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11.8 Resource ImmunizationEvaluation - Content

Public Health icon

Work Group

Maturity Level: 1

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.

11.8.1 Scope and Usage

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 is fully protected against vaccine-preventable diseases. It is also a necessary prerequisite to generating a customized set of immunization recommendations for the patient.

11.8.2 Boundaries and Relationships

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 ImmunizationRecommendation 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 (e.g. a dose is due or the patient is complete) relative to the hepatitis B series.

11.8.3 Background and Context

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.

11.8.4 References to this Resource

Implements: Event
Resource References: ImmunizationRecommendation

11.8.5 Resource Content

Structure

Name	Flags	Card.	Type	Description & Constraints
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 Binding: 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	CodeableConcept	The vaccine preventable disease schedule being evaluated Binding: Immunization 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 Binding: Immunization Evaluation Dose Status codes (Example)
doseStatusReason		0..*	CodeableConcept	Reason why the doese is considered valid, invalid or some other status Binding: Immunization Evaluation Dose Status Reason codes (Example)
description		0..1	markdown	Evaluation notes
series		0..1	string	Name of vaccine series
doseNumber		0..1	CodeableConcept	Dose number within series Binding: DoseNumber (Example)
seriesDoses		0..1	CodeableConcept	Recommended number of doses for immunity Binding: SeriesDoses (Example)
Documentation for this format

See the Extensions for this resource

XML Template

<ImmunizationEvaluation xmlns="http://hl7.org/fhir"> 
 <!-- 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><!-- 1..1 CodeableConcept The vaccine preventable disease schedule being evaluated --></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 why the doese is considered valid, invalid or some other status --></doseStatusReason>
 <description value="[markdown]"/><!-- 0..1 Evaluation notes -->
 <series value="[string]"/><!-- 0..1 Name of vaccine series -->
 <doseNumber><!-- 0..1 CodeableConcept Dose number within series --></doseNumber>
 <seriesDoses><!-- 0..1 CodeableConcept Recommended number of doses for immunity --></seriesDoses>
</ImmunizationEvaluation>

JSON Template

{
  "resourceType" : "ImmunizationEvaluation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "status" : "<code>", // R!  completed | entered-in-error
  "patient" : { Reference(Patient) }, // R!  Who this evaluation is for
  "date" : "<dateTime>", // Date evaluation was performed
  "authority" : { Reference(Organization) }, // Who is responsible for publishing the recommendations
  "targetDisease" : { CodeableConcept }, // R!  The vaccine preventable disease schedule being evaluated
  "immunizationEvent" : { Reference(Immunization) }, // R!  Immunization being evaluated
  "doseStatus" : { CodeableConcept }, // R!  Status of the dose relative to published recommendations
  "doseStatusReason" : [{ CodeableConcept }], // Reason why the doese is considered valid, invalid or some other status
  "description" : "<markdown>", // Evaluation notes
  "series" : "<string>", // Name of vaccine series
  "doseNumber" : { CodeableConcept }, // Dose number within series
  "seriesDoses" : { CodeableConcept } // Recommended number of doses for immunity
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ 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:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier
  fhir:status [ code ] ; # 1..1 completed | entered-in-error
  fhir:patient [ Reference(Patient) ] ; # 1..1 Who this evaluation is for
  fhir:date [ dateTime ] ; # 0..1 Date evaluation was performed
  fhir:authority [ Reference(Organization) ] ; # 0..1 Who is responsible for publishing the recommendations
  fhir:targetDisease [ CodeableConcept ] ; # 1..1 The vaccine preventable disease schedule being evaluated
  fhir:immunizationEvent [ Reference(Immunization) ] ; # 1..1 Immunization being evaluated
  fhir:doseStatus [ CodeableConcept ] ; # 1..1 Status of the dose relative to published recommendations
  fhir:doseStatusReason  ( [ CodeableConcept ] ... ) ; # 0..* Reason why the doese is considered valid, invalid or some other status
  fhir:description [ markdown ] ; # 0..1 Evaluation notes
  fhir:series [ string ] ; # 0..1 Name of vaccine series
  fhir:doseNumber [ CodeableConcept ] ; # 0..1 Dose number within series
  fhir:seriesDoses [ CodeableConcept ] ; # 0..1 Recommended number of doses for immunity
]

Changes from both R4 and R4B

ImmunizationEvaluation

ImmunizationEvaluation.description

Type changed from string to markdown

ImmunizationEvaluation.doseNumber

Renamed from doseNumber[x] to doseNumber
Add Type CodeableConcept
Remove Types positiveInt, string

ImmunizationEvaluation.seriesDoses

Renamed from seriesDoses[x] to seriesDoses
Add Type CodeableConcept
Remove Types positiveInt, string

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Structure

Name	Flags	Card.	Type	Description & Constraints
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 Binding: 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	CodeableConcept	The vaccine preventable disease schedule being evaluated Binding: Immunization 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 Binding: Immunization Evaluation Dose Status codes (Example)
doseStatusReason		0..*	CodeableConcept	Reason why the doese is considered valid, invalid or some other status Binding: Immunization Evaluation Dose Status Reason codes (Example)
description		0..1	markdown	Evaluation notes
series		0..1	string	Name of vaccine series
doseNumber		0..1	CodeableConcept	Dose number within series Binding: DoseNumber (Example)
seriesDoses		0..1	CodeableConcept	Recommended number of doses for immunity Binding: SeriesDoses (Example)
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<ImmunizationEvaluation xmlns="http://hl7.org/fhir"> 
 <!-- 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><!-- 1..1 CodeableConcept The vaccine preventable disease schedule being evaluated --></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 why the doese is considered valid, invalid or some other status --></doseStatusReason>
 <description value="[markdown]"/><!-- 0..1 Evaluation notes -->
 <series value="[string]"/><!-- 0..1 Name of vaccine series -->
 <doseNumber><!-- 0..1 CodeableConcept Dose number within series --></doseNumber>
 <seriesDoses><!-- 0..1 CodeableConcept Recommended number of doses for immunity --></seriesDoses>
</ImmunizationEvaluation>

JSON Template

{
  "resourceType" : "ImmunizationEvaluation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "status" : "<code>", // R!  completed | entered-in-error
  "patient" : { Reference(Patient) }, // R!  Who this evaluation is for
  "date" : "<dateTime>", // Date evaluation was performed
  "authority" : { Reference(Organization) }, // Who is responsible for publishing the recommendations
  "targetDisease" : { CodeableConcept }, // R!  The vaccine preventable disease schedule being evaluated
  "immunizationEvent" : { Reference(Immunization) }, // R!  Immunization being evaluated
  "doseStatus" : { CodeableConcept }, // R!  Status of the dose relative to published recommendations
  "doseStatusReason" : [{ CodeableConcept }], // Reason why the doese is considered valid, invalid or some other status
  "description" : "<markdown>", // Evaluation notes
  "series" : "<string>", // Name of vaccine series
  "doseNumber" : { CodeableConcept }, // Dose number within series
  "seriesDoses" : { CodeableConcept } // Recommended number of doses for immunity
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ 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:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier
  fhir:status [ code ] ; # 1..1 completed | entered-in-error
  fhir:patient [ Reference(Patient) ] ; # 1..1 Who this evaluation is for
  fhir:date [ dateTime ] ; # 0..1 Date evaluation was performed
  fhir:authority [ Reference(Organization) ] ; # 0..1 Who is responsible for publishing the recommendations
  fhir:targetDisease [ CodeableConcept ] ; # 1..1 The vaccine preventable disease schedule being evaluated
  fhir:immunizationEvent [ Reference(Immunization) ] ; # 1..1 Immunization being evaluated
  fhir:doseStatus [ CodeableConcept ] ; # 1..1 Status of the dose relative to published recommendations
  fhir:doseStatusReason  ( [ CodeableConcept ] ... ) ; # 0..* Reason why the doese is considered valid, invalid or some other status
  fhir:description [ markdown ] ; # 0..1 Evaluation notes
  fhir:series [ string ] ; # 0..1 Name of vaccine series
  fhir:doseNumber [ CodeableConcept ] ; # 0..1 Dose number within series
  fhir:seriesDoses [ CodeableConcept ] ; # 0..1 Recommended number of doses for immunity
]

Changes from both R4 and R4B

ImmunizationEvaluation

ImmunizationEvaluation.description

Type changed from string to markdown

ImmunizationEvaluation.doseNumber

Renamed from doseNumber[x] to doseNumber
Add Type CodeableConcept
Remove Types positiveInt, string

ImmunizationEvaluation.seriesDoses

Renamed from seriesDoses[x] to seriesDoses
Add Type CodeableConcept
Remove Types positiveInt, string

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

11.8.5.1 Terminology Bindings

Path	ValueSet	Type	Documentation
ImmunizationEvaluation.status	ImmunizationEvaluationStatusCodes	Required	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the current status of the evaluation for vaccine administration event.
ImmunizationEvaluation.targetDisease	ImmunizationTargetDiseaseCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the disease that the dose is being administered against. This value set is provided as a suggestive example and includes SNOMED CT concepts from the 64572001 (Disease) hierarchy.
ImmunizationEvaluation.doseStatus	ImmunizationEvaluationDoseStatusCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the validity of a dose relative to a particular recommended schedule. This value set is provided as a suggestive example.
ImmunizationEvaluation.doseStatusReason	ImmunizationEvaluationDoseStatusReasonCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why an administered dose has been assigned a particular status. Often, this reason describes why a dose is considered invalid. This value set is provided as a suggestive example.
ImmunizationEvaluation.doseNumber		Example
ImmunizationEvaluation.seriesDoses		Example

Path

ValueSet

Type

Documentation

ImmunizationEvaluation.status

ImmunizationEvaluationStatusCodes

Required

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the current status of the evaluation for vaccine administration event.

ImmunizationEvaluation.targetDisease

ImmunizationTargetDiseaseCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the disease that the dose is being administered against. This value set is provided as a suggestive example and includes SNOMED CT concepts from the 64572001 (Disease) hierarchy.

ImmunizationEvaluation.doseStatus

ImmunizationEvaluationDoseStatusCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the validity of a dose relative to a particular recommended schedule. This value set is provided as a suggestive example.

ImmunizationEvaluation.doseStatusReason

ImmunizationEvaluationDoseStatusReasonCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why an administered dose has been assigned a particular status. Often, this reason describes why a dose is considered invalid. This value set is provided as a suggestive example.

ImmunizationEvaluation.doseNumber

Example

ImmunizationEvaluation.seriesDoses

Example

11.8.6 Cardinality of Related Resources

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 ImmunizationRecommendation resource.

11.8.7 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to 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	26 Resources
dose-status	token	The status of the dose relative to published recommendations	ImmunizationEvaluation.doseStatus
identifier	token	ID of the evaluation	ImmunizationEvaluation.identifier	65 Resources
immunization-event	reference	The vaccine administration event being evaluated	ImmunizationEvaluation.immunizationEvent (Immunization)
patient	reference	The patient being evaluated	ImmunizationEvaluation.patient (Patient)	65 Resources
status	token	Immunization evaluation status	ImmunizationEvaluation.status
target-disease	token	The vaccine preventable disease being evaluated against	ImmunizationEvaluation.targetDisease