For our use of FamilyMemberHistory, we find the guidance around leveraging the List resource to be cumbersome for our app developers. We do not have a true List endpoint in our system and have come up with a solution to leverage only FamilyMemberHistory for all of our workflows, even when there is no known family history for a patient or one of their relatives:

Since relationship is 1..1, we are considering using a generic relationship like ‘self’ or ‘family-member’ (or something else completely since we don’t love these) to support a patient level status:

• No significant Fam Hx for a given patient:
• FMH.status = completed
• FMH.dataAbsentReason = nil
• FMH.patient = populated
• FMH.relationship = self or fammeb or something else
• No other details

• Unknown Fam Hx for a given patient:
• FMH.status = health-unknown
• FMH.dataAbsentReason = subject-unknown
• FMH.patient = populated
• FMH.relationship = self or fammeb or something else
• No other details

• Unable to Obtain Fam Hx for a given patient:
• FMH.status = health-unknown
• FMH.dataAbsentReason = unable-to-obtain
• FMH.patient = populated
• FMH.relationship = self or fammeb or something else
• No other details

It would allow developers to just call FMH rather than have to know when to call List vs. FMH depending on the WRITE workflow they are dealing with.

Proposal to update the guidance to allow for flexibility to use only FamilyMemberHistory for these workflows and not need to rely on the List resource.