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DatabaseImpl.kt LGTM. That being said I'm not a Room expert, but DatabaseImpl doesn't seem to be doing anything esoteric. The one question I have is how are the indexes handled.
FhirSynchronizer.kt LGTM too. The only thing that pops up is that It downloads resource types sequentially (line47) , which could potentially be done concurrently, but if not in any critical path it's perfectly fine that way.
Is your feature request related to a problem? Please describe.
Current implementation needs to be reviewed. Related to this discussion #482 (comment)
Describe the solution you'd like
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