prevent duplicates from being loaded to elasticsearch when patient ID changes in the source
new field surgery_procedures.primary_procedure is now loaded to elasticsearch. This requires a historic reload of surgery procedures. Requires application changes before the field is searchable.
convert reals/floats to the more suitable numeric datatypes, fixing an issue where numbers such as 3.6 were misrepresented as for example 3.599992350327. This requires a historic reload of measurements and observation