Immunization Incubator Implementation Guide
0.1.0 - International flag

Immunization Incubator Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/immunization-incubator/ and changes regularly. See the Directory of published versions

Resource: Immunization Evaluation

Official URL: http://hl7.org/fhir/StructureDefinition/ImmunizationEvaluation Version: 0.1.0
Standards status: Trial-use Draft as of 2021-01-02 Maturity Level: 1 Computable Name: ImmunizationEvaluation
Other Identifiers: OID:2.16.840.1.113883.4.642.5.1275

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

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.

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.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Resource Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ImmunizationEvaluation 0..* 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: ImmunizationEvaluationStatusCodes (required): The status of the evaluation being done.
... patient Σ 1..1 Reference(Patient) Who this evaluation is for
... 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: ImmunizationTargetDiseaseCodes (example): The vaccine preventable disease the dose is being evaluated against.
... immunizationEvent Σ 1..1 Reference(Immunization) Immunization being evaluated
... doseStatus Σ 1..1 CodeableConcept Status of the dose relative to published recommendations
Binding: ImmunizationEvaluationDoseStatusCodes (example): The status of the administered dose relative to the published recommendations for the target disease.
... doseStatusReason 0..* CodeableConcept Reason why the doese is considered valid, invalid or some other status
Binding: ImmunizationEvaluationDoseStatusReasonCodes (example): The reason the dose status was assigned.
... description 0..1 markdown Evaluation notes
... series 0..1 string Name of vaccine series
... doseNumber 0..1 CodeableConcept Dose number within series
Binding Description: (example): A code expressing the vaccine dose number - several coding schemes exist or will be defined for each jurisdiction.
... seriesDoses 0..1 CodeableConcept Recommended number of doses for immunity
Binding Description: (example): A code expressing the doses recommended or expected - several coding schemes exist or will be defined for each jurisdiction.

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ImmunizationEvaluation.​status Base required Immunization Evaluation Status Codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​targetDisease Base example Immunization Target Disease Codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​doseStatus Base example Immunization Evaluation Dose Status codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​doseStatusReason Base example Immunization Evaluation Dose Status Reason codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​doseNumber Base example Not State Unknown
ImmunizationEvaluation.​seriesDoses Base example Not State Unknown 
<ImmunizationEvaluation xmlns="http://hl7.org/fhir"> ​​doco
 ​<id value="[id]"/><!-- 0..1 ​* ​Logical id of this artifact  -->
 ​<meta><!-- ​I 0..1 ​* ​Metadata about the resource  --></meta>
 ​<implicitRules value="[uri]"/><!-- ​I 0..1 ​* ​A set of rules under which this content was created  -->
 ​<language value="[code]"/><!-- ​I 0..1 ​* Language of the resource content  -->
 ​<text><!-- ​I 0..1 ​* ​Text summary of the resource, for human interpretation  --></text>
 ​<contained><!-- 0..* ​* ​Contained, inline Resources  --></contained>
 ​<extension><!-- See Extensions  ​Additional content defined by implementations  --></extension>
 ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- 0..* ​* ​Business identifier  --></identifier>
 <status value="[code]"/><!-- 1..1 ​* completed | entered-in-error  -->
 <patient><!-- 1..1 ​* ​Who this evaluation is for  --></patient>
 <date value="[dateTime]"/><!-- 0..1 ​* ​Date evaluation was performed  -->
 <authority><!-- 0..1 ​* ​Who is responsible for publishing the recommendations  --></authority>
 <targetDisease><!-- 1..1 ​* The vaccine preventable disease schedule being evaluated  --></targetDisease>
 <immunizationEvent><!-- 1..1 ​* ​Immunization being evaluated  --></immunizationEvent>
 <doseStatus><!-- 1..1 ​* Status of the dose relative to published recommendations  --></doseStatus>
 <doseStatusReason><!-- 0..* ​* 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 ​* ​Dose number within series  --></doseNumber>
 <seriesDoses><!-- 0..1 ​* ​Recommended number of doses for immunity  --></seriesDoses>
</ImmunizationEvaluation>

​
{​​doco
  "resourceType" : "ImmunizationEvaluation",
  "id" : "<id>", // 0..1 ​Logical id of this artifact
  "meta" : { Meta }, // ​I 0..1 ​Metadata about the resource
  "implicitRules" : "<uri>", // ​I 0..1 ​A set of rules under which this content was created
  "language" : "<code>", // ​I 0..1 Language of the resource content
  "text" : { Narrative }, // ​I 0..1 ​Text summary of the resource, for human interpretation
  "contained" : [{ ​Resource }], // 0..* ​Contained, inline Resources
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
  "identifier" : [{ Identifier }], // 0..* ​Business identifier
  "status" : "<code>", // 1..1 completed | entered-in-error
  "patient" : { Reference(Patient) }, // 1..1 ​Who this evaluation is for
  "date" : "<dateTime>", // 0..1 ​Date evaluation was performed
  "authority" : { Reference(Organization) }, // 0..1 ​Who is responsible for publishing the recommendations
  "targetDisease" : { CodeableConcept }, // 1..1 The vaccine preventable disease schedule being evaluated
  "immunizationEvent" : { Reference(Immunization) }, // 1..1 ​Immunization being evaluated
  "doseStatus" : { CodeableConcept }, // 1..1 Status of the dose relative to published recommendations
  "doseStatusReason" : [{ CodeableConcept }], // 0..* Reason why the doese is considered valid, invalid or some other status
  "description" : "<markdown>", // 0..1 ​Evaluation notes
  "series" : "<string>", // 0..1 ​Name of vaccine series
  "doseNumber" : { CodeableConcept }, // 0..1 ​Dose number within series
  "seriesDoses" : { CodeableConcept } // 0..1 ​Recommended number of doses for immunity
}

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


[ a fhir:ImmunizationEvaluation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  fhir:id [ id ] ; # 0..1 Logical id of this artifact
  fhir:meta [ Meta ] ; # 0..1 ​I Metadata about the resource
  fhir:implicitRules [ uri ] ; # 0..1 ​I A set of rules under which this content was created
  fhir:language [ code ] ; # 0..1 ​I Language of the resource content
  fhir:text [ Narrative ] ; # 0..1 ​I Text summary of the resource, for human interpretation
  fhir:contained  ( [ Resource ] ... ) ; # 0..* Contained, inline Resources
  fhir:extension  ( [ Extension ] ... ) ; # 0..* ​I Additional content defined by implementations
  fhir:modifierExtension  ( [ Extension ] ... ) ; # 0..* ​I Extensions that cannot be ignored
  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
]

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ImmunizationEvaluation 0..* 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: ImmunizationEvaluationStatusCodes (required): The status of the evaluation being done.
... patient Σ 1..1 Reference(Patient) Who this evaluation is for
... 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: ImmunizationTargetDiseaseCodes (example): The vaccine preventable disease the dose is being evaluated against.
... immunizationEvent Σ 1..1 Reference(Immunization) Immunization being evaluated
... doseStatus Σ 1..1 CodeableConcept Status of the dose relative to published recommendations
Binding: ImmunizationEvaluationDoseStatusCodes (example): The status of the administered dose relative to the published recommendations for the target disease.
... doseStatusReason 0..* CodeableConcept Reason why the doese is considered valid, invalid or some other status
Binding: ImmunizationEvaluationDoseStatusReasonCodes (example): The reason the dose status was assigned.
... description 0..1 markdown Evaluation notes
... series 0..1 string Name of vaccine series
... doseNumber 0..1 CodeableConcept Dose number within series
Binding Description: (example): A code expressing the vaccine dose number - several coding schemes exist or will be defined for each jurisdiction.
... seriesDoses 0..1 CodeableConcept Recommended number of doses for immunity
Binding Description: (example): A code expressing the doses recommended or expected - several coding schemes exist or will be defined for each jurisdiction.

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ImmunizationEvaluation.​status Base required Immunization Evaluation Status Codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​targetDisease Base example Immunization Target Disease Codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​doseStatus Base example Immunization Evaluation Dose Status codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​doseStatusReason Base example Immunization Evaluation Dose Status Reason codes 📦6.0.0-ballot3 FHIR Std.
ImmunizationEvaluation.​doseNumber Base example Not State Unknown
ImmunizationEvaluation.​seriesDoses Base example Not State Unknown

 

Other representations of resource: CSV, Excel

Notes:

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.

Name Type Description Expression
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
patient reference

The patient being evaluated

 ImmunizationEvaluation.patient
status token

Immunization evaluation status

 ImmunizationEvaluation.status
target-disease token

The vaccine preventable disease being evaluated against

 ImmunizationEvaluation.targetDisease