- Slides: 13
Immunization FHIR Jira Tickets
FHIR-27015: Add Immunization. based. On - as core or support standard extension • The Event pattern includes the. based. On element for linking an event such as Immunization to the request that triggered it • Immunization is an “event” workflow pattern • This can also be used in Immunization - e. g. an immunization can be result of a physician's order (e. g. non-mandatory or scheduled vaccines), or any other indication for the patient • Currently, the Immunization resource does not include a “based. On” element • An alternative to adding a based. On element would be to create a “based. On” extension
FHIR-27015: Add Immunization. based. On - as core or support standard extension • Proposal: • To add "Immunization. based. On" as a Reference attribute with a cardinality of 0. . * • Allowed Resources that could be referenced would be: • Care. Plan • Medication. Request • We have previously discussed that a Medication. Request is the appropriate Resource for an immunization order but Service. Request also exists • At this point in time, we are not suggesting to allow Service. Request • Immunization. Recommendation • We would NOT allow Observation or Condition as those are “reasons” to vaccinate and would seem to be more appropriate to put in reason. Reference • The Definition would be: • A plan, recommendation or order that is fulfilled in whole or in part by this Immunization.
FHIR-27016: Immunization. Recommendation - link a patient's immunization recommendation to the protocol • In cases where a patient's immunization recommendation is a result of a protocol which is documented somewhere , we should have a way to link the recommendation to the protocol. For this, the request pattern has two attributes: instantiates. Canonical and intantiates. Url. • Suggest adding these as optional parameters. Or if this is considered residual, add support for the standard extension (in case it isn't yet). • At this point, at least in the US, there may not be many protocols to point to • This could apply equally to Immunization and Immunization. Recommendation as they both may be based on a particular protocol
FHIR-27016: Immunization. Recommendation - link a patient's immunization recommendation to the protocol • Proposal: • To add instantiates. Canonical and instantiates. Uri with a cardinality of 0. . * to both Immunization and Immunization. Recommendation • Question: Should we add these to Immunization. Evaluation as well to point to the recommendation that was being evaluated? • The resource already contains an “authority” Organization reference.
FHIR-27017: Add a Plan. Definition as an example of a vaccination protocol • For adding support to formally defined vaccination plans, we could add an example of how Plan. Definition can instantiate a vaccination schedule. • Create an example of a Vaccination Schedule with the overall plan (e. g. Basis vaccination schema for Flanders) as well as the "swimlanes" for each disease or group of diseases, which are grouped under the overall plan. • Jose Costa-Teixeira has volunteered to create the Plan. Definition
FHIR-27017: Add a Plan. Definition as an example of a vaccination protocol • Proposal: • Assuming FHIR-27016 to add instantiates. Canonical and instantiates. Uri is approved, an example Plan. Definition would be created and referenced in an example Immunization. Recommendation resource in the instantiates. Canonical element
FHIR-27018: Add "product" explicitly to Immunization: • Historically, we have tried to harmonize Immunization with Medication. Administration (the equivalent of the “new” event) and Medication. Statement (the equivalent of the “historical” event) • In FHIR Release 5, Pharmacy has changed the name of Medication. Statement to Medication. Usage • Release 5 also introduces the concept of a Codeable. Reference which allows either a Codeable. Concept or a Resource Reference (or both) • A profile can constrain to one or the other if necessary
FHIR-27018: Add "product" explicitly to Immunization: • In Release 5, both Medication. Administration and Medication. Usage have changed the. medication element to use Codeable. Reference to use either a coded concept or a reference to a Medication Resource • Previously, . medication was a choice between a Codeable. Concept or a Resource reference
FHIR-27018: Add "product" explicitly to Immunization: • Currently, Immunization has. vaccine. Code as a Codeable. Concept with the expectation that it will contain a vaccine identifier in the form of a CVX code, NDC code or SNOMED code (really, any type of code)
FHIR-27018: Add "product" explicitly to Immunization: • The Medication resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use. • The Medication. batch backbone element includes elements for both lot. Number and expiration. Date, both of which are currently part of Immunization • EHR users probably aren’t capturing lots of vaccine in a formal way consistent with Medication • Resources can be “contained” within other resources as non-stand alone resources
FHIR-27018: Add "product" explicitly to Immunization: • Possible options: • No change - leave. vaccine. Code as it is • Add an “administered. Product” element as a Codeable. Reference beside Immunization. code so that both a code and a Medication (possibly as a contained resource) can be exchanged • Convert Immunization. vaccine. Code to a Codeable. Reference so that a Medication resource could be referenced
FHIR-27018: Add "product" explicitly to Immunization: • Feedback from the FHIR-I workflow group: • No change - leave. vaccine. Code as it is • There is no compelling evidence that the immunization community is tracking inventory in a way consistent with providing an option to use Medication • We don’t want to create complexity for the sake of consistency between resources • Update the Immunization resource narrative (Boundaries and Relationships) to make the link between the usage of manufacturer, lot number and expiration date in Immunization with the use of the elements in Medication • Within the Immunization resource, leave the lot number and expiration date elements as they are defined, but move them up in the list of elements to be more proximal to vaccine. Code (Optional) • Add usage notes to vaccine. Code to indicate that it can be used at a wide level of granularity, from the most general (eg. A CVX code like “flu” to a very specific product identifier (such as an NDC))