Quarter: Q4

Discussion items

15 min.Exchange of Data for Breakthrough CasesHeather Patrick
  • FDA was asking about collecting data for breakthrough cases (positive COVID-19 cases for fully vaccinated individuals)
  • Nathan: AIRA hasn't heard anything from the IIS community about wanting to collect COVID-19 lab test results, etc. directly
  • Some payers do query IIS to capture immunization data and consolidate it with other clinical data
  • Erin: Tennessee DOH queries their IIS (using HL7 V2) from their ELR surveillance system to identify breakthrough cases
  • On a separate ELR thread, there was some discussion about adding AOE questions about vaccination status to COVID-19 lab test orders, but the ELR community was concerned about the feasibility of widely adopting this
  • AMS: the Los Angeles County HIE (LANES) queries CAIR to store immunization data with the patient's record and include it in CCDs
5 min.Expanding Value Sets in V2.5.1 IGLori Reed-Fourquet
  • Discussions within IIP about expanding SNOMED value set for adverse reactions
  • Other value sets are expected to change regularly, e.g., CVX, MVX
  • Since the V2.5.1 IG is owned by CDC and not balloted through HL7, it's probably better to discuss this within AIRA's Standards and Interoperability Steering Committee (SISC)
10 min.Recommendations Based on Additional Clinical DataLori Reed-Fourquet
  • Currently CDSi recommendations are only based on a patient's age, gender, and previous immunization history
  • Better recommendations could be made based on other clinical details, e.g. lab results, social determinants, occupation, travel history, etc.
  • Some preliminary discussions previously occurred about this in the context of the Immunization CDS FHIR IG
  • Would be a good topic to discuss further during the Fri. Immunization Discussion Group calls (which were just updated to a biweekly cadence)
5 min.SMART Health Cards QuestionNathan Bunker / Max Masnick
  • What happens if a patient gets multiple cards from different sources?  How to determine which one to verify?
  • Max: next steps for the SMART Health Cards IG are to expand on the verification implementation experience
    • including verification of other diseases beyond COVID-19
10 min.AIRA UpdatesNathan Bunker
  • SISC Small Groups being convened:
    • Guidance for printing VCI barcodes on IIS-generated PDFs
      • including full immunization history (not just COVID-19 vaccines)
    • Querying IIS for PDF ("Certificate of Immunizations")
      • develop a standardized methodology (e.g., a possible FHIR use case?)
    • Querying IIS via FHIR
      • New, non-traditional partners may not want to develop V2 QBP / RSP interfaces
      • Inter-program (e.g., ELR to IIS) / inter-jurisdictional data sharing
    • ERR-5 error codes – waiting on IIS vendor implementations to re-engage and finish previous work
  • Let Nathan know if you're interested in participating in any of these
  • AIRA is also working on a technology improvement plan, including standards advancement (e.g., FHIR)
5 min.NIST UpdateRob Snelick
  • NIST has added a new "IZ COVID-19 Test Plan" (separate from the "ONC 2015 Test Plan") in the Context-Based section of the Immunization Test Suite
  • Similar to existing ONC 2015 certification test cases but with a few differences:
    • COVID-19-specific codes
    • EUA fact sheets instead of VIS
    • dose number in series
    • status in series
10 min.Process / Need for Updating V2.5.1 IGRob Snelick
20 min. Newman

FHIR-27018 - Getting issue details... STATUS

  • Historically, we've tried to harmonize the Immunization resource with MedicationAdministered (for newly administered immunizations) and MedicationUsage (for hsitorical records)
  • For R5, the Pharmacy WG updated the "medication" element in MedicationAdministered and MedicationUsage to be a CodeableReference that can point to a Medication resource
  • Should we similarly update the "vaccineCode" element in the Immunzation resource to be a CodeableReference that can point to a Medication resource?
  • Issue: both Medication and Immunization have simliar elements that could be duplicated (or worse, different values between 2 linked resources):
    • lotNumber
    • expirationDate
    • manufacturer / marketingAuthorizationHolder
  • If we remove these elements from Immunization to avoid any discrepancy, that would require that a Medication resource always be included (even as a contained resource) to convey these data elements
  • Previous suggestion from FHIR-I was to leave vaccineCode as-is but provide appropriate narrative explaining proper usage
  • Group was amenable to changing vaccineCode to CodeableReference to allow flexibility, but felt it was best to leave lotNumber, expirationDate, and manufacturer in the base Immunization resource
    • further constraints can be added by profiling (e.g., US Core)
5 min.Immunization Resource FMM valuesCraig Newman
  • FHIR-I is pushing to advance the maturity of the Immunization Resource to normative
  • Group felt advancing to FMM-5 was reasonable in the timeframe of R5 but not normative
    • Nathan: would like to see adoption of FHIR by IIS before being OK with normative