R6 Ballot (2nd Draft)

Publish-box (todo)

11.8 Resource ImmunizationEvaluation - Content

Public Health icon Work GroupMaturity Level: 1 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.

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

11.8.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
... 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 string Dose number within series
... seriesDoses 0..1 string Recommended number of doses for immunity

doco Documentation for this format icon

See the Extensions for this resource

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] « null (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] « null (Strength=Example) ImmunizationTargetDiseaseCodes?? »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] « null (Strength=Example) ImmunizationEvaluationDoseSta...?? »Provides an explanation as to why the vaccine administration event is valid or not relative to the published recommendationsdoseStatusReason : CodeableConcept [0..*] « null (Strength=Example) ImmunizationEvaluationDoseSta...?? »Additional information about the evaluationdescription : markdown [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 series as determined by the outcome of the evaluation processdoseNumber : string [0..1]The recommended number of doses to achieve immunity as determined by the outcome of the evaluation processseriesDoses : string [0..1]

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: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 [ string ] ; # 0..1 Dose number within series
  fhir:seriesDoses [ string ] ; # 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
  • Remove Type positiveInt
ImmunizationEvaluation.seriesDoses
  • Renamed from seriesDoses[x] to seriesDoses
  • Remove Type positiveInt

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
... 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 string Dose number within series
... seriesDoses 0..1 string Recommended number of doses for immunity

doco Documentation for this format icon

See the Extensions for this resource

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] « null (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] « null (Strength=Example) ImmunizationTargetDiseaseCodes?? »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] « null (Strength=Example) ImmunizationEvaluationDoseSta...?? »Provides an explanation as to why the vaccine administration event is valid or not relative to the published recommendationsdoseStatusReason : CodeableConcept [0..*] « null (Strength=Example) ImmunizationEvaluationDoseSta...?? »Additional information about the evaluationdescription : markdown [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 series as determined by the outcome of the evaluation processdoseNumber : string [0..1]The recommended number of doses to achieve immunity as determined by the outcome of the evaluation processseriesDoses : string [0..1]

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: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 [ string ] ; # 0..1 Dose number within series
  fhir:seriesDoses [ string ] ; # 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
  • Remove Type positiveInt
ImmunizationEvaluation.seriesDoses
  • Renamed from seriesDoses[x] to seriesDoses
  • Remove Type positiveInt

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.

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