Stream: smart/health-cards
Topic: Vaccination exemptions IG
Max Masnick (Feb 28 2022 at 15:57):
VCI has a draft IG for vaccination exemptions. The GitHub repo is here -- issues and pull requests are welcome!
Michael Turman (Feb 28 2022 at 17:12):
Do the systems that Issue SHCs also capture vaccine exemption data in a structured, uniform way? I am following up with some SMEs to see how Cerner might record this - but my initial reaction is that this is not feasible to implement for many Issuers (i.e. do state IIS receive vaccine exemption data on individuals?)
Josh Mandel (Feb 28 2022 at 17:27):
It's likely that this will only be practical (and useful) in jurisdictions with fairly centralized and consistent public health support for documenting exemptions. Our documenting this was driven in large part by feature requests from Canada, where those conditions hold.
Michael Turman (Feb 28 2022 at 23:14):
Following up with some more info on how Cerner represents the concept of a 'vaccine exemption'.
Clinical Workflow:
A provider can document a vaccine does as 'not given' or 'not done' for a variety of reasons. This primarily exists to inform the patient's immunization schedule (e.g. the patient is currently sick with the flu, so XYZ vaccine is being postponed until the next visit). When documenting that a vaccine was not given, the provider documents a Type and Reason against an Immunization (e.g. COVID19, DTap, etc). Type may include entries such as 'Contraindicated', 'Refused', or 'Unnecessary', with a corresponding Reason that flexes by Type, such as 'Current Acute Illness' or 'Patient Currently Pregnant'.
Immunization records documented as 'not given' can be sent to an IIS but this is variable by healthcare provider and the state IIS. Not all states ISS in the US accept records for 'not given'.
Data Representation:
In Cerner, Immunization records documented as 'not given' are returned as a FHIR Immunization resource. These records have a status of 'not-done' with a corresponding statusReason code.
Below is an example response for a patient with their COVID immunization recorded as 'refused'.
{
"fullUrl": "https://fhir-ehr.cerner.com/r4/nya9mWd9vqI_z1LcF5uLfCwewAGCVrY1/Immunization/M30182295",
"resource": {
"resourceType": "Immunization",
"id": "M30182295",
"meta": {
"versionId": "1",
"lastUpdated": "2022-02-28T14:11:11-06:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Immunization</b></p><p><b>Vaccine</b>: SARS-CoV-2 (COVID-19) AstraZeneca vacc</p><p><b>Occurrence</b>: Feb 28, 2022</p><p><b>Patient</b>: GLAZA, THOMAS</p><p><b>Status</b>: Not Done</p><p><b>Status Reason</b>: Postpone due to refusal</p><p><b>Organization</b>: Baseline West Primary Care Clinic</p></div>"
},
"identifier": [
{
"system": "https://fhir.cerner.com/ceuuid",
"value": "CE4d4104c0-5fd3-43b6-8fb3-0e9680f3cfcd-30182295-2022022820111100"
}
],
"status": "not-done",
"statusReason": {
"coding": [
{
"system": "https://fhir.cerner.com/nya9mWd9vqI_z1LcF5uLfCwewAGCVrY1/codeSet/30441",
"code": "688466",
"display": "Postpone due to refusal",
"userSelected": true
},
{
"system": "http://snomed.info/sct",
"code": "12661000175102",
"display": "Temporarily refused (qualifier value)",
"userSelected": false
}
],
"text": "Postpone due to refusal"
},
"vaccineCode": {
"coding": [
{
"system": "https://fhir.cerner.com/nya9mWd9vqI_z1LcF5uLfCwewAGCVrY1/codeSet/72",
"code": "731783247",
"display": "SARS-CoV-2 (COVID-19) AstraZeneca vacc",
"userSelected": true
},
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "210",
"display": "SARS-COV-2 (COVID-19) vaccine, vector non-replicating, recombinant spike protein-ChAdOx1, preservative free, 0.5 mL",
"userSelected": false
}
],
"text": "SARS-CoV-2 (COVID-19) AstraZeneca vacc"
},
"patient": {
"reference": "Patient/4314314",
"display": "GLAZA, THOMAS"
},
"occurrenceDateTime": "2022-02-28",
"primarySource": true,
"performer": [
{
"actor": {
"reference": "Organization/667844",
"display": "Baseline West Primary Care Clinic"
}
}
]
},
"search": {
"mode": "match"
}
},
Josh Mandel (Feb 28 2022 at 23:49):
This detail is super helpful! It raises for me a clear distinction between an immunization that was not given (and a record of such) versus an exemption from immunization which to a first approximation is established by public health or by a patient's circumstances meeting definitions from public health. Exempt implies exempt from some sort of requirement, rather than just the fact that immunization was not given.
Max Masnick (Mar 01 2022 at 15:30):
Thanks -- we can note this distinction in the IG
Paul Denning (Mar 01 2022 at 16:19):
Note that QI-Core has a profile for Immunization Not Done http://build.fhir.org/ig/HL7/fhir-qi-core/StructureDefinition-qicore-immunizationnotdone.html
Nathan Bunker (Mar 03 2022 at 23:03):
Just adding a little bit of information for exemptions in the US. At the American Immunization Registry Association we have seen no requests from our states or other jurisdictions to represent exemptions in Smart Health Cards. So we are supportive of having this capability but don't see any need in the US for implementation. If anybody knows of someone in the US implementing, it would be great to know.
I can also concur with the discussion on the important difference between not-administering and exempt. We have the concept of "refusals" in the US, and that has been somewhat developed. But we haven't created any standards for documenting or tracking exemptions.
Last updated: Apr 12 2022 at 19:14 UTC
