Immunization is an important component of preventive health care. Immunization information may be found on many different health information systems. Successful interoperable communication between these systems is required to optimize timely and appropriate immunization. HL7 has developed a number of artifacts which support this interoperability.

An Immunization Domain Analysis Model is available and is a document that is intended to paint a picture of the domain around immunization. This includes the types of immunization data important in clinical medicine and public heath, the interactions between health information systems regarding immunization which support these efforts. It seeks to provide a framework to support HL7 efforts in messaging, documents and services. The DAM was published as an informative document in May 2012. Since then, significant work has occurred in this domain. While must of the DAM remains relevant, some use cases and data elements may have evolved in the interim.

HL7 v2 Immunization Implementation Guide Release 1.0


This project aims to define how to generate and populate HL7 version 2 messages used to fulfill the data exchange use cases associated with immunization data. It defines message profiles which are used as the basis for building and consuming individual messages exchanged by interoperable systems. 

The most recent Meaningful Use/MACRA and EHR certification regulations reference Release 1.5 of the CDC/AIRA implementation guide. The Office of the National Coordinator (ONC) has expressed a strong preference to reference SDO balloted documents in regulation. The PHER work group has expressed a strong interest in balloting existing specifications referenced in regulations that are currently not HL7 balloted. This project will transfer the content of the existing non-HL7 balloted document to a new HL7-balloted document to meet these purposes. 

Previously released versions of the implementation guide are available from the CDC.

Project Description

Final ballot recon spreadsheet:

Published IG

STU Comment Page

Other Information

The immunization community is busy implementing Release 1.5 of the CDC published IG. It is Release 1.5 that is expected to be the gold standard in immunization interoperability for the foreseeable future.

The American Immunization Registry Association (AIRA) also maintains a number of interoperability technical documents in their Repository.

Immunization FHIR Resources


The Public Health WG is responsible for the creation and management of the immunization related FHIR resources. Currently, two such resources exist. The Immunization resource is related to a description of an immunization event. As of R4, the evaluation of an immunization event against a set of standard recommendations has been moved out of the Immunization resource and into a separate resource called ImmunizationEvaluation. The ImmunizationRecommendation resource is used to exchange data about recommendations for future doses of vaccine.

Project Links

[Project Description]

[Immunization Resource]

[ImmunizationRecommendation Resource]

ImmunizationEvaluation Resource

Other Information

Minor changes are being made for Release 5.

FHIR Forecast Implementation Guide


Clinical Decision Support for Immunizations is increasingly being used in health information systems to indicate which vaccinations a patient is due for next. Many of these expert systems are built as stand-alone systems that respond to web service requests. While these independent systems have similar requirements and outputs they use different web service standards. This project aims to create a common FHIR implementation guide that these expert systems may use to provide a common consistent interface. This common interface will be used for two main purposes:

  • Provide a common interface that NIST can use for testing and verifying that these CDS engines are working correctly. 
  • Provide a common interface that health information systems may write to and gain access to their choice of CDS engines. 

Project Links

Project Description

Current Build of FHIR IG

Other Information

CDS Hooks is a related effort that proposes a standard for integrating Clinical Decision Support into clinical workflows. This project will coordinate its efforts with the CDS Hooks project to ensure the final solution is consistent with the larger vision of clinical decision support.

The first publication of the STU IG is expected in late Summer of 2020.

Phase 2 of the project will look at inclusion of clinical data in the operation (eg problems/conditions, occupational data, pregnancy status, etc) to allow for a more personalized forecast.

The project team meets Fridays from 11-12 Eastern. Please contact Craig Newman or Nathan Bunker if you'd like to participate.

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