NPHCDA Immunization FHIR IG
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NPHCDA Immunization FHIR IG, published by https://nphcda.gov.ng. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Nigeria-FHIR-Community/ImmunizationIG/ and changes regularly. See the Directory of published versions

Business Processes

A business process, or process, is a set of related activities or tasks performed together to achieve the objectives of the health Programme area, such as registration, counseling, and referrals. Workflows are a visual representation of the progression of activities (tasks, events, and interactions) that are performed within the business process. The workflow provides a story for the business process being diagrammed and is used to enhance communication and collaboration among users, stakeholders, and engineers.

The business processes here have been informed by WHO Digital adaptation kit for immunizations.

Business Processes

Table 2: Overview of Business Processes

# Process Name Process ID Personas Objectives Task Set
Title ID used to reference this process throughout the DAK Individuals interacting to complete the process A concrete statement describing what the process seeks to achieve The general set of activities performed within the process
A Health Facility Registration
icon-a-facility-registration		 IMMZ.A System administrator All vaccinator locations (public and private facilities) able to administer vaccines should be registered and uniquely identified to allow appropriate tracking of vaccine coverage and stock.

Starting point: The system administrator registers a new vaccination location (e.g, a PHC).

  • Validate against the National Master Facility List/Health Facility Registry (MFL/HFR).
  • Notify NMFL of changes/updates.
  • Request and submit additional information.
  • Create and update vaccination location record.
  • Generate EIR Unique identifier for vaccination.
  • Send vaccination location registration notification.
B Plan immunization session
icon-b-plan-session		 IMMZ.B Health worker In preparation for a vaccination session, ensure sufficient supply and plan their workload.

Starting point: The health worker reviews vaccination records to determine vaccine needs estimates.

  • Record details on the planning sheet.
  • Order additional stock.
  • Record stock received.
  • Assemble all needed materials for vaccination.
C Client Registration
icon-c-client-registration		 IMMZ.C Health worker To create, retrieve and/or update a Client's lifelong vaccine record in the EIR (or Immunization module in EMR) to support future vaccine administration.

Starting point: The Client arrives at the vaccination point and the health worker locates the client’s immunization history.

  • Search for the Client’s record via the EIR or Immunization module in EMR.
  • Review and update the Client’s record.
  • Create new Client records as required.
  • Save the record.
D Administer Vaccine
icon-d-vaccine-administration		 IMMZ.D Health worker To determine what vaccines a Client needs, administer those and record the data both in the system and the client’s home-based vaccination record.

Starting point: The Client has been registered in the system.

  • Capture or query Client’s record.
  • Determine Client’s vaccination eligibility (also check contraindication).
  • Prepare and administer vaccines.
  • Record the appropriate data.
  • Monitor the Client for any adverse effects following vaccination.
  • Inform the Client when to return for vaccination/set Client reminder.
  • Provide Client with vaccination card
E Manage and Report AEFI
icon-e-manage-report-aefi		 IMMZ.E Health worker To monitor, record, and report AEFI.

Starting point: The Client reports AEFI or present with AEFI complaint at health facility

  • The health worker searches the record and records the AEFI against the vaccine administered.
  • Monitor and Report any AEFI as appropriate
  • Counsels the Client and treats them appropriately.
  • Advises Client on when to come for the next vaccine.
F Client reminder
icon-f-client-reminder		 IMMZ.F Health worker This is to remind clients that it is time to return for vaccination.

Starting point: The Client’s records are evaluated to determine if they meet the defined criteria to recieve reminders.

  • Select notification method.
  • Generate a list of clients.
  • Send reminder notifications.
G Defaulter tracking
icon-g-defaulter-tracking		 IMMZ.G Community health worker To identify clients that are overdue for follow-up.

Starting point: Clients are overdue for vaccination.

  • Determine if and which vaccines were missed.
  • Generate a list of cCients and their contact information.
  • Send the Client’s info to the respective CHPs.
  • Plan for and conduct follow-up.
H Report generation
icon-h-report-generation		 IMMZ.H Health worker To provide data access and analysis for decision-making.

Starting point: Define the reporting parameters.

  • Generate report.
  • High-level review and analyze.
I Resolve duplicate Client records
icon-i-resolve-duplicate-client		 IMMZ.I Health Facility Systems Administrator To ensure accurate and unified client data by identifying and merging duplicate records.

Starting point: Flag duplicate client records for evaluation and resolution.

  • Review duplicate Client records.
  • Determine if the duplicate records can be merged.
  • Merge records.
J Resolve duplicate vaccination events
icon-i-resolve-duplicate-event		 IMMZ.J Routine immunization service provider To maintain reliable immunization records by detecting and resolving duplicate vaccination entries.

Starting point: Identify groups of vaccination events for evaluation and resolution.

  • Review duplicate events
  • Select the most accurate/suitable event record.
  • Update vaccination event.

Table 3: Business process symbols used in workflows

Symbol Symbol Name Description
swim-lane Swim lane Each individual or type of user is assigned to a swim lane, a designated area for noting the activities performed or expected of that specific actor. For example, a family planning health worker may have one swim lane; the supervisor would be in another swim lane; the clients/patients would be classified in another swim lane. If the activities can be performed by either actor, then those activities can be depicted overlapping the two relevant swim lanes.
start-event Start event or Trigger event The workflow diagram should contain both a start and an end event, defining the beginning and completion of the task, respectively.
end-event End event There can be multiple end events depicted across multiple swimlanes in a business process diagram. However, for diagram clarity, there should only be one end event per swim lane.
activity Activity, Process, Step or Task Each activity should start with a verb, e.g., “Register client”, “Calculate risk”. Between the start and end of a task, there should be a series of activities noted - in the successive actions performed by the actor for that swim lane. There can also be sub-processes within each activity.
activity-with-sub-process Activity with sub-process This symbol denotes an activity that has a much longer sub-process, to be detailed in another diagram. If the diagram starts to become too complex and unhelpful, the sub-process symbol should be used to reference this sub-another process depicted on another diagram page. (Activity with sub-process in grey box is not covered in this DAK).
sequence-flow Sequence flow This symbol denotes the flow direction from one process to the next. The end event should not have any output arrows. All symbols (except the Start event) may have an unlimited number of input arrows. All symbols (except the end event and the Gateway) should have one and only one output arrow, leading to a new symbol, looping back to a previously used symbol, or pointing to the End event symbol. Connecting arrows should not intersect (cross) each other.
gateway Gateway This symbol is used to depict a fork, or decision point, in the workflow, which may be a simple binary (for example, yes/no) filter with two corresponding output arrows or a different set of outputs. In this document, there should typically be only two different outputs that originate from the decision point. If you find yourself needing more than two “output” or sequence flow direction arrows, this is most likely trying to depict “decision-support logic” or a “business rule”. This should be depicted as an “Activity with business rule”.
throw-link Throw – Link The “Throw–Link” serves as the start of an off-page connector. It is the end of the process when there is no more room on your page for that workflow. It is the end of a process on your current page or the end of a sub-process that is part of a larger process. When used, there will need to be a corresponding “Catch–Link” on the other page that shows the continuation of the workflow that follows the “Throw–Link”.
catch-link Catch – Link The “Catch–Link” serves as an off-page connector. It is the start of a new process that follows a previous process, a continuation of a process from a previous page, on a different page from the “Throw – Link” or the start of a sub-process that is part of a larger process. Every “CatchLink” needs to align with at least one corresponding “Throw–Link” that is aligned to the prior process diagram “Catch–Link”.
loop-activity Loop Activity This “Loop Activity” or loop task symbolizes an activity or task that is repeated until it no longer needs to be repeated. For example, vaccine administration can happen as many times as the number of vaccines that need to be given.

The overview of the business processes in this DAK captures all business processes at a high level.

summary

Workflows

Health Facility Registration

Objective: To register and uniquely identify vaccination locations in order to administer vaccines and enable appropriate tracking of vaccine coverage and stock.

health_facility_registration.png


Plan Service delivery

Objective: To prepare for an immunization session, either at the vaccination location or done at an outreach site.

plan-service-delivery.png


Client registration

Objective: To start the client’s lifelong immunization record.

client-registration


Vaccine administration

Objective: To determine what vaccines a client needs, administer those, and record the data both in the system and on the client’s vaccination card.

administer-vaccine.png


Manage AEFIs

Objective: To manage caregiver reports or client presenting at health facilities with cases of AEFI based on set triggers.

manage-and-report-aefi.png


Client reminder

Objective: To send vaccination reminders to community health workers that certain clients are due for vaccination.

client-reminder.png


Defaulter tracing

Objective: To identify clients that are overdue for follow-up

defaulter-tracking.png


Report generation

Objective: To provide data access and analysis for decision-making

report-generation.png


Resolve duplicate client record

Objective: To ensure accurate and unified client data by identifying and merging duplicate records.

resolve-duplicate-client-records.png


Resolve duplicate vaccination events

Objective: To maintain reliable immunization records by detecting and resolving duplicate vaccination entries.

resolve-duplicate-vaccination-event.png