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11.14 11.8 Resource ImmunizationEvaluation - Content

Public Health and Emergency Response Work Group Maturity Level : 0   Trial Use Security Category : Patient Compartments : Patient

Describes a comparison of an immunization event against published recommendations to determine if the administration is "valid" in relation to those recommendations.

STU Note: The Public Health work group wants to draw the attention of reviewers and implementers to the following issues for feedback:

The ImmunizationEvaluation resource can be thought of as a specialization of a generic evaluation against a set of standardized recommendations (for a medication or a procedure, etc.). Is it better to have a single generic evaluation resource that is then profiled for use in specific domains (immunization evaluation, medication evaluation, etc.) or individual, specific resources for each domain which require less profiling and may be easier for domain implementers to understand? Should the ImmunizationEvaluation resource be harmonized with the CDS Hooks project?

The ImmunizationEvaluation resource is intended to cover communicating the results of an evaluation of a vaccine administration event (documented using the Immunization resource) against a set of published recommendations (protocols). Evaluating administered doses in a patient's immunization history is central to ensuring that the patient if fully protected against vaccine-preventable diseases. It is also a necessary prerequisite to generating a customized set of immunization recommendations for the patient.

The ImmunizationEvaluation resource communicates the results of an evaluation of an instance of the Immunization resource relative to a set of published recommendations. It is intended to communicate if the vaccine administration event was "valid" or "not valid" relative to the recommendations. Once all vaccine administration events in a patient's record have been evaluated, it is then possible to generate a set of vaccination related recommendations, unique for the patient. These recommendations are communicated using the ImmunizationRecommedation resource.

As the ImmunizationEvaluation resource is focused on the evaluation of a single vaccine administration event, it does not include data regarding the overall patient status relative to the recommendations used in the evaluation. For example, a total of 3 doses of hepatitis B vaccine may be required for patient protection, but an instance of the ImmunizationEvaluation resource will be concerned with only one of the doses (although other instances of ImmunizationEvaluation should exist for the other doses). The ImmunizationRecommendation resource is used to convey the overall patient status (eg. a dose is due or the patient is complete) relative to the hepatitis B series.

Through FHIR Release 3, the Immunization resource contained a "protocol" backbone element which functioned as an evaluation of the vaccine administration event. Beginning in Release 4, this new resource replaces the Immunization.protocol element.

This resource is referenced by immunizationrecommendation ImmunizationRecommendation .

This resource implements the Event pattern.

Structure

Name Flags Card. Type Description & Constraints doco
. . ImmunizationEvaluation TU DomainResource Immunization evaluation information
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business identifier
. . . status ?! Σ 1..1 code completed | entered-in-error
Immunization Evaluation Status Codes ( Required )
. . . patient Σ 1..1 Reference ( Patient ) Who this evaluation is for
. . . date 0..1 dateTime Date evaluation was performed
. . . authority 0..1 Reference ( Organization ) Who is responsible for publishing the recommendations
. . . targetDisease Σ 1..* 1..1 CodeableConcept Evaluation target disease
Immunization Evaluation Target Disease Codes ( Example )
. . . immunizationEvent Σ 1..1 Reference ( Immunization ) Immunization being evaluated
. . . doseStatus Σ 1..1 CodeableConcept Status of the dose relative to published recommendations
Immunization Evaluation Dose Status codes ( Example )
. . . doseStatusReason 0..* CodeableConcept Reason for the dose status
Immunization Evaluation Dose Status Reason codes ( Example )
. . . description 0..1 string Evaluation notes
. . . series 0..1 string Name of vaccine series
. . . doseNumber[x] 0..1 Dose number within series
. . . . doseNumberPositiveInt white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy> white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy> white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy> positiveInt white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy>
. . . . doseNumberString string
. . . seriesDoses[x] 0..1 Recommended number of doses for immunity
. . . . seriesDosesPositiveInt positiveInt
. . . . seriesDosesString string

doco Documentation for this format

UML Diagram ( Legend )

ImmunizationEvaluation ( DomainResource ) A unique identifier assigned to this immunization evaluation record identifier : Identifier [0..*] Indicates the current status of the evaluation of the vaccination administration event (this element modifies the meaning of other elements) status : code [1..1] « The status of the evaluation being done done. (Strength=Required) Immunization Evaluation Statu... ImmunizationEvaluationStatusC... ! » The individual for whom the evaluation is being done patient : Reference [1..1] « Patient » The date the evaluation of the vaccine administration event was performed date : dateTime [0..1] Indicates the authority who published the protocol (e.g. ACIP) authority : Reference [0..1] « Organization » The vaccine preventable disease the dose is being evaluated against targetDisease : CodeableConcept [1..*] [1..1] « The vaccine preventable disease the dose is being evaluated against against. (Strength=Example) Immunization Evaluation Targe... ImmunizationEvaluationTargetD... ?? » The vaccine administration event being evaluated immunizationEvent : Reference [1..1] « Immunization » Indicates if the dose is valid or not valid with respect to the published recommendations doseStatus : CodeableConcept [1..1] « The status of the administered dose relative to the published recommendations for the target disease. (Strength=Example) Immunization Evaluation Dose ... ImmunizationEvaluationDoseSta... ?? » Provides an explanation as to why the vaccine administration event is valid or not relative to the published recommendations doseStatusReason : CodeableConcept [0..*] « The reason the dose status was assigned assigned. (Strength=Example) Immunization Evaluation Dose ... ImmunizationEvaluationDoseSta... ?? » Additional information about the evaluation description : string [0..1] One possible path to achieve presumed immunity against a disease - within the context of an authority series : string [0..1] Nominal position in a series doseNumber[x] : Type [0..1] « positiveInt | string » The recommended number of doses to achieve immunity seriesDoses[x] : Type [0..1] « positiveInt | string »

XML Template

<ImmunizationEvaluation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <status value="[code]"/><!-- 1..1 completed | entered-in-error -->
 <patient><!-- 1..1 Reference(Patient) Who this evaluation is for --></patient>
 <date value="[dateTime]"/><!-- 0..1 Date evaluation was performed -->
 <authority><!-- 0..1 Reference(Organization) Who is responsible for publishing the recommendations --></authority>
 <</targetDisease>

 <targetDisease><!-- 1..1 CodeableConcept Evaluation target disease --></targetDisease>

 <immunizationEvent><!-- 1..1 Reference(Immunization) Immunization being evaluated --></immunizationEvent>
 <doseStatus><!-- 1..1 CodeableConcept Status of the dose relative to published recommendations --></doseStatus>
 <doseStatusReason><!-- 0..* CodeableConcept Reason for the dose status --></doseStatusReason>
 <description value="[string]"/><!-- 0..1 Evaluation notes -->
 <series value="[string]"/><!-- 0..1 Name of vaccine series -->
 <doseNumber[x]><!-- 0..1 positiveInt|string Dose number within series --></doseNumber[x]>
 <seriesDoses[x]><!-- 0..1 positiveInt|string Recommended number of doses for immunity --></seriesDoses[x]>
</ImmunizationEvaluation>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:ImmunizationEvaluation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImmunizationEvaluation.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ImmunizationEvaluation.status [ code ]; # 1..1 completed | entered-in-error
  fhir:ImmunizationEvaluation.patient [ Reference(Patient) ]; # 1..1 Who this evaluation is for
  fhir:ImmunizationEvaluation.date [ dateTime ]; # 0..1 Date evaluation was performed
  fhir:ImmunizationEvaluation.authority [ Reference(Organization) ]; # 0..1 Who is responsible for publishing the recommendations
  fhir:

  fhir:ImmunizationEvaluation.targetDisease [ CodeableConcept ]; # 1..1 Evaluation target disease

  fhir:ImmunizationEvaluation.immunizationEvent [ Reference(Immunization) ]; # 1..1 Immunization being evaluated
  fhir:ImmunizationEvaluation.doseStatus [ CodeableConcept ]; # 1..1 Status of the dose relative to published recommendations
  fhir:ImmunizationEvaluation.doseStatusReason [ CodeableConcept ], ... ; # 0..* Reason for the dose status
  fhir:ImmunizationEvaluation.description [ string ]; # 0..1 Evaluation notes
  fhir:ImmunizationEvaluation.series [ string ]; # 0..1 Name of vaccine series
  # ImmunizationEvaluation.doseNumber[x] : 0..1 Dose number within series. One of these 2
    fhir:ImmunizationEvaluation.doseNumberPositiveInt [ positiveInt ]
    fhir:ImmunizationEvaluation.doseNumberString [ string ]
  # ImmunizationEvaluation.seriesDoses[x] : 0..1 Recommended number of doses for immunity. One of these 2
    fhir:ImmunizationEvaluation.seriesDosesPositiveInt [ positiveInt ]
    fhir:ImmunizationEvaluation.seriesDosesString [ string ]
]

Changes since R3

ImmunizationEvaluation
ImmunizationEvaluation.status
  • Change value set from http://hl7.org/fhir/ValueSet/immunization-evaluation-status|4.0.0 to http://hl7.org/fhir/ValueSet/immunization-evaluation-status|4.1.0

This resource did not exist in Release 2 See the Full Difference for further information

This analysis is available as XML or JSON .

Structure

Name Flags Card. Type Description & Constraints doco
. . ImmunizationEvaluation TU DomainResource Immunization evaluation information
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Business identifier
. . . status ?! Σ 1..1 code completed | entered-in-error
Immunization Evaluation Status Codes ( Required )
. . . patient Σ 1..1 Reference ( Patient ) Who this evaluation is for
. . . date 0..1 dateTime Date evaluation was performed
. . . authority 0..1 Reference ( Organization ) Who is responsible for publishing the recommendations
. . . targetDisease Σ 1..* 1..1 CodeableConcept Evaluation target disease
Immunization Evaluation Target Disease Codes ( Example )
. . . immunizationEvent Σ 1..1 Reference ( Immunization ) Immunization being evaluated
. . . doseStatus Σ 1..1 CodeableConcept Status of the dose relative to published recommendations
Immunization Evaluation Dose Status codes ( Example )
. . . doseStatusReason 0..* CodeableConcept Reason for the dose status
Immunization Evaluation Dose Status Reason codes ( Example )
. . . description 0..1 string Evaluation notes
. . . series 0..1 string Name of vaccine series
. . . doseNumber[x] 0..1 Dose number within series
. . . . doseNumberPositiveInt white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy> white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy> white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy> positiveInt white; #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class=hierarchy>
. . . . doseNumberString string
. . . seriesDoses[x] 0..1 Recommended number of doses for immunity
. . . . seriesDosesPositiveInt positiveInt
. . . . seriesDosesString string

doco Documentation for this format

UML Diagram ( Legend )

ImmunizationEvaluation ( DomainResource ) A unique identifier assigned to this immunization evaluation record identifier : Identifier [0..*] Indicates the current status of the evaluation of the vaccination administration event (this element modifies the meaning of other elements) status : code [1..1] « The status of the evaluation being done done. (Strength=Required) Immunization Evaluation Statu... ImmunizationEvaluationStatusC... ! » The individual for whom the evaluation is being done patient : Reference [1..1] « Patient » The date the evaluation of the vaccine administration event was performed date : dateTime [0..1] Indicates the authority who published the protocol (e.g. ACIP) authority : Reference [0..1] « Organization » The vaccine preventable disease the dose is being evaluated against targetDisease : CodeableConcept [1..*] [1..1] « The vaccine preventable disease the dose is being evaluated against against. (Strength=Example) Immunization Evaluation Targe... ImmunizationEvaluationTargetD... ?? » The vaccine administration event being evaluated immunizationEvent : Reference [1..1] « Immunization » Indicates if the dose is valid or not valid with respect to the published recommendations doseStatus : CodeableConcept [1..1] « The status of the administered dose relative to the published recommendations for the target disease. (Strength=Example) Immunization Evaluation Dose ... ImmunizationEvaluationDoseSta... ?? » Provides an explanation as to why the vaccine administration event is valid or not relative to the published recommendations doseStatusReason : CodeableConcept [0..*] « The reason the dose status was assigned assigned. (Strength=Example) Immunization Evaluation Dose ... ImmunizationEvaluationDoseSta... ?? » Additional information about the evaluation description : string [0..1] One possible path to achieve presumed immunity against a disease - within the context of an authority series : string [0..1] Nominal position in a series doseNumber[x] : Type [0..1] « positiveInt | string » The recommended number of doses to achieve immunity seriesDoses[x] : Type [0..1] « positiveInt | string »

XML Template

<ImmunizationEvaluation xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <status value="[code]"/><!-- 1..1 completed | entered-in-error -->
 <patient><!-- 1..1 Reference(Patient) Who this evaluation is for --></patient>
 <date value="[dateTime]"/><!-- 0..1 Date evaluation was performed -->
 <authority><!-- 0..1 Reference(Organization) Who is responsible for publishing the recommendations --></authority>
 <</targetDisease>

 <targetDisease><!-- 1..1 CodeableConcept Evaluation target disease --></targetDisease>

 <immunizationEvent><!-- 1..1 Reference(Immunization) Immunization being evaluated --></immunizationEvent>
 <doseStatus><!-- 1..1 CodeableConcept Status of the dose relative to published recommendations --></doseStatus>
 <doseStatusReason><!-- 0..* CodeableConcept Reason for the dose status --></doseStatusReason>
 <description value="[string]"/><!-- 0..1 Evaluation notes -->
 <series value="[string]"/><!-- 0..1 Name of vaccine series -->
 <doseNumber[x]><!-- 0..1 positiveInt|string Dose number within series --></doseNumber[x]>
 <seriesDoses[x]><!-- 0..1 positiveInt|string Recommended number of doses for immunity --></seriesDoses[x]>
</ImmunizationEvaluation>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:ImmunizationEvaluation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImmunizationEvaluation.identifier [ Identifier ], ... ; # 0..* Business identifier
  fhir:ImmunizationEvaluation.status [ code ]; # 1..1 completed | entered-in-error
  fhir:ImmunizationEvaluation.patient [ Reference(Patient) ]; # 1..1 Who this evaluation is for
  fhir:ImmunizationEvaluation.date [ dateTime ]; # 0..1 Date evaluation was performed
  fhir:ImmunizationEvaluation.authority [ Reference(Organization) ]; # 0..1 Who is responsible for publishing the recommendations
  fhir:

  fhir:ImmunizationEvaluation.targetDisease [ CodeableConcept ]; # 1..1 Evaluation target disease

  fhir:ImmunizationEvaluation.immunizationEvent [ Reference(Immunization) ]; # 1..1 Immunization being evaluated
  fhir:ImmunizationEvaluation.doseStatus [ CodeableConcept ]; # 1..1 Status of the dose relative to published recommendations
  fhir:ImmunizationEvaluation.doseStatusReason [ CodeableConcept ], ... ; # 0..* Reason for the dose status
  fhir:ImmunizationEvaluation.description [ string ]; # 0..1 Evaluation notes
  fhir:ImmunizationEvaluation.series [ string ]; # 0..1 Name of vaccine series
  # ImmunizationEvaluation.doseNumber[x] : 0..1 Dose number within series. One of these 2
    fhir:ImmunizationEvaluation.doseNumberPositiveInt [ positiveInt ]
    fhir:ImmunizationEvaluation.doseNumberString [ string ]
  # ImmunizationEvaluation.seriesDoses[x] : 0..1 Recommended number of doses for immunity. One of these 2
    fhir:ImmunizationEvaluation.seriesDosesPositiveInt [ positiveInt ]
    fhir:ImmunizationEvaluation.seriesDosesString [ string ]
]

Changes since DSTU2 Release 3

ImmunizationEvaluation
ImmunizationEvaluation.status
  • Change value set from http://hl7.org/fhir/ValueSet/immunization-evaluation-status|4.0.0 to http://hl7.org/fhir/ValueSet/immunization-evaluation-status|4.1.0

This resource did not exist in Release 2 See the Full Difference for further information

This analysis is available as XML or JSON .

 

Alternate See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis a

Path Definition Type Reference
ImmunizationEvaluation.status The status of the evaluation being done done. Required Immunization Evaluation Status Codes ImmunizationEvaluationStatusCodes
ImmunizationEvaluation.targetDisease The vaccine preventable disease the dose is being evaluated against against. Example Immunization Evaluation Target Disease Codes ImmunizationEvaluationTargetDiseaseCodes
ImmunizationEvaluation.doseStatus The status of the administered dose relative to the published recommendations for the target disease. Example Immunization Evaluation Dose Status codes ImmunizationEvaluationDoseStatusCodes
ImmunizationEvaluation.doseStatusReason The reason the dose status was assigned assigned. Example Immunization Evaluation Dose Status Reason codes ImmunizationEvaluationDoseStatusReasonCodes

A single vaccine administration event (as communicated via the Immunization resource) may be evaluated against multiple published recommendations, against the same set of published recommendations at different points in time or against published recommendations for different vaccine-preventable diseases. That is a single Immunization record may be linked to multiple ImmunizationEvaluation records.

For example a dose of Twinrix contains antigen against both Hepatitis A and Hepatitis B. The evaluation of such a dose should happen against recommendations for both types of Hepatitis. Furthermore, the dose may be evaluated against both national and local recommendation or may be evaluated against either set of recommendations at multiple points in time (yearly as the patient comes in for standard "well person" appointment with their care provider).

Typically a single "recommendation" is prepared for the patient based on the evaluation of all of the vaccine administration events in the patient's history. This "recommendation" may include individual recommendations for multiple vaccines/vaccine groups. For example, a recommendation may be generated that includes recommendations for both influenza and diphtheria/tetanus vaccinations. Such recommendations use the ImmunizationRecommedation resource.

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
date date Date the evaluation was generated ImmunizationEvaluation.date
dose-status token The status of the dose relative to published recommendations ImmunizationEvaluation.doseStatus
identifier token ID of the evaluation ImmunizationEvaluation.identifier
immunization-event reference The vaccine administration event being evaluated ImmunizationEvaluation.immunizationEvent
( Immunization )
patient reference The patient being evaluated ImmunizationEvaluation.patient
( Patient )
status token Immunization evaluation status ImmunizationEvaluation.status
target-disease token The vaccine preventable disease being evaluated against ImmunizationEvaluation.targetDisease