Relationship Inference

After entity resolution deduplicates clinical records across sources, the patient graph is a set of isolated nodes: conditions, medications, labs, and so on. Those nodes do not yet know about each other. Relationship inference adds the edges that connect them.

The result is a directed, typed graph where each edge encodes a specific clinical meaning. This structure is what allows the VFS to assemble condition stories that include medications, monitoring labs, and complications without querying across separate tables.

Nodes

Each node in the graph corresponds to one resolved clinical entity. Most entity types map directly to the VFS path categories; the last two are edge endpoints only, so they appear in a fact's relationship list without having a path of their own:

Nodes carry all field values from their contributing sources, resolved conflicts, and the full provenance trace. See Provenance and Auditability.

memory and narrative are explained under the edges they carry, below.

Edges

Edges are directed and typed. Several mechanisms produce them, and each edge records which one it came from.

Knowledge-base edges are emitted when the clinical knowledge base identifies a known relationship between two entities already in the graph:

Each knowledge-base edge carries a confidence score derived from the strength level in the knowledge base: strong indications produce confidence ~0.90, moderate ~0.75, weak ~0.60.

Temporal inference edges are emitted when timing patterns suggest a linkage that is not in the knowledge base:

occurred_during uses graded confidence based on how closely the condition onset aligns with the encounter window (0.80 for onset within the encounter period, down to 0.60 for onset within 30 days). It is skipped when an explicit has_reason or occurred_during edge already exists from the source data.

Memory edges are emitted when memories are generated for a session and a clinically-anchored memory (symptom or adherence) is matched against the patient's facts. See Memory.

Memory edges never modify the target fact. A conflicts edge surfaces the disagreement without touching the fact's value, status, or confidence. concern and preference memories produce no edges.

Narrative edges use the same three types, but come from a different place: they are emitted during ingestion, when a fact is adjudicated against the free-text narrative content of the documents the patient's record already contains. Where a memory edge speaks for something said in a session, a narrative edge speaks for something written in a note.

A narrative edge carries the evidence for its verdict: the verbatim quote, the passage the quote came from, and the strength of the reading. Like memory edges, it never modifies the target fact — a conflicts edge records the disagreement and leaves the fact's value, status, and confidence alone.

Explicit vs. inferred edges

Whether an edge was stated or inferred matters more than which mechanism inferred it, and the two are handled differently.

Explicit edges are lifted directly from the source data. FHIR reasonReference links and CDA entryRelationship elements are preserved as-is. They are never overridden by inference.

Inferred edges are added by the mechanisms described above — the knowledge base, temporal patterns, memory generation, and narrative verification. For the two that connect facts to each other, the relationship resolver only adds an inferred edge when no explicit edge of the same type already exists between the pair, so the knowledge base cannot contradict structured data that came from a clinician. Memory and narrative edges raise no such conflict: they run between a fact and an endpoint that source data never links to, in edge types no source record states.

Every edge records in the entity's relationship list which mechanism produced it, so the distinction is always visible. The possible values of source are:

• explicit_reference - Lifted directly from the source data, never inferred
• knowledge_base - Inferred from a known relationship in the clinical knowledge base
• temporal_inference - Inferred from how the two entities line up in time
• llm_inferred - Inferred by a model, as memory edges are
• narrative_verification - Inferred by adjudicating a fact against narrative content

Where the graph is visible

The relationship graph surfaces in three places:

• Condition stories (_story.md) are assembled by traversing the graph from a condition node outward to its linked medications, labs, and complications. See Condition Stories.
• _raw.json at any condition path includes the full list of typed relationship edges for that node, both explicit and inferred.
• The reconciliation report (GET /v1/patients/{patientId}/reconciliation) lists every inferred edge added during the inference pass. See Review the Reconciliation Summary.