FHIR Implementation Guide: Vaccination-Immunization

1 Introduction

This page describes 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 resources in FHIR. A transaction will retrieve all administered vaccinations from the XIS.

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

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 Use case 1: Retrieve vaccinations

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.

3.1 Introduction

The retrieve vaccinations transaction is used by the PHR to retrieve vaccinations from a XIS.

3.2 Actors

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

3.3 Invocations

3.3.1 PHR: request message

The request message represents an HTTP GET parameterized query from the PHR to the XIS.

3.3.1.1 Trigger events

When the patient (PHR) wants to obtain vaccinations, it issues a retrieve vaccinations request message.

3.3.1.2 Message semantics

Search

The PHR executes an HTTP GET conform to the FHIR RESTful and search specification against the XIS's Observation 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:patient
location	This will specify the resource for the location where the Immunization took place.	Retrieve the Immunization and Location resource: GET [base]/Immunization?_include:location
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:performer

At this point in time, there are no use cases for filter parameters on the query. 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 FHIR R4 Implementation Guide.

3.3.1.2.1 Expected actions

The XIS SHALL process the query to retrieve patient's Immunization resources and the referenced resources.

3.3.2 XIS: response message

The XIS returns an HTTP Status code appropriate to the processing as well as a FHIR Bundle including the matching information.

3.3.2.1 Trigger events

The XIS completed processing of the retrieve vaccinations request message.

3.3.2.2 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 FHIR R4 Implementation Guide.

Profile name	FHIR Resource	HCIM EN	Canonical URL
nl core Vaccination event	Immunization	Vaccination	http://nictiz.nl/fhir/StructureDefinition/nl-core-Vaccination-event
nl core Patient	Patient	Patient	http://nictiz.nl/fhir/StructureDefinition/nl-core-Patient
nl core HealthProfessional	Practitioner	HealthProfessional	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-Practitioner
nl core HealthProfessional PractitionerRole	PractionerRole		http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthProfessional-PractitionerRole
nl core HealthcareProvider Organization	Organization	HealthcareProvider	http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider-Organization
nl core HealthcareProvider	Location		http://nictiz.nl/fhir/StructureDefinition/nl-core-HealthcareProvider
nl core PharmaceuticalProduct	Medication	PharmaceuticalProduct	http://nictiz.nl/fhir/StructureDefinition/nl-core-PharmaceuticalProduct

3.3.2.3 Expected actions

The PHR processes the results according to application-defined rules.

4 Release notes

Release notes can be found on the functional design page.

5 Support

For questions and change requests regarding this IG, please create a ticket in BITS.