PCR Replaced-By Propagated Extension

Canonical	../StructureDefinition/pcr-replaced-by-propagated
Status	draft · 1.26.0
Base	Extension (constraint)
Context	Patient (element)
Source	FSH · JSON

One Patient.link of type replaced-by whose merge has already been sent to the provincial client registry. REPEATS: a record merged more than once carries one of these per merge that has been sent.

Overview

The value is the surviving patient's reference as a plain string -- Patient/<id> -- and it is compared literally against Patient.link.other.reference. It is a string rather than a Reference because it is a marker matched against a reference that already exists on the record, not a second way of pointing at the surviving patient. The link is the merge; this only says the registry has been told about it.

READ IT AS A PAIR WITH Patient.link, AND READ THE ABSENCE. A replaced-by link with no matching value here is a merge this EMR has recorded and the registry has not yet been sent. That gap is the whole point of the element: it is what lets the integration find a merge still owing transmission after the chart has already been updated. A consumer that reads only Patient.link sees the merge and cannot tell whether the province knows about it; a consumer that reads only this element sees the merges already reported and misses the ones outstanding.

It is not a merge status from the registry. Nothing here reflects what the registry did with the merge afterwards, and nothing removes the value if the registry later disagrees.

MIGRATION. Nexus EMR writes this extension today at http://services.well.com/fhir/pcr/replacedByInPcr (FHIR-381): that address is live in stored patient records and in code, and is under migration to the canonical declared here. Write the canonical; when reading, match both addresses exactly -- the two share no segment, so a suffix rule does not reach the pre-migration one.