[Immunization] How to define the task timing | Content Changes

[dubdabasoduba]

Context

• Immunizations have an ideal timing for when they should be administered. They also have a defined period after which
  the administration is not allowed. This means the immunization is expired.
• Use the Task.executionPeriod and Task.restriction attributes to define the period of administration and the expiry
  period respectively.

Implementation Details

Generate 2 Encounters to record the Immunization recording and Immunization Administration

• We would have 2 Encounters created for each task closed. 1 Encounter will represent the health worker immunization
  record event and the other will represent the immunization administration event.
• Both encounters will be linked to the Task via the Task.output attribute.

1. Encounter 1: Tasks completion event

   • A Task completion Encounter will be used to record the date that the health worker is recording the
     Immunization.
     • The Encounter.period.start and Encounter.period.end attributes will hold the current date that the data is
       recorded. i.e. the date will be now()
     • The Encounter.type will hold the vaccination code which
       is {"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]}
     • Link the Encounter to the specific task via the Task.output attribute. This link will be needed during
       Search, in order to get the Immunization administration date from the Immunization, tied to the *
       Encounter*
       • The Task.output.type attribute is set
         to {"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]}
       • The Task.output.value attribute is set to the Encounter reference
         e.g. {"reference":"Encounter/<string-uuid>"}
       • Here is a complete example of the Task.output
         attribute {"type":{"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]},"value":{"reference":"Encounter/<string-uuid>"}}

2. Encounter 2: Immunization administration event

   • A Immunization administration Encounter will be used to record the date the immunization was administered.
     This will mostly be found on the patient's vaccination cards.
     • The Encounter.period.end attributes will hold the date the immunization was administered.
     • The Encounter.type will hold the vaccination code which
       is {"coding":[{"system":"http://snomed.info/sct","code":"33879002","display":"Administration of vaccine to produce active immunity (procedure)"}]}
     • The Encounter.reasonCode will hold the code to represent the Specific Task (Immunization). This should be
       found on the Tasks.reasonCode attribute.
     • Link the Encounter to the specific Immunization record encounter a.k.a Encounter 1 via the Encounter.partOf attribute. This link will be needed during
       Search, in order to get the Immunization administration date from the Immunization, tied to the *
       Encounter*
       • Get the Task.output.type attribute is set
         to {"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]}
       • Using the Encounter.partOf attribute find the encounter that references the Id from on the Task.outputattribute.
       • Find the Immunization resource that references the Encounter 2 (Administration Encounter)

Generating an Immunization resource to track the immunization given

• We would generate an Immunization resource instead of the Immunization record Observation
• The Immunization will have the following attributes
  • The Immunization.status -- This is the status of the immunization resources. It will always be marked as
    completed.
  • The Immunization.encounter -- This is a reference to the Tasks completion Encounter which is the Immunization Administration Encounter.
  • The Immunization.occurrenceDatetime -- This is the date the immunization was administered.
  • The Immunization.reasonCode -- Holds the code to represent the Specific Task (Immunization). This should be
    found on the Tasks.reasonCode attribute.

How to use the Task.restriction.period

• The Task.restriction.period.end attribute is used to define when the task expires and cannot be performed anymore.
  For e.g. most of the immunization data might be irrelevant if recorded after 5 yrs (for child immunizations).
  • The Task.restriction.period.end attribute will be set to the date the child gets to 5 years. This date can also
    be used to restrict the max date when recording backdated information
  • The expiry implementation has been implemented here [Quest] Write a service to mark Tasks as expired.  #1703
• The Task.restriction.period.start attribute should always be the same as the date the Task was initially supposed to
  be DUE/start
  • In most tasks without prerequisites this date will be the same as the Task.excecutionPeriod.start

Different schools of thought

Required decisions

• Review the Proposed option versus the different schools of thought before the implementation
  • Document the decision in a comment on this discussion

[pld]

For the encounter/encounter/immunization strategy, what if you give the immunization at the same time you record it?

[pld]

Chatted w/@dubdabasoduba, you'd want to still store 2 encounters so you can write indicators independently. I think the encounter/encounter/immunization strategy makes sense

[dubdabasoduba]

Other options not considered

Immunization record Encounter

• A Task completion Encounter will be used to record the date that the health worker is recording the Immunization.
  • The Encounter.period.start and Encounter.period.end attributes will hold the current date that the data is
    recorded. i.e. the date will be now()
  • The Encounter.type will hold the vaccination code which
    is {"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]}
  • Link the Encounter to the specific task via the Task.output attribute. This link will be needed during
    Search, in order to get the Immunization administration date from the Observations, tied to the Encounter
    • The Task.output.type attribute is set
      to {"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]}
    • The Task.output.value attribute is set to the Encounter reference
      e.g. {"reference":"Encounter/<string-uuid>"}
    • Here is a complete example of the Task.output
      attribute {"type":{"coding":[{"system":"http://snomed.info/sct","code":"41000179103","display":"Immunization record (record artifact)"}]},"value":{"reference":"Encounter/<string-uuid>"}}

Immunization administration Observation

• Create an administration Observation for Immunization if the recording is done through the Record all button
  on the profile cards.
  • if the recording is done on the individual tasks form then we only generate one Observation.
  • The Observation will have the following attributes
    • category -- This is a static code to mark the observation as a vaccination
      Observation {"coding":[{"system":"http://snomed.info/sct","code":"33879002","display":"Administration of vaccine to produce active immunity (procedure)"}]}
    • code -- This is a code to represent the Specific Task (Immunization). This should be found on
      the Tasks.reasonCode attribute
    • effectiveDateTime -- Represents the immunization administration date.
    • encounter -- A reference to the Task administration Encounter
  • Here is an Observation
    example {"resourceType":"Observation","id":"<uuid>","status":"final","category":[{"coding":[{"system":"http://snomed.info/sct","code":"33879002","display":"Administration of vaccine to produce active immunity (procedure)"}]}],"code":{"coding":[{"system":"http://snomed.info/sct","code":"42284007","display":"BCG vaccination"}],"text":"BCG vaccination"},"effectiveDateTime":"<administration-date>","encounter":{"reference":"Encounter/<encounter-id>"}}

[dubdabasoduba]

Immunization Record Encounter Sample

  {
    "resourceType": "Encounter",
    "id": "14e2ae52-32fc-4507-8736-1177cdaafe90",
    "identifier": {
      "use": "official",
      "value": "6cf76a14-d701-4054-ae1f-4eb387f08e8f"
    },
    "status": "finished",
    "type": [
      {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "41000179103",
            "display": "Immunization record (record artifact)"
          }
        ]
      }
    ],
    "subject": {
      "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
    },
    "period": {
      "start": "2021-10-15T00:00:00+00:00",
      "end": "2021-10-15T00:00:00+00:00"
    }
  }

[dubdabasoduba]

Immunization Administration Encounter sample

  {
    "resourceType": "Encounter",
    "id": "ebcfb052-47ed-4846-bb13-0f136cdc53a1",
    "identifier": {
      "use": "official",
      "value": "4b62fff3-6010-4674-84a2-71f2bbdbf2e5"
    },
    "status": "finished",
    "type": [
      {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "33879002",
            "display": "Administration of vaccine to produce active immunity (procedure)"
          }
        ]
      }
    ],
    "subject": {
      "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
    },
    "period": {
      "end": "2021-10-01T00:00:00+00:00"
    },
    "partOf": {
      "reference": "Encounter/14e2ae52-32fc-4507-8736-1177cdaafe90"
    }
  }

[dubdabasoduba]

Immunization Resource sample

  {
    "resourceType": "Immunization",
    "id": "41921cfe-5074-4eec-925f-2bc581237660",
    "identifier": {
      "use": "official",
      "value": "6a637a79-df7b-4cc9-93b2-f73f965c31ab"
    },
    "status": "completed",
    "patient": {
      "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
    },
    "encounter": {
      "reference": "Encounter/14e2ae52-32fc-4507-8736-1177cdaafe90"
    },
    "occurrenceDateTime": "2021-10-01T00:00:00+00:00"
  }

[dubdabasoduba]

OPV 0 resource sample

  {
    "resourceType": "Task",
    "id": "650203d2-f327-4eb4-a9fd-741e0ce29c3f",
    "identifier": [
      {
        "use": "official",
        "value": "ad17cda3-0ac8-43c5-8d9a-9f3adee45e2b"
      }
    ],
    "basedOn": [
      {
        "reference": "CarePlan/28d7542c-ba08-4f16-b6a2-19e8b5d4c229"
      }
    ],
    "status": "requested",
    "intent": "plan",
    "priority": "routine",
    "code": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "33879002",
          "display": "Administration of vaccine to produce active immunity (procedure)"
        }
      ]
    },
    "description": "OPV 0 at 0 d vaccine",
    "for": {
      "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
    },
    "executionPeriod": {
      "start": "2021-10-01T00:00:00+00:00",
      "end": "2021-10-15T00:00:00+00:00"
    },
    "authoredOn": "2023-03-28T10:46:59+00:00",
    "requester": {
      "reference": "Practitioner/3812"
    },
    "owner": {
      "reference": "Practitioner/3812"
    },
    "reasonCode": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "111164008",
          "display": "Poliovirus vaccine"
        }
      ],
      "text": "OPV"
    },
    "reasonReference": {
      "reference": "Questionnaire/9b1aa23b-577c-4fb2-84e3-591e6facaf82"
    },
    "output": [
      {
        "type": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "41000179103",
              "display": "Immunization record (record artifact)"
            }
          ]
        },
        "value": {
          "reference": "Encounter/14e2ae52-32fc-4507-8736-1177cdaafe90"
        }
      }
    ]
  }

[dubdabasoduba]

OPV 1 resource sample

  {
    "resourceType": "Task",
    "id": "a9100c01-c84b-404f-9d24-9b830463a152",
    "identifier": [
      {
        "use": "official",
        "value": "a20e88b4-4beb-4b31-86cd-572e1445e5f3"
      }
    ],
    "basedOn": [
      {
        "reference": "CarePlan/28d7542c-ba08-4f16-b6a2-19e8b5d4c229"
      }
    ],
    "partOf": {
      "reference": "Task/650203d2-f327-4eb4-a9fd-741e0ce29c3f"
    },
    "status": "requested",
    "intent": "plan",
    "priority": "routine",
    "code": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "33879002",
          "display": "Administration of vaccine to produce active immunity (procedure)"
        }
      ]
    },
    "description": "OPV 1 at 6 wk vaccine",
    "for": {
      "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
    },
    "executionPeriod": {
      "start": "2021-11-12T00:00:00+00:00",
      "end": "2026-11-11T00:00:00+00:00"
    },
    "authoredOn": "2023-03-28T10:46:59+00:00",
    "requester": {
      "reference": "Practitioner/3812"
    },
    "owner": {
      "reference": "Practitioner/3812"
    },
    "reasonCode": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "111164008",
          "display": "Poliovirus vaccine"
        }
      ],
      "text": "OPV"
    },
    "reasonReference": {
      "reference": "Questionnaire/9b1aa23b-577c-4fb2-84e3-591e6facaf82"
    },
    "input": [
      {
        "type": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "900000000000457003",
              "display": "Reference set attribute (foundation metadata concept)"
            }
          ]
        },
        "value": {
          "reference": "Task/650203d2-f327-4eb4-a9fd-741e0ce29c3f"
        }
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "371154000",
              "display": "Dependent (qualifier value)"
            }
          ]
        },
        "value": 28
      }
    ],
    "output": [
      {
        "type": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "41000179103",
              "display": "Immunization record (record artifact)"
            }
          ]
        },
        "value": {
          "reference": "Encounter/14e2ae52-32fc-4507-8736-1177cdaafe90"
        }
      }
    ]
  }