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http://build.fhir.org/immunization.html

See also 

Used to document the fact of a vaccine being (or not being) administered.  Note does not include passive immunization ie is about vaccination.

FHIR 4 ElementStrength / CardinatlityBindingDiscussion
statusRequired 1..1completed | entered-in-error | not-done
statusReason
http://terminology.hl7.org/CodeSystem/v3-ActReasonOnly used when vaccination is not done - as per Event pattern.
vaccineCodeExample 1..1

Include all codes defined in http://hl7.org/fhir/sid/cvx
Include all codes defined in urn:oid:1.2.36.1.2001.1005.17

Suggest <<  787859002 |Vaccine product (product)|

Currently a mix of CVX and Australian Codes.

Note use of ImmunizationRecommendation.recommendation.contraindicatedVaccineCode for products that should not be used eg inhaler supplied when patient has asthma.

InformationSource (R5)
Or reference to other resource (Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
location
Reference to Location resource
manufacturer
Reference to Organization resourceNote that national extensions can represent eg "suppliers" via single SNOMED codes - however may be no direct link through drug dictionary.
lotNumber
String
expirationDate
Date
site

Suggest we restrict this to the routinely used administration sites? Note that some of these are routes of administration rather than sites. Jeremy Rogers thought there would be about 13 (in lateralized pairs).

What site would be entered for oral preparation? See Route.

Note that usage of some sites would invalidate the effectiveness of the vaccine eg rabies invalid when injected into glut.

91775009|Structure of left shoulder region (body structure)|

762211005|Structure of part of left upper limb (body structure)| aka deltoid?

37622008|Deltoid region structure (body structure)|

723979003|Structure of left buttock (body structure)|

61396006|Structure of left thigh (body structure)|

762084003|Structure of left quadriceps femoris muscle (body structure)|

91774008|Structure of right shoulder region (body structure)|

762212003|Structure of part of right upper limb (body structure)|

723980000|Structure of right buttock (body structure)|

11207009|Structure of right thigh (body structure)|

762085002|Structure of right quadriceps femoris muscle (body structure)|"

Update 31 March 2020 UK Refset here: http://diseasesdatabase.co.uk/snomed/refset_metadata.aspx?id=1127941000000100

route

http://terminology.hl7.org/CodeSystem/v3-RouteOfAdministration


<< 284009009 |Route of administration value (qualifier value)|

IDINJ Injection, intradermal
IM Injection, intramuscular
NASINHLC Inhalation, nasal, prongs
IVINJ Injection, intravenous
PO Swallow, oral
SQ Injection, subcutaneous
TRNSDERM Transdermal

Note that Medication has a fuller list of SNOMED CT codes for this same field

http://build.fhir.org/valueset-route-codes.html specifies << 284009009 |Route of administration value (qualifier value)|

Update 31 March 2020 UK Refset here: http://diseasesdatabase.co.uk/snomed/refset_metadata.aspx?id=115231000001104

UK Refset Metadata example (note not currently computable): https://dd4c.digital.nhs.uk/dd4c/publishedmetadatas/intid/808?size=10

doseQuantity
SimpleQuantity - cannot use comparator so will be absolute value.

How would concentration be entered eg 10mg/ml (in SNOMED CT we'd express the denominator in the FSN eg 10mg /1 mL)

Answer: value = 10 unit or code (eg UCUM) = "mg/mL"

Craig suggested mostly in the US administration is expressed as milliliters.

reasonCode
TODO A more complete list was felt to be desirable

Currently mapped to ValueSet of:

429060002 |Procedure to meet occupational requirement (procedure)|
*281657000 |Travel vaccinations (procedure)|

2nd one is inactive, replaced by 14747002 |Elective immunization for international travel (procedure)|

JC: Reasons such as "school" or "childhood" obviously missing.

AP: Context is not balanced here, using a procedure code for a reason.

See here under Indication: https://developer.nhs.uk/apis/digitalmedicines-1.1.1-alpha/explore_vaccinations.html

April 14: the reason value set has a procedure concept 429060002 |Procedure to meet occupational requirement (procedure)|

http://build.fhir.org/valueset-immunization-reason.html


isSubpotent
boolean
subpotentReason

partial - Partial Dose - The full volume of the dose was not administered to the patient.
coldchainbreak - Cold Chain Break - The vaccine experienced a cold chain break.
recall Manufacturer - Recall - The vaccine was recalled by the manufacturer.

fundingSource

private / public
reaction
Reference to an Observation resource
protocolApplied0..*

series
StringHL7 have not been able to encode this field.
protocolApplied.targetDisease
Note that this list could also be used for ImmunizationEvaluation.

Selected valueset from Disorder see http://build.fhir.org/valueset-immunization-target-disease.html

Craig Newman suggested there was a list of SNOMED CT codes for vaccination responsive diseases.

JC: Could be derived from the list of vaccine products. Jim also mentioned discussion underway on possibly adding the target disease to the vaccination concept model as an attribute, which again would make a list of relevant disorders easy to determine.

protocolApplied.doseNumber


protocolApplied.series

Recommended number of doses for immunity.

31 March 2020

JC: Immunization is not the same thing as vaccination.  FHIR spec says: While the terms "immunization" and "vaccination" are not clinically identical, for the purposes of the FHIR resources, the terms are used synonymously.

Passive immunization products (eg gamma globulin or immune serum) could be handled using a Medication Resource.

Changes in R4 (R5 - current build):

Recording of information source (further changes for R5)

R4 split Event and Validity into separate resources - ImmunizationEvaluation (as recommendations may change over time)

Question:  Why not just use Medication resource for this?  Possibly due to vaccine specific elements.  May be worth comparing with Medication.

Jeremy Rogers brought up issue in tracking immunizations for specific conditions when vaccine product treats more than one thing - how is that held against the primary immunization schedule ie moving from 3 to 4 components could mean finishing one schedule while only starting one for the 4th disease.  Answer (Craig Newman): ImmunizationEvaluation (Maturity 0) is an attempt to address this sort of thing, which might then cause an ImmunizationRecommendation (Maturity 1) to be generated.

Jeremy Rogers asked if immunization for cancer by injecting tumour cells (autoimmune therapy) is in scope.   HL7 have not discussed explicitly "does not include administration of non-vaccine agents"

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