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Quarter: Q1 10:00 AM - 11:30 AM ET

Chair: Craig Newman

Scribe: Danny Wise

Immunization Round Table

Discussion items

10 min.FHIR Resource MaturityCraig Newman
  • update from FHIR-I:
    • working on "interim" R4B for 2021
    • R5 expected for ballot in 2022
  • PHWG has been getting and handling feedback about the immunization-resources, but there doesn't seem to be anything critical for R4B that can't wait for R5
  • we may want to consider advancing the maturity of the resources
    • ImmunizationEvaluation is new as of R4 so still has maturity 0 – can probably advance to 1
    • ImmunizationRecommendation currently at 1, can it advance?
  • challenging to measure adoption levels – who is implementing them?
  • Mark Kramer – FHIR endpoints are routinely polled by Lantern for capabilities
  • Immunization resource is exchanged for clinical care outside of Public Health, and Public Health itself hasn't widely adopted FHIR
    • Craig mused whether the PHWG was really the appropriate owner of the Immunization resource – would Pharmacy be better?
    • Public Health does have unique needs to be considered for the resource definition
    • Public Health has domain expertise for immunizations even if limited FHIR experience
  • Craig will follow up with Lloyd McKenzie / FHIR-I to come to a PHWG call to further discuss maturity and next steps
15 min.CDS FHIR IG UpdateNathan Bunker
  • this IG is intended to be used "under the cover" between IIS and CDS engines
    • there is still a V2 exchange between EHRs and IIS
    • CDS results returned to IIS as FHIR would be repackaged into V2 RSP to send back to querying EHR
    • goal is to standardize how IIS interoperate with 3rd-party CDS engines
  • initial intent was to publish with FHIR R3 and for International
    • have since updated to FHIR R4
    • also moving to US Realm only since there has been no international participation
      • this is causing tooling issues for publication – waiting for Grahame's feedback before next steps
    • Amit – why not stay as International?
    • Nathan – a lot of the previous ballot feedback has been about adopting US Core, but may warrant reconsideration
  • project is currently in brief hiatus due to COVID-19 and availability of Public Health resources
    • Lori – shouldn't COVID-19 provide more urgency?
    • Genny – there are discussions at CDC about prioritizing resources for projects like this
  • looking ahead – want to add support for patients with special conditions
    • Craig – what about travel history, travel plans, OHD Observation profiles, etc?
    • Nathan – there is a question about where the complexity should be added
      • should EHRs submit that additional data to IIS so that the CDS engines can factor it in?
      • or should the IIS return what it knows and let the EHR sort out the additional factors?
    • Amit – we need to better understand use cases and business drivers to take on additional complexity, else the buy-in will be low
15 min.AIRA SISC Small Group ProgressNathan Bunker
  • AIRA's Standards & Interoperability Steering Committee (SISC) has generated several small groups to address needs for additional guidance documents created by COVID-19
    1. patient priority groups for receiving COVID-19 vaccine and other emergency situations (e.g., Texas is interested in the context of hurricane season)
      • initial guidance document expected to be published on AIRA website next week
      • can reconvene small group if additional work becomes urgent
    2. serology / immunity results for COVID-19
      • is it enough to know positive results?
        • for dengue fever, negative results are needed too because that's an indication to immunize – positive serology should not be immunized
      • still waiting for new SNOMED codes for COVID-19 serology
      • can reconvene small group if additional work becomes urgent
    3. error codes in ACKs
      • defining specific error codes so EHRs / providers can make them actionable and ultimately improve data quality
      • IIP Collaborative has its own project about improving ACK outcomes; SISC's project is specifically to define more codes
      • Amit – are some codes being deprecated?
      • Nathan – there doesn't seem to be a current use case for deprecating codes
      • Danny – current code set is fairly minimal anyway
    4. Immunization Forecast
  • AIRA has found with previous guidance documents that implementations are not consistent
    • in addition to the guidance documents themselves, the small groups are charged with creating test cases and / or technical demonstrations (similar to Connectathon) to ensure consistent implementations
10 min.USCDI / ONDECChrissy Miner
  • CDC CSELS submitting ONDEC proposals to include the following data elements in USCDI:
    • date of vaccination
    • administered vs. historical
    • mother's maiden name
    • next of kin name
    • next of kin relationship
  • these data elements are already supported for V2 VXUs and required for EHR certification – including them in USCDI will keep it as rich and harmonized as possible
    • also may be other sources of immunization data than certified EHR products
  • Craig – anyone can submit ONDEC proposals; ONC might pay more attention to certain requests if there are multiple similar submissions
20 min.FHIR resources for improved value set updatesLori Reed-Fourquet
  • previous discussions with Rob Snelick / NIST regarding NIST's FHIR server tooling – how to synchronize systems when value sets (e.g, CVX codes) are updated?
  • can vendors use a FHIR service to deploy value set updates?
  • IHE has a FHIR profile for sharing value sets –
  • Amit – it's more complex that simply adding new CVX codes
    • also need to know descriptions, relationships with other data elements (e.g., mapping to NDCs, Vaccine Information Statements)
  • Danny – CDC has Vaccine Code Set Management Service with similar intent
  • Danny – other medical terminology service vendors (e.g., IMO, Wolters Kluwer) should be involved in discussions of vaccine code set updates
    • already existing pathways for terminology distribution that may be able to be leveraged for immunization-specific codes too
10 min.Historical vs. Newly Administered Data RequirementsLori Reed-Fourquet
  • IG includes conditionality for a number of fields based on historical vs. newly administered
    • for historical records, those fields are typically optional
    • for newly-administered records, they may be R or RE instead
  • "historical" doesn't mean "old," but in some cases old records may be marked as historical if every required data element wasn't captured at the time
  • Craig – what should "historical" represent when the sender is not the source of the data?  E.g., in RSPs from IIS, or when the IZ Gateway Share component forwards data to other jurisdictions?
    • if the sender is not the source, should the record always be historical even if it represents an actual administration event?
  • Nathan – "historical" vs. "newly-administered" is effectively a confidence indication
10 min.IIP Collaborative Update / QuestionsAmit Popat
  • most of the challenges with immunization data exchange these days seem to be more a matter of implementation than standards
  • CDC, AIRA, and IIP Collaborative have been tackling some of these implementation issues
  • what is the role of the HL7 Public Health Work Group?  at this point, the immunization standards are fairly mature and widely adopted (and / or "locked" by regulation)....
  • Danny – a lot of the same folks are involved in the different groups
    • important to be mindful not to duplicate work between groups
  • Amit – can a CDC roadmap be published for future changes coming out of IIS so that EHR vendors can be aware and plan accordingly?
  • Stuart – discussions about roadmaps have been on-going but have recently been sidelined somewhat due to COVID-19