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11.18 Resource ImmunizationEvaluation - Content

Public Health and Emergency Response Work GroupMaturity Level: 0 Trial UseSecurity 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.

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

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImmunizationEvaluation TUDomainResourceImmunization evaluation information
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness identifier
... status ?!Σ1..1codecompleted | entered-in-error
Immunization Evaluation Status Codes (Required)
... patient Σ1..1Reference(Patient)Who this evaluation is for
... date 0..1dateTimeDate evaluation was performed
... authority 0..1Reference(Organization)Who is responsible for publishing the recommendations
... targetDisease Σ1..1CodeableConceptEvaluation target disease
Immunization Evaluation Target Disease Codes (Example)
... immunizationEvent Σ1..1Reference(Immunization)Immunization being evaluated
... doseStatus Σ1..1CodeableConceptStatus of the dose relative to published recommendations
Immunization Evaluation Dose Status codes (Example)
... doseStatusReason 0..*CodeableConceptReason for the dose status
Immunization Evaluation Dose Status Reason codes (Example)
... description 0..1stringEvaluation notes
... series 0..1stringName of vaccine series
... doseNumber[x] 0..1Dose number within series
.... doseNumberPositiveIntpositiveInt
.... doseNumberStringstring
... seriesDoses[x] 0..1Recommended number of doses for immunity
.... seriesDosesPositiveIntpositiveInt
.... seriesDosesStringstring

doco Documentation for this format

UML Diagram (Legend)

ImmunizationEvaluation (DomainResource)A unique identifier assigned to this immunization evaluation recordidentifier : 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. (Strength=Required)ImmunizationEvaluationStatusC...! »The individual for whom the evaluation is being donepatient : Reference [1..1] « Patient »The date the evaluation of the vaccine administration event was performeddate : 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 againsttargetDisease : CodeableConcept [1..1] « The vaccine preventable disease the dose is being evaluated against. (Strength=Example) ImmunizationEvaluationTargetD...?? »The vaccine administration event being evaluatedimmunizationEvent : Reference [1..1] « Immunization »Indicates if the dose is valid or not valid with respect to the published recommendationsdoseStatus : CodeableConcept [1..1] « The status of the administered dose relative to the published recommendations for the target disease. (Strength=Example) ImmunizationEvaluationDoseSta...?? »Provides an explanation as to why the vaccine administration event is valid or not relative to the published recommendationsdoseStatusReason : CodeableConcept [0..*] « The reason the dose status was assigned. (Strength=Example) ImmunizationEvaluationDoseSta...?? »Additional information about the evaluationdescription : string [0..1]One possible path to achieve presumed immunity against a disease - within the context of an authorityseries : string [0..1]Nominal position in a seriesdoseNumber[x] : Type [0..1] « positiveInt|string »The recommended number of doses to achieve immunityseriesDoses[x] : Type [0..1] « positiveInt|string »

XML Template

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: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

This resource did not exist in Release 2

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = Not Mapped)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImmunizationEvaluation TUDomainResourceImmunization evaluation information
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness identifier
... status ?!Σ1..1codecompleted | entered-in-error
Immunization Evaluation Status Codes (Required)
... patient Σ1..1Reference(Patient)Who this evaluation is for
... date 0..1dateTimeDate evaluation was performed
... authority 0..1Reference(Organization)Who is responsible for publishing the recommendations
... targetDisease Σ1..1CodeableConceptEvaluation target disease
Immunization Evaluation Target Disease Codes (Example)
... immunizationEvent Σ1..1Reference(Immunization)Immunization being evaluated
... doseStatus Σ1..1CodeableConceptStatus of the dose relative to published recommendations
Immunization Evaluation Dose Status codes (Example)
... doseStatusReason 0..*CodeableConceptReason for the dose status
Immunization Evaluation Dose Status Reason codes (Example)
... description 0..1stringEvaluation notes
... series 0..1stringName of vaccine series
... doseNumber[x] 0..1Dose number within series
.... doseNumberPositiveIntpositiveInt
.... doseNumberStringstring
... seriesDoses[x] 0..1Recommended number of doses for immunity
.... seriesDosesPositiveIntpositiveInt
.... seriesDosesStringstring

doco Documentation for this format

UML Diagram (Legend)

ImmunizationEvaluation (DomainResource)A unique identifier assigned to this immunization evaluation recordidentifier : 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. (Strength=Required)ImmunizationEvaluationStatusC...! »The individual for whom the evaluation is being donepatient : Reference [1..1] « Patient »The date the evaluation of the vaccine administration event was performeddate : 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 againsttargetDisease : CodeableConcept [1..1] « The vaccine preventable disease the dose is being evaluated against. (Strength=Example) ImmunizationEvaluationTargetD...?? »The vaccine administration event being evaluatedimmunizationEvent : Reference [1..1] « Immunization »Indicates if the dose is valid or not valid with respect to the published recommendationsdoseStatus : CodeableConcept [1..1] « The status of the administered dose relative to the published recommendations for the target disease. (Strength=Example) ImmunizationEvaluationDoseSta...?? »Provides an explanation as to why the vaccine administration event is valid or not relative to the published recommendationsdoseStatusReason : CodeableConcept [0..*] « The reason the dose status was assigned. (Strength=Example) ImmunizationEvaluationDoseSta...?? »Additional information about the evaluationdescription : string [0..1]One possible path to achieve presumed immunity against a disease - within the context of an authorityseries : string [0..1]Nominal position in a seriesdoseNumber[x] : Type [0..1] « positiveInt|string »The recommended number of doses to achieve immunityseriesDoses[x] : Type [0..1] « positiveInt|string »

XML Template

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: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 Release 3

This resource did not exist in Release 2

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = Not Mapped)

 

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

PathDefinitionTypeReference
ImmunizationEvaluation.status The status of the evaluation being done.RequiredImmunizationEvaluationStatusCodes
ImmunizationEvaluation.targetDisease The vaccine preventable disease the dose is being evaluated against.ExampleImmunizationEvaluationTargetDiseaseCodes
ImmunizationEvaluation.doseStatus The status of the administered dose relative to the published recommendations for the target disease.ExampleImmunizationEvaluationDoseStatusCodes
ImmunizationEvaluation.doseStatusReason The reason the dose status was assigned.ExampleImmunizationEvaluationDoseStatusReasonCodes

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.

NameTypeDescriptionExpressionIn Common
datedateDate the evaluation was generatedImmunizationEvaluation.date
dose-statustokenThe status of the dose relative to published recommendationsImmunizationEvaluation.doseStatus
identifiertokenID of the evaluationImmunizationEvaluation.identifier
immunization-eventreferenceThe vaccine administration event being evaluatedImmunizationEvaluation.immunizationEvent
(Immunization)
patientreferenceThe patient being evaluatedImmunizationEvaluation.patient
(Patient)
statustokenImmunization evaluation statusImmunizationEvaluation.status
target-diseasetokenThe vaccine preventable disease being evaluated againstImmunizationEvaluation.targetDisease