Immunization Registry Content

Introduction

This is a draft of the Immunization Registry Content Profile (IRC) supplement to the PCC Technical Framework. This draft is a work in progress, not the official supplement or profile.

Profile Abstract

The Immunization Registry Content Profile (IRC)

Glossary

Immunization Information System (IIS)

Definition

Issue Log

Open Issues

1. If we include POIZ in the Immunization Summary, there are two approaches: (1) make sure all the POIZ elements have counterparts in CareRecord; (2) propose changes to CareRecord that incorporate the syntax of POIZ in CareRecord. Is the latter out of scope to this exercise?
2. Can we rename the profile to not include the word "registry" - i.e. Immunization Content or Immunization Information System Content? Immunization registries are trying to get away from that phrase and instead call themselves Immunization Information Systems. Also, the word "registry" implies a Central Data Repository model; this content profile can be used for applications reaching beyond that model.
3. Should any mention of V2 content be included here? The plan is not to, but on the other hand, where then will it be included?

Responses:

1. The overarching issue which can be discussed in Phoenix at HL7 is the harmonization of messages and documents. The developer does not want to have to translate one to the other, even if all the elements in the one match the elements in another. A precedent was set for this by CCD. However this may be out of scope to our current exercise.

Closed Issues

1. What PCC templates should be used?
2. In what order should the specified templates appear?
3. How will codesets be specified?
4. What happens if two consecutive messages have conflicting content?
5. Can we include the HL7 V3 Immunization message (POIZ) in the Immunization Summary so as to harmonize with POIZ?
6. If we don't include POIZ in the Immunization Summary, how do we get the important elements that are currently missing from the immunization template included, for example, the person who gave the shot?

Resolution

1. Immunizations, Allergies & Intolerances, Vitals, Medications, Past Medical History, Problems
2. Order does not matter. This is the precedent from other content profiles.
3. IHE may leave codesets to implementation, following HITSP recommendations, etc. Keith: IHE profile should leave it somewhat open, but U.S. realm would use CVX codesets for immunizatons, and ICD9 or SNOMED for problems or allergies. But for realms outside U.S. codesets could and would be different.
4. This will be handled in the integration profile.
5. It appears that all the POIZ elements are currently included in CareRecord, but this needs to be checked in detail. This has been done by Keith and will be looked at further in Phoenix by authors of POIZ. So far no major show-stoppers have surfaced. Most differences include items that are introduced in POIZ but not necessarily in use in installed bases. Base IZ class includes activity time and uncertainly code, not reflected in CR. POIZ includes more support in the protocol area (which is related to decision support), also a new area.
6. CareRecord can include person who administered vaccine in Performer role. That would amount to an update to the current immunization template.

Volume I

Add the following bullet to the list of profiles

• Immunization Registry Content - The Immunization Registry Content profile identifies the data to be sent to Immunization Registries

Dependencies

Add the following row(s) to the list of dependencies

Integration Profile	Dependency	Dependency Type	Purpose
Immunization Registry Content

Profile Name

The Immunization Content Profile (IISC)

The Immunization Content Profile (IISC) provides a template for exchanging immunization data.

Immunization data includes two types of content:

1. information about vaccines
2. care provision information required in making decisions about vaccines

Thus, IISC draws from two HL7 Version 3 message paradigms: Care Provision and Immunizations. (Something about how CareRecord and POIZ harmonization is resolved.)

It seems there are two cases: one where just the immunization summary is passed and the other where the entire CareRecord is passed.

Should we include: To provide for compatibility with the U.S. installed base of Immunization Information Systems (IISs), or Immunization Registries, HL7 Version 2 content is also included.

The IC Profile is also intended to pave the way for content to be passed to immunization-related decision support services. This however is out of scope for the 2007-2008 year and is on the IHE roadmap for the future.

Use Cases

Use Case Name 1

EMR system queries IIS for Immunization Summary only. Elaborate.

Use Case Name 2

One or more paragraphs describing a clinical scenario.

Actors/Transaction

There are two actors in this profile, the Content Creator and the Content Consumer. Content is created by a Content Creator and is to be consumed by a Content Consumer. The sharing or transmission of content from one actor to the other is addressed by the appropriate use of IHE profiles described below, and is out of scope of this profile.

Immunization Registry Content Actor Diagram

Options

Immunization Registry Content Options

Actor	Option	Section
Content Consumer	Immunization Summary Option (1) Care Record Option (1) HL7 V2 Option (1)	PCC TF-1: X.X.X PCC TF-1: X.X.X PCC TF-1: X.X.X
Content Creator	Immunization Summary Option (1) Care Record Option (1) HL7 V2 Option (1)	PCC TF-1: X.X.X PCC TF-1: X.X.X PCC TF-1: X.X.X

Note ¹: The Actor shall support at least one of these options.

Content Modules

Content modules describe the content of a payload found in an IHE transaction. Content profiles are transaction neutral. They do not have dependencies upon the transaction that they appear in.

Process Flow

More text about process flow

Actor Definitions

Actor

Definition

Transaction Definitions

Transaction

Definition

Volume II

Immunization Registry Content Content

Standards

Implementation Guide for Immunization Data Transactions Using V 2.3.1 of the Health Level Seven (HL7) Standard Protocol

Implementation Guide for Immunization Data Transactions Using V 2.3.1 of the Health Level Seven (HL7) Standard Protocol.

HSSP Retrieve, Locate and Update Service

Implementation Service Functional Model (SFM), balloted HL7 Draft Standard for Trial Use (DSTU) HL7.

HSSP Retrieve, Locate and Update Service

Initial submission to OMG includes a profile that demonstrates immunization data retrieval and update in conformance to SFM

HL7 V3 Immunizations (Click on Universal Domains, Immunizations)

HL7 Version 3 Standard: Immunization, Release 1 DSTU Ballot 3 - May 2008

HL7 V3 Care Provision (Click on Universal Domains, Care Provision)

HL7 Version 3 Standard: Care Provision, Release 1 Last Ballot: DSTU Ballot 3 - September 2007

Data Element Index

Immunization Registry Content Data Elements

Data Elements	Other Reference	LOINC Section or CDA Element
Data Element 1
Data Element 2
Data Element 3

Document Specification

Immunization Registry Content Constraints

Data Element	Opt	Section	Template ID
Data Element 1	R		1.3.6.1.4.1.19376.1.5.3.1.3.X
Data Element 2	R2		1.3.6.1.4.1.19376.1.5.3.1.3.Y
Data Element 3	O		1.3.6.1.4.1.19376.1.5.3.1.3.Z

Section Template 1

TemplateID	1.3.6.1.4.1.19376.1.5.3.1.3.X
Parent Template	1.3.6.1.4.1.19376.1.5.3.1.3.Y
General Description	This section shall ...
LOINC Code	Opt	Description
#####-#	R	Description
Entries	Opt	Description
1.3.6.1.4.1.19376.1.5.3.1.4.A	O	Description
Sub-sections	Opt	Description
1.3.6.1.4.1.19376.1.5.3.1.3.D	R	Description

Header Template 1

<entry>An XML Example</entry>

entry

Description of the entry element.

Entry Template 1

<entry>An XML Example</entry>

entry

Description of the entry element.