This topic is a starting point of a broad discussion, and perhaps a place to share ideas or already made templates on how to structure Covid-19 vaccinations in openEHR. There are archetypes available in the international CKM, but might need tweeking or spesialization. It is anticipated that there will be national requirements that has to be solved locally, but there is a hope that we at least can share a few general structures.
As per now, there will be no formal lead of the work, any volunteers are welcome.
I finally found time to work on the idea of specialising CLUSTER.medication to record vaccin information. I think it works pretty well. Only renamed some discriptions (some yet to be done). And added an element for ‘treated disease’. That could even make sense to be added to the parent archetype so that we don’t need this specialisation but could just do it in a template.
Interested to hear your feedback. openEHR-EHR-CLUSTER.medication-vaccin.v1.adl (80.9 KB)
@Paulmiller and I did something a little different which was to add the Target disease and some other elements that are required for public health reporting and vaccine certification to a specialisation of the ACTION.medication archetype.
This is the Vaccination record in the context of a Vaccination certificate template (in line with EU/WHO recommendations).
We think this will work pretty well. One thing that we have to capture and can be a bit confusing is
The target disease: ’ covid-19’
The generic vaccine medication name : ‘Covid-19 vaccine’ - e popped this under Medication name in the root ACTION.medication specialisation
The specific product name : ‘AstraZeneca Covid-19 vaccine’… this seemed to work under the CLUSTER.medication name
The immunisation protocol (not used in this template but might be something like ‘Covid-19 2 dose protocol’
One other thing that we needed to extend was the total number of expected doses in the protocol, which is not in the original meds archetype but perhaps should be.
I generally agree. I do think it’s more about immunisation to an infectious agent (e.g. immunisation against SARS-CoV-2) instead of a disease (COVID-19). But either could work. If we’d go for the ‘target disease’ I think you could specialise the ‘clinical indication’ element in ACTION.medication.
2 and 3 I had the same thought. But I think we have the same need for medications that are not vaccines. So I’d like to add elements for ‘generic name (Pfizer covid vaccin)’, ‘brand name (comirnaty)’ and ‘product name (flask of 3ml of pfizer covid vaccine, as a powder for injection)’.
agreed that information is most relevant in the protocol of an action and instruction. But we could make a field for ‘standard protocol’. This as well makes sense for many medications. e.g. antibiotics.
I would like to work this out on CLUSTER.medication because that can efficiently be reused in ACTION.medication, INSTRUCTION.medication_order OBSERVATION.medication/vaccination_statement and the new EVALUATION.medication_summary
Yes I also wondered about target disease vs. clinical indication but ‘target disease’ tends to be how the public health folks /WHO describe it and I suspect this may be more about reporting, so felt it better tp keep it separate from clinical indication.
The Medication clusters were designed to be nested to handle potentially complex detail or mixtures so
'‘brand name (comirnaty)’ and ‘product name (flask of 3ml of pfizer covid vaccine, as a powder for injection)’ could both be handled as separate Medication Clusters - BTW this is pretty well identical to the way that the FHIR Medicaiton resource works.
'‘brand name (comirnaty)’ and ‘product name (flask of 3ml of pfizer covid vaccine, as a powder for injection)’ could both be handled as separate Medication Clusters
how about nesting the comirnaty cluster in the product name cluster?
I do feel it has value to create seperate elements for generic name and brand name and product name, because they can have a different meaning and you want to be able to display a different variant of the name in the interface.
If target disease is the name of the element I would not put it under clinical indication either. But if you want to register the indication of the vaccine (immunisation against sars-cov2) that could very well go under clinical indication right? Or is that more a goal than an indication?
In the Immunisation summary archetype, we currently have ‘Infectious disease or agent’, which is the target
We need to be able to clearly manage recording #1 of a course of ‘n’ vaccinations, plus manage the textual status for ‘Booster’ - see CR-363 in CKM. It’s not as simple as a count, but maybe needs to be SCT coded as ‘first’, ‘second’, ‘booster’.
In addition, curious why you modelled the certification as an admin archetype. Is it possible or reasonable to add it as part of protocol? Does/could/will the vaccinator also do the certification or is this likely to be a secondary step by someone else?
We possibly need to handle this in a variety of ways.
For the SNOMED Coded values, the plan was to use the ‘Vaccination procedure’ element in protocol - as in the UK GP systems we would have things like ‘First Tetanus’, Booster tetanus’ that are really abut schedule management.
Vaccine Certificate as ADMIN_ENTRY.?
TBH a bit of an arbitrary choice. I guess we had seen this as something different to the vaccine recorditself but much of the official certificate dataset is essentially directly drawn from the record so I could easily be persuaded to add this to protocol.
Do we think directly into protocol or as a CLUSTER in case we end up with some variations? (Hope not but !!).
Has anyone else made any headway in terms of vaccination certificates?
We are slated to join the EC initiaitve and will need the following data points as discussed previously
(a) name: surname(s) and forename(s), in that order;
(b) date of birth;
(c) disease or agent targeted: COVID-19 (SARS-CoV-2 or one of its variants);
(d) COVID-19 vaccine or prophylaxis;
(e) COVID-19 vaccine product name;
(f) COVID-19 vaccine marketing authorisation holder or manufacturer;
(g) number in a series of doses as well as the overall number of doses in the series;
(h) date of vaccination, indicating the date of the latest dose received;
(i) Member State or third country in which the vaccine was administered;
(j) certificate issuer;
(k) unique certificate identifier.
Which currently feels like a mix of the immunisation summary, Medication management, Medication cluster.
I know within the EHR items like (a) & (b) would be captured elsewhere in the EHR (or is it ok to capture here for a certificate) but how would we capture (i), (j) & (k) a new archetype?
I have started playing around here, using @ian.mcnicoll’s template but feel my new archetype (Vaccination Certificate Details) is very much a bastardization.
Here’s my take on documenting the requirements for a Vaccination certificate… by extending the EVALUATION.Immunisation_summary (suitable for any vaccine or course) and creating a COMPOSITION for a Certificate.
I haven’t seen examples of content, but I would think that a recovery or test result certificate would be standalone documents, perhaps re-using the COMPOSITION I have proposed (and uploaded as a candidate to and incubator on CKM - Clinical Knowledge Manager.
The content would be purpose-specific, hopefully reusing existing content eg the OBS.laboratory_test_result etc.
I can also imagine that both the recovery and test result certificates could/should be linked to the Problem/diagnosis archetype for COVID, rather than a vaccination certificate. But I’m guessing without seeing the requirements…
Thanks Ian