imm:Vissue-Nictiz-26747 FHIR Vaccination-Immunization

Dit is een tijdelijke pagina met wijzigingen voor issue Nictiz-26747. De gepubliceerde versie vind je hier.

This FHIR IG is currently under development and can not be considered stable and ready for use. For questions and change requests regarding this IG, please create a ticket in BITS.

1 Introduction

This is the technical design (TO) for the information standard (IS) Vaccination-Immunization. This TO must be used together with the IS functional design functional design Vaccination-Immunization 2.0.4. The data exchange format used in this version is: HL7 FHIR R4.

1.1 Support

For questions, feedback, or change requests, please contact our support team at Nictiz Servicemanagement.

1.2 Boundaries

This information standard may overlap with other standards related to identification, roles, and geographic classifications, requiring careful alignment to ensure consistency and avoid duplication. For more information, see functional design Vaccination-Immunization 2.0.4.

1.3 Prerequisite knowledge

This TO assumes that the reader is familiar with the following:

• The functional design Vaccination-Immunization 2.0.4 accompanying this TO.
• This information standard uses the data exchange formats HL7 FHIR R4, which you can find here:
  • general FHIR R4 Implementation Guide
  • use case overarching principles
  • FHIR packages.

2 Components

HL7 FHIR R4 is used to accommodate the Dutch Clinical Information Models (zibs) used in the IS.

2.1 HL7 FHIR R4

Vaccination-Immunization uses the FHIR Packaging mechanism. This conveniently bundles all profiles, terminology, example material and other conformance resources you need into a single archive, which can be downloaded or installed using the appropriate FHIR tooling. This version of the information standard uses the following packages: nictiz.fhir.nl.r4.immunization version 2.0.0 or compatible nictiz.fhir.nl.r4.nl-core version 0.11.0-beta.1 or compatible Note: packages use Semantic Versioning. Other versions can be used at will as long as they have the same major.minor number or a minor number higher than the stated version.

2.2 Artifacts

The artifacts of the information standard are presented in the following table:

zib	FHIR resource	FHIR profile
Vaccination	Immunization	http://nictiz.nl/fhir/StructureDefinition/imm-Vaccination-event
	Immunization	https://nictiz.nl/fhir/StructureDefinition/imm-Vaccination-event-carenetwork
PharmaceuticalProduct	Medication	https://nictiz.nl/fhir/StructureDefinition/imm-PharmaceuticalProduct
Patient	Patient	http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient
HealthcareProvider	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
	Location	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider
HealthProfessional	PractitionerRole	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole
	Practitioner	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner

2.3 Examples of FHIR instances

You can find examples of FHIR-instances (filled-in FHIR profiles) in the Simplifier Immunization R4 package

3 Transactions

3.1 Use case: retrieve vaccinations in a personal health environment

3.1.1 Introduction

This use case describes the patient's use case for the retrieval of vaccination results, in a personal health environment (PHR) context. Functional specifications are described at the functional design wiki page. This use case consists of enabling a patient to view his own administered vaccinations in a PHR. The technical specification is described here. HL7 FHIR R4 is used for this purpose. Vaccinations are represented by the Immunization resource in FHIR. A transaction will retrieve all administered vaccinations from the XIS.

This FHIR implementation guide assumes that the PHR system is able to make a connection to the right XIS that contains the patient's information. It does not provide information on finding the right XIS nor does it provide information about security. Moreover, each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'Afsprakenstelsel'. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason, search parameters should not be included for patient identification.

Note: This implementation guide builds on the general guidelines described in the use case overarching principles.

3.1.2 Actors involved

Actors		Systems		FHIR CapabilityStatements
Name	Description	Name	Description	Name	Description
Patient	The user of a personal healthcare environment.	PHR	Personal health record	CapabilityStatement: Retrieve Serve	FHIR client/server requirements
(Healthcare) provider	The user of a XIS	XIS	(Healthcare) information system

3.1.3 Transaction groups involved

Transaction group	Transaction	Actor	Role
Retrieve vaccinations(PULL)	Retrieve vaccinations request	Patient (using a PHR)	Request vaccinations from the XIS
	Retrieve vaccinations response	(Healthcare) provider (using a XIS)	Serves vaccinations to the PHR

3.1.4 Invocations

3.1.4.1 PHR: request message

When the patient (PHR) wants to obtain vaccinations, it issues a retrieve vaccinations request message. The request message represents an HTTP GET parameterized query from the PHR to the XIS.

Search

The PHR executes an HTTP GET conform to the FHIR RESTful and search specification against the XIS's Immunization endpoint. This search query URL is configurable by the PHR and has the following format.

GET [base]/Immunization{?[includes]}

Search Parameters

The PHR may supply, and the XIS shall be capable of processing, all inlcudes listed below. These includes are a selection of the defined includes. The includes can also be combined to retrieve multiple resources.

Immunization
Name	Description	Example
patient	This will specify the resource for the patient that the immunization is performed on.	Retrieve the Immunization and Patient resource: GET [base]/Immunization?_include=Immunization:patient
performer	This will specify the resource for the healthcareprovider who performed the immunization on the patient.	Retrieve the Immunization and Practitioner or Organization resource: GET [base]/Immunization?_include=Immunization:performer

At this point in time, there are no use cases for filter parameters on the query.

3.1.4.2 XIS: response message

The expected action for the XIS is that the XIS SHALL process the query to retrieve patient's Immunization resources and the referenced resources. The trigger event is the XIS completed processing of the retrieve vaccinations request message. The XIS returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching information.

Message semantics

The returned data to the PHR should conform to the profiles listed in the table below. The resources in the response message SHALL conform to the requirements as described in the MedMij FHIR R4 Implementation Guide.

zib	FHIR resource	FHIR profile
Vaccination	Immunization	http://nictiz.nl/fhir/StructureDefinition/imm-Vaccination-event
PharmaceuticalProduct	Medication	https://nictiz.nl/fhir/StructureDefinition/imm-PharmaceuticalProduct
Patient	Patient	http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient
HealthcareProvider	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
	Location	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider
HealthProfessional	PractitionerRole	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole
	Practitioner	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner

The stated query will return a Bundle with all known administered immunizations. Each immunization is conveyed in an Immunization resource. The Immunization resource will contain references to actors such as the patient (Patient resource), the health professional (PractitionerRole and Practitioner resources) and the organization (Organization resource). The client SHALL be able to resolve there referenced resources, as described in the MedMij FHIR R4 Implementation Guide.

(*) The vaccination location, may or may not be a fully specified address and may or may not be a location of a healthcare provider. It is conceivable that it is as vague as "Germany" when a parent informs the registry of a having received a vaccination "in Germany" without any further info. In these cases it might be unreasonable to assume a full Location resource which is separately accessible. FHIR has a mechanism contained for information that only makes sense in the context of some parent resource. The reference simply starts with a point sign '#', signalling that the target is internal to the resource. In this case Immunization.contained.Location. It is the prerogative of the source system whether or not Location is an independent object. The expectation is that healthcare provider locations are independent Location resources. Receiving systems should expect normal FHIR rules for resolving references, which include resolving contained references. Example fragment

3.2 Use case: retrieve vaccinations in XIS

This retrieve vaccinations transaction is used by a XIS (careprovider A) to retrieve vaccinations from another XIS (careprovider B).

3.2.1 Involved actors

Abbreviations: IMM-VAR = Immunisatie-vaccinatie raadplegend (systeem), IMM-VAB = Immunisatie-vaccinatie beschikbaarstellend (systeem).

Transaction group	Transaction	Actor	System role code	FHIR CapabilityStatement
Retrieve vaccinations(PULL)	Retrieve vaccinations request	XIS careprovider A (Client)	IMM-VAR-FHIR	CapabilityStatement: Retrieve Serve
	Retrieve vaccinations response	XIS careprovider B (Server)	IMM-VAB-FHIR

3.2.2 Search parameters

The XIS of careprovider A (Client) may supply, and the XIS careprovider B (Server) shall be capable of processing, all includes and search parameters listed below. These includes and parameters are a selection of the defined includes and search parameters. The includes can also be combined to retrieve multiple resources.

XIS executes a HTTP GET/POST conform to the FHIR RESTful and search specification

FHIR Search Parameter	Description	FHIR Resource	Example
Immunization
_include=Immunization:patient	The client may request that the server returns resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources. This will specify the resource for the patient that the immunization is performed on.	Immunization	Retrieves all Immunization resources and includes the Patient resource in the search results. GET [base]/Immunization?_include=Immunization:patient
_include=Immunization:performer	The client may request that the server returns resources related to the search results, in order to reduce the overall network delay of repeated retrievals of related resources. This will specify the resource for the performer (organization) by whom the immunization was carried out.	Immunization	Retrieves all Immunization resources and includes the Organization resource in the search results. GET [base]/Immunization?_include=Immunization:performer
patient.identifier	The client may search on patient identification number.	Immunization	The parameters are encoded in the URL or as an application/x-www-form-urlencoded submission for a POST. Retrieves all Immunizations resources of a patient with a fake BSN of 111222333. GET [base]/Immunization?patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333 POST [base]/Immunization/_search {patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|111222333}
patient.birthdate	The client may search on the patient's date of birth.	Immunization	Retrieves all Immunizations resources of a patient with a date of birth 11-11-1999 GET [base]/Immunization?patient.birthdate=1999-11-11 POST [base]/Immunization/_search {patient.birthdate=1999-11-11}
patient.family	The client may search on the family name of the patient.	Immunization	Retrieves all Immunizations resources of a patient with family name de Jong GET [base]/Immunization?patient.family=de Jong POST [base]/Immunization/_search {patient.family=de Jong}

3.2.3 Response Resources

The returned data to the client XIS (careprovider A) should conform to the profiles listed in the table below. The resources in the response message SHALL conform to the requirements as described in the MedMij FHIR R4 Implementation Guide.

zib	FHIR resource	FHIR profile
Vaccination	Immunization	https://nictiz.nl/fhir/StructureDefinition/imm-Vaccination-event-carenetwork
PharmaceuticalProduct	Medication	https://nictiz.nl/fhir/StructureDefinition/imm-PharmaceuticalProduct
Patient	Patient	http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient
HealthcareProvider	Organization	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
	Location	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider