Page History

imm recommendation

• Continuation of discussion with Clinical Decision support group in Baltimore. Considered Replace Imm rec with a general clinical decisions support resource. Or could consider as a request. Discussed in the Friday calls.
• Felt that immRecomendation still served a unique purpose, may lead to a medication request, but doesn’t need to. Made sense to leave as is.
• Get diagram from Nathan B.
  • Could result for a medication request for a specific vax.
  • Could result in no medication request because they completed their vax series.
  • What’s in stock, Population analysis, official school records, smart health link
  • Could result in a medication request, apt scheduled, med administration, change to history
• There is no aspect of the immunization recommendation would be a part of the clinical workflow. By the time you get to the workflow, it would be a medication request. The Imm rec would still require clinical review.
• Possibly include this diagram in an immunization module with some explanatory text, possibly under medication.
• Completeness is not currently in the medication request but is needed for imm recommendation. AS well as dates but these wouldn’t be necessary for the medication request itself. The imm recommendation might be general, like give a flu shot, where as the medication request is more specific.
• Need to consider social and clinical risk factors than may impact the forecast or recommendation (see pilot in TX with STC product making recommendations to FQHCs)
• The imm recommendation is listed a request pattern. The resource itself is reflecting several things and therefore the cardinality may not be one to one. So, we are struggling with listing this as a request. It seems to be a documentation of an outcome, but not an event itself. Documentation? Need to follow up with FHIR-I- is this a request pattern?
• Need to write up and get on a confluence page and discuss how to get in base spec eventually.
• May want to consider adding to the diagram other data inputs.

• The CDC Imm Implementation Guide is at release 1.5. Want to move to 1.6.
  • Plan to put in a PSS
  • Would stand up an IG working team
  • New guide would be an iteration of the 1.5 guide. Will stay in 2.5.1 spec and will try to accommodate whats needed in the community based on what’s been implemented. A lot of language improvements. Would possibly do a 1.7 guide and split stuff between the two.
  • Working to continue to ID gaps. Just because a gap is identified doesn’t mean that it will make it in 1.6. SISC (Standards and Interoperability Steering Committee) any one can join.
  • Will be following the PHL project management process and will be coming through the PH working group. Expecting conformance may be a co-sponsor.
  • Will discuss things like inclusion of SOGI inclusion... will have topic focus groups
  • Need to consolidate guidance documents.
  • Timeline-
    • PSS in spring, balloting in January

Other input: 

• • Occupational Health Clinics should not be presented with a full imm record because they are only authorized to see the vaccines associated with the work. Need to figure out where best to deal with this. May want to create a guidance on how to solve it and then consider for a future guide. What the clinic can see is based on their occupation/industry. Contact Ginny for more info.
    • Consider a smart on fhir ap?
  • Demonstration of smart health cards and interoperability with WHO and G20 (Wash)
    • Vocab standards we are using in US realm CVX codes don’t mean anything to others outside of north America?
    • This is discussed in the Imm group
    • Might be something worth considering for future guides

• • 6 week course
  • Starts Jan 25
  • Already have 200 participants
  • Will be very focused on VXU queries....
  • Last year they did a broad interop course and plan to do it again

• In ImmunizationEvaluation.description (optional eval notes, string) and ImmunizationRecommendation.recommendation.description (string, optional for each recommendation)
• IF they are expected to contain more and simple paragraph of text, then the data type should be markdown and not string. Its backwards compatible.
• Markdown and string don’t really have anything about you get the data in or out, it more about how you display.
• Reasonable suggestion.
• Disposition- persuasive with mod. Correction.
  • We agree that the data type for the .description data elements should be markdown opposed to string. AS well , when reviewing we found the short display and definition of the recommendation.description was incorrect and should be updated to read: Contains additional information about the recommendation.
  • Short display: Recommendation notes.
  • Motion: Keith moves to accept disposition as documented
  • Second: Eric
  • Vote: 23,0,0 voters

• Maturity levels for resources
  • All resources are assigned a maturity level
  • Imm- is currently level 3. Do we want to go to 4 or 5?
    • Its in IPS. Need to check with Belgium.
    • Want to move Imm to at least FMM 4 and eventually FMM 5 if we can verify use in a second country.
      • Update 11/19 - John Stamm verified that Immunization is use in Canada Netherlands and Finland - should meet the requirements for FMM5
  • ImmEvaluation- currently at 0
    • It is included in CDS.
    • Very new.
    • HLN has implemented for bulk data.
    • Want to move to FMM 1.
  • ImmRecommendation currently level 1
    • Implemented in multiple systems and QI Core. Have had substantive change and tracker items with 10 distinct implementer comments.
    • Want to move to 2 and potentially FMM 3 if we can confirm it meets the quality guidelines.
  • Advantage in moving- gaining faith in supporting

MOTION: Nathan motioned to approve maturity changes to:

• • • Imm to at least FMM 4
    • ImmEvaluation to at least FMM 1
    • ImmRecommendation to FMM 2

Keith-Second

VOTE: 22,0,0

• • Will evaluate for further maturity and possibly bring about a new vote later.