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.

This mapping was first published on 9 April 2018 and updated 15 April 2018 and again 24 April 2018 based on discussion and further modeling considerations. Note FHIR tracker items in May ballot added based on the content for Immunization, Administered and Immunization, Order - 15930, 15931, 15932 - details described in the tables below.

Note, the work initially mapped Immunization, Order to the FHIR resource Immunization Recommendation; however, it is clear that the FHIR Immunization Recommendation resource is specifically designed to provide an immunization forecast from a forecasting engine to a provider, basically to carry clinical decision support recommendations specific to immunizations. Therefore, the most closely associated resource for the QDM datatype Immunization, Order is MedicationRequest. There is no comparable FHIR resource to specify ImmunizationRequest. Hence, the mapping for Immunization, Order uses MedicationRequest (24 April 2018).

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.- ImmunizationRecommendation. 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. See FHIR Tracker Item 15931.
Active dateTime	IImmunizationRecommendation.recommendation.dateCriterion	QDM matched to QI Core / FHIR
Dosage	Immunization.doseQuantity	There is no QI Core Counterpart for immunization order. ImmunizationRecommendation allows specification of a forecast that includes dose number and sequence in a series, but it does not indicate Immunization dose. Immunization includes a doseQuantity, but Immunization is used to indicate immunizations that have ben administered; it does not reference orders for immunizations. See FHIR Tracker Item 15932.
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	There is no QI Core Counterpart for immunization order. ImmunizationRecommendation allows specification of a forecast that includes dose number and sequence in a series, but it does not indicate the anticipated Immunization route. Immunization includes a .route, but Immunization is used to indicate immunizations that have ben administered; it does not reference orders for immunizations. See FHIR Tracker Item 15932.
Author dateTime	ImmunizationRecommendation.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	ImmunizationRecommendation.recommendation.vaccineCode	QDM matched to QI Core / FHIR
id	ImmunizationRecommendation.id	QDM matched to QI Core / FHIR
Source	ImmunizationRecommendation.recommendation.protocol.authority	QDM matched to FHIR