FamilyMemberHistory	Information about patient's relatives, relevant for patient
meta
tag		1..1	Coding	Tags applied to this resource Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: https://wiki.mobilehealth.va.gov/x/Onc1C
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2ce6d9aa-c068-4809-8dda-662bcb16d09a
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
sibling	S	0..1	integer	MultiBirth indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-MultiBirth
adopted	S	0..1	boolean	Adopted indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Adopted
ethnicity	S	0..*	CodeableConcept	Ethnicity URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Ethnicity Binding: Ethnicity (preferred)
race	S	0..*	CodeableConcept	Race URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Race Binding: Race (preferred)
instantiatesCanonical		0..0
instantiatesUri		0..0
status		1..1	code	partial \| completed \| entered-in-error \| health-unknown
dataAbsentReason		0..0
patient		1..1	Reference(Patient)	Patient history is about
date		1..1	dateTime	When history was recorded or last updated
name	S	0..1	string	The family member described
relationship		1..1	CodeableConcept	Relationship to the subject
sex	S	0..1	CodeableConcept	male \| female \| other \| unknown
born[x]	S	0..1	Period, date, string	(approximate) date of birth
Slices for age[x]	S	0..1	Age, Range, string	(approximate) age Slice: Unordered, Open by type:$this
age[x]:ageString		0..1	string	should use strings from [Ages](CodeSystem-Ages.html)
estimatedAge	S	0..1	boolean	Age is estimated?
deceased[x]	S	0..1	boolean, Age, Range, date, string	Dead? How old/when?
reasonCode		0..0
reasonReference		0..0
note
text	S	1..1	markdown	The annotation - text content (as markdown)
condition	S	0..*	BackboneElement	Condition that the related person had
code		1..1	CodeableConcept	Condition suffered by relation
outcome	S	0..1	CodeableConcept	deceased \| permanent disability \| etc.
contributedToDeath	S	0..1	boolean	Whether the condition contributed to the cause of death
onset[x]	S	0..1	Age, Range, Period, string	When condition first manifested
note		0..0
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
FamilyMemberHistory	C	0..*	FamilyMemberHistory	Information about patient's relatives, relevant for patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
sibling	S	0..1	integer	MultiBirth indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-MultiBirth
adopted	S	0..1	boolean	Adopted indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Adopted
ethnicity	S	0..*	CodeableConcept	Ethnicity URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Ethnicity Binding: Ethnicity (preferred)
race	S	0..*	CodeableConcept	Race URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Race Binding: Race (preferred)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	partial \| completed \| entered-in-error \| health-unknown Binding: FamilyHistoryStatus (required): A code that identifies the status of the family history record.
patient	Σ	1..1	Reference(Patient)	Patient history is about
date	Σ	1..1	dateTime	When history was recorded or last updated
name	SΣ	0..1	string	The family member described
relationship	Σ	1..1	CodeableConcept	Relationship to the subject Binding: FamilyMember (example): The nature of the relationship between the patient and the related person being described in the family member history.
sex	SΣ	0..1	CodeableConcept	male \| female \| other \| unknown Binding: AdministrativeGender (extensible): Codes describing the sex assigned at birth as documented on the birth registration.
born[x]	SC	0..1		(approximate) date of birth
bornPeriod			Period
bornDate			date
bornString			string
Slices for age[x]	SΣC	0..1		(approximate) age Slice: Unordered, Open by type:$this
ageAge			Age
ageRange			Range
ageString			string
age[x]:ageString	ΣC	0..1	string	should use strings from [Ages](CodeSystem-Ages.html)
estimatedAge	SΣC	0..1	boolean	Age is estimated?
deceased[x]	SΣ	0..1		Dead? How old/when?
deceasedBoolean			boolean
deceasedAge			Age
deceasedRange			Range
deceasedDate			date
deceasedString			string
note		0..*	Annotation	General note about related person
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
condition	S	0..*	BackboneElement	Condition that the related person had
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Condition suffered by relation Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
outcome	S	0..1	CodeableConcept	deceased \| permanent disability \| etc. Binding: ConditionOutcomeCodes (example): The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.
contributedToDeath	S	0..1	boolean	Whether the condition contributed to the cause of death
onset[x]	S	0..1		When condition first manifested
onsetAge			Age
onsetRange			Range
onsetPeriod			Period
onsetString			string
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
FamilyMemberHistory.status	required	FamilyHistoryStatus
FamilyMemberHistory.relationship	example	FamilyMember
FamilyMemberHistory.sex	extensible	AdministrativeGender
FamilyMemberHistory.condition.code	example	Condition/Problem/DiagnosisCodes
FamilyMemberHistory.condition.outcome	example	ConditionOutcomeCodes

Description & Constraints

FamilyMemberHistory

C

0..*

FamilyMemberHistory

Information about patient's relatives, relevant for patient

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path

Conformance

ValueSet / Code

FamilyMemberHistory.meta.security

extensible

All Security Labels

FamilyMemberHistory.meta.tag

example

Pattern: 2ce6d9aa-c068-4809-8dda-662bcb16d09a

FamilyMemberHistory.language

preferred

CommonLanguages

Additional Bindings

Purpose

AllLanguages

Max Binding

FamilyMemberHistory.status

required

FamilyHistoryStatus

FamilyMemberHistory.relationship

example

FamilyMember

FamilyMemberHistory.sex

extensible

AdministrativeGender

FamilyMemberHistory.condition.code

example

Condition/Problem/DiagnosisCodes

FamilyMemberHistory.condition.outcome

example

ConditionOutcomeCodes

This structure is derived from FamilyMemberHistory

Summary

Mandatory: 1 element (1 nested mandatory element)
Must-Support: 15 elements
Prohibited: 6 elements

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

The element FamilyMemberHistory.age[x] is sliced based on the value of type:$this

Differential View

This structure is derived from FamilyMemberHistory

Name	Flags	Card.	Type	Description & Constraints
FamilyMemberHistory		0..*	FamilyMemberHistory	Information about patient's relatives, relevant for patient
meta
tag		1..1	Coding	Tags applied to this resource Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: https://wiki.mobilehealth.va.gov/x/Onc1C
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2ce6d9aa-c068-4809-8dda-662bcb16d09a
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
sibling	S	0..1	integer	MultiBirth indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-MultiBirth
adopted	S	0..1	boolean	Adopted indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Adopted
ethnicity	S	0..*	CodeableConcept	Ethnicity URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Ethnicity Binding: Ethnicity (preferred)
race	S	0..*	CodeableConcept	Race URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Race Binding: Race (preferred)
instantiatesCanonical		0..0
instantiatesUri		0..0
status		1..1	code	partial \| completed \| entered-in-error \| health-unknown
dataAbsentReason		0..0
patient		1..1	Reference(Patient)	Patient history is about
date		1..1	dateTime	When history was recorded or last updated
name	S	0..1	string	The family member described
relationship		1..1	CodeableConcept	Relationship to the subject
sex	S	0..1	CodeableConcept	male \| female \| other \| unknown
born[x]	S	0..1	Period, date, string	(approximate) date of birth
Slices for age[x]	S	0..1	Age, Range, string	(approximate) age Slice: Unordered, Open by type:$this
age[x]:ageString		0..1	string	should use strings from [Ages](CodeSystem-Ages.html)
estimatedAge	S	0..1	boolean	Age is estimated?
deceased[x]	S	0..1	boolean, Age, Range, date, string	Dead? How old/when?
reasonCode		0..0
reasonReference		0..0
note
text	S	1..1	markdown	The annotation - text content (as markdown)
condition	S	0..*	BackboneElement	Condition that the related person had
code		1..1	CodeableConcept	Condition suffered by relation
outcome	S	0..1	CodeableConcept	deceased \| permanent disability \| etc.
contributedToDeath	S	0..1	boolean	Whether the condition contributed to the cause of death
onset[x]	S	0..1	Age, Range, Period, string	When condition first manifested
note		0..0
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
FamilyMemberHistory	C	0..*	FamilyMemberHistory	Information about patient's relatives, relevant for patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
sibling	S	0..1	integer	MultiBirth indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-MultiBirth
adopted	S	0..1	boolean	Adopted indication URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Adopted
ethnicity	S	0..*	CodeableConcept	Ethnicity URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Ethnicity Binding: Ethnicity (preferred)
race	S	0..*	CodeableConcept	Race URL: https://johnmoehrke.github.io/MHV-PGHD/StructureDefinition/FM-Race Binding: Race (preferred)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	partial \| completed \| entered-in-error \| health-unknown Binding: FamilyHistoryStatus (required): A code that identifies the status of the family history record.
patient	Σ	1..1	Reference(Patient)	Patient history is about
date	Σ	1..1	dateTime	When history was recorded or last updated
name	SΣ	0..1	string	The family member described
relationship	Σ	1..1	CodeableConcept	Relationship to the subject Binding: FamilyMember (example): The nature of the relationship between the patient and the related person being described in the family member history.
sex	SΣ	0..1	CodeableConcept	male \| female \| other \| unknown Binding: AdministrativeGender (extensible): Codes describing the sex assigned at birth as documented on the birth registration.
born[x]	SC	0..1		(approximate) date of birth
bornPeriod			Period
bornDate			date
bornString			string
Slices for age[x]	SΣC	0..1		(approximate) age Slice: Unordered, Open by type:$this
ageAge			Age
ageRange			Range
ageString			string
age[x]:ageString	ΣC	0..1	string	should use strings from [Ages](CodeSystem-Ages.html)
estimatedAge	SΣC	0..1	boolean	Age is estimated?
deceased[x]	SΣ	0..1		Dead? How old/when?
deceasedBoolean			boolean
deceasedAge			Age
deceasedRange			Range
deceasedDate			date
deceasedString			string
note		0..*	Annotation	General note about related person
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
condition	S	0..*	BackboneElement	Condition that the related person had
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Condition suffered by relation Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
outcome	S	0..1	CodeableConcept	deceased \| permanent disability \| etc. Binding: ConditionOutcomeCodes (example): The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.
contributedToDeath	S	0..1	boolean	Whether the condition contributed to the cause of death
onset[x]	S	0..1		When condition first manifested
onsetAge			Age
onsetRange			Range
onsetPeriod			Period
onsetString			string
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
FamilyMemberHistory.status	required	FamilyHistoryStatus
FamilyMemberHistory.relationship	example	FamilyMember
FamilyMemberHistory.sex	extensible	AdministrativeGender
FamilyMemberHistory.condition.code	example	Condition/Problem/DiagnosisCodes
FamilyMemberHistory.condition.outcome	example	ConditionOutcomeCodes