Immunization (QDM)

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QDM defines Immunization as vaccines administered to patients in healthcare settings but does not include non-vaccine agents. QDM defines two contexts for immunization: Immunization, Administered; Immunization, Order.

Immunization, Administered

QDM Attribute	QI Core Metadata Element	Comment
Immunization, Administered	Immunization (the .status metadata allows conformance to the specific QDM datatype context)	QDM matched to QI Core / FHIR
Dosage	Immunization.doseQuantity	QDM matched to QI Core / FHIR
Negation Rationale	Immunization.explanation.reasonNotGiven	QDM matched to QI Core / FHIR
Reason	Immunization.explanation.reason	QDM matched to QI Core / FHIR
Route	Immunization.route	QDM matched to QI Core / FHIR
Author dateTime	Immunization.date	QDM matched to QI Core / FHIR
Supply		Not addressed in QI Core. Discussion in the HL7 CQI Workgroup (13April2108) suggested that supply might assist with determining the lot number and the stock from which the vaccine administered was taken (e.g., a guarantee program such as Vaccines for Children). Immunization.vaccineCode specifies the vaccine but not the source of the vaccine. The FHIR Immunization resource does not seem to have a way to indicate the source of the vaccine. See FHIR Tracker item [15930].
Code	Immunization.vaccineCode	QDM matched to QI Core / FHIR
id	Immunization.id	QDM matched to QI Core / FHIR
Source	Immunization.primarySource	Source addressed by primarySource or reportOrigin

Immunization, Order

QDM Attribute	QI Core Metadata Element	Comment
Immunization, Order	Immunization (the .status metadata allows conformance to the specific QDM datatype context)	Note - FHIR 3.0 ImmunizationRecommendation modeling is consistent with information provided by clinical decision support for immunization forecasting. (Definition: A patient's point-in-time immunization and recommendation (i.e. forecasting a patient's immunization eligibility according to a published schedule) with optional supporting justification.- [[1]]. There is no concept comparable to MedicationRequest which includes an .intent metadata element allows reference to "proposal" consistent with clinical decision support forecasting, "plan" consistent with a recommendation a clinician provides to a patient, and "order" consistent with an order placed in EHRs or other clinical software. This is an important distinction since in some practices, the physician sends a prescription (order) to a pharmacy for the patient to pick up, bring back to the practice for it to be administered. Thus, Immunization, Order should have a ImmunizationRecommendation.intent to indicate the "order" which is distinct from an ImmunizationRecommendation.intent proposal for forecasting and ImmunizationRecommendation.plan for a recommendation to a patient which may or may not be heeded.
Active dateTime	IImmunizationRecommendation.recommendation.dateCriterion	QDM matched to QI Core / FHIR
Dosage	Immunization.doseQuantity	Not necessarily a good fit since it addresses what was given, not what should be given. There is no QI Core Counterpart for immunization order
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	QDM matched to QI Core / FHIR
Reason	ImmunizationRecommendation.recommendation.protocol	QDM matched to QI Core / FHIR
Route	Immunization.route	Not necessarily a good fit since it addresses the route used, not what route should be used. There is no QI Core Counterpart for immunization order
Author dateTime	Immunization.date	QDM matched to QI Core / FHIR
Supply		Not addressed in QI Core. Discussion in the HL7 CQI Workgroup (13April2108) suggested that supply might assist with determining the lot number and the stock from which the vaccine administered was taken (e.g., a guarantee program such as Vaccines for Children). Immunization.vaccineCode specifies the vaccine but not the source of the vaccine. The FHIR Immunization resource does not seem to have a way to indicate the source of the vaccine.
Code	ImmunizationRecommendation.recommendation.vaccineCode	QDM matched to QI Core / FHIR
id	ImmunizationRecommendation.id	QDM matched to QI Core / FHIR
Source	ProcedureRequest.requester	QDM matched to QI Core / FHIR