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Also, any indices on such field would need to be rebuild. Indices on %String properties are expected to start with an empty space thus your queries using these indices won't return any existing (non-updated) rows.

Is the question how to write a trigger or how to send a SMS from within Cache/IRIS? 

You should be able to find how to do both things in the Intersystems documentation (link not working for me right now).

We may need more clarity to answer the specific question you have but here are some answers to things I could pull from your post:

- The reason relationships are not showing in ERD is because adding an object reference from one class to another doesn't generate a ForeignKey (only relationships do this automatically) thus no relationship is defined in the generated ERD. If a FK is required then it should be defined manually.

- The primary keys for the tables in the ERD diagram are listed in your posted image. The fields listed there are the ones that correspond to the primary key of each of the tables displayed. If you're looking for a programmatically way to see the primary (assuming you don't have access to the code) then you could check information_schema.key_column_usage for constraint_type = "PRIMARY KEY". You may need to look deeper depending on whether table correspond to a global mapped (legacy) table or a "pure" SQL table. 

- As for the different results, it may be you're passing the wrong value to the query (eg. ID for one table being used to query another) or indices are out of sync or corrupted (rebuilding indices should fix this).

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