Covid-19 vaccination

Hi, everyone

I realised I started this topic, and just disappeared. Shame on me! :crazy_face:

I think both Ian’s and Heather’s template will work. And Ian’s is already in use, I suppose. My comments:

First, the COMPOSITION:

I like the new Certificate COMPOSITION, as linked to the CKM above . There are a lot of use cases for certificate: Death certificate, Birth certificate, Medical condition certificate (i.e. needing assistance), Medication certificate (i.e. bringing opioid medications with you abroad and prevent you from being arrested for drug traffic), Vaccination status, Stating you are fit to (still) drive a car, etc. Keeping certificates apart from other COMPOSITIONS is a wise thing to do, IMO. Likewise to add elements relevant to the certificate within that context is a good idea, i.e. the certificate issuer, validity, …

I don’t know if it should be only one general certificate COMP, and specialize them, or having more specific certificate COMPOSITIONS. Any thoughts on that?

Secondly, EVALUATION.Immunisation_summary vs ACTION.medication-vaccination:

I see that the health service provider need an ACTION to record that a specific vaccine has been given. I might demonstrate my lack of understanding, but is it the ACTON that leads to the vaccination certificate? The ACTION.medication is for recording a given medication, regardless of if it is a vaccine or another product. It even says so in the Concept description.

Shouldn’t the ACTION populate a persistent archetype which keeps track of which number in a (potential) sequence of jabs, and when the next vaccination is due? This is what the EVAL.Immunisation_summary does.

It would be nice to agree upon how to deal with vaccinations within the community. I fear that implementations are deviating, and will cause trouble later.

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Hi Vebjørn,
Thank you for bringing up these good questions. Late last year we tried to get a common approach to vaccinations of the ground just before covid started. But in the end everybody did his own thing with only loos correlation. I for Nedap created a quick and dirty archetype. The only semi decent pattern is it uses a “covid vaccine” CLUSTER that specialises CLUSTER.medication (it includes Dutch batchid valuesets and rules to set the manufacturer name based on the valueset). With my current level of understanding maybe this should have been a template cluster.
What we can learn from this is using medication.cluster can work for a vaccination usecase.

Furthermore I’d like to share that I’m concerned about the certificate based on EHR data. Especially if it has legal status (not just health information for other caregivers), as it does in the Netherlands and many other countries. This fundamentally changes/adds to the usecases of the EHR data. And I’m concerned that it will impact the way we uses the EHR since it’s no longer just used to record information to the benefit of the individual patient. Please let me know if my concern resonates, I’m struggling to explain it😅
I guess we can’t (shouldn’t) be against secondary use of the EHR data, but let’s think carefully before adding certificates to the EHR.

Leaving that for now, semantically I think you’re right the process should be vaccination action → immunisation evaluation → immunisation certificate composition. Maybe it’s possible to generate a evaluation based on a decision logic that takes (only) the action into account. But sementicaly you’re interested in the immunisation status, not the vaccination action. Although the difference for covid is non existent atm for the certificate. But for other vaccinations eg hep b it’s common to judge the immunisation status with a blood (antigen titer) test, not just the action.

https://github.com/nedap/archetypes/blob/master/COVID/openEHR-EHR-CLUSTER.covid_vaccin.v1.38.0.adls

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Hi Joost
Thanks for your support and views!

Excactly, thank you for wording that better than I did!

I guess that will vary between legislations. If there is a need to issue a “certificate-like” statement from a clinician, and from the EHR, then we should provide a COMPOSITION for that. And if it is not suitable in a country, then don’t use it. Mayby the name “certificate” is the issue here? We can change to something different, if it helps. “Medical statement” or similar?

I guess how and by whom issuing of COVID-19 certificate is done, is different between countries. In Norway it’s issued from a “Core EPR” run by a governmental organisation, which recieves messages from different parts of the health system. Nevertheless, all data has to be captured , stored and sent from each potential health service provider. Whether this is sent using a “Certificate” COMP, or “Medical statement” COMP, or simply by creating a message directly from ACTION and/or OBS and/or EVAL archetypes is not important. Either way will work, AFAIK. But it will be easier to trace what has been sent if it is within a COMPOSITION. Any vendor, please correct me if I’m wrong.

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And yes, I do remember. Everyone suddenly got very busy! I think the next pandemic should be better planned. I suggest that it will be notified at least one year ahead, so we can prepare better :wink:

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My concern is more about the goal and context of a certificate, e.g. a covid vaccination certificate is used to allow e.g. entrance to restaurants (in the Netherlands) and should be issued by a (government) authority. Stuff like chain of evidence, verifiability, trust in the authority etc is very important in that context. And moreover it’s very black and white. It’s either valid or invalid, while most of the info in the EHR is on a much more subtle scale between true and not true.
The goal of the EHR is to record information used to care for an individual. And I’m concerned that the requirements for a legal piece of evidence will interfere with that main goal of the EHR.

Ho Joost,

That’s a perfectly reasonable cultural perspective, but AFAIK, in the UK the source of truth is ultimately the original vaccination record or Covid test record, which would , at least in the UK, definitely be stored in the EHR (may be cached elsewhere).

And it 's not just vaccination info that is ‘black and white’, at least in terms of decision support. As an example UK Covid shielding/ vaccination prioritisation was very largely based on coded diagnosis entries in GP systems.

I’m not against an approach that has a specific certification composition but in other contexts in can imagine that this may be ‘assembled’ dynamically from the core EHR records, albeit via s specific service which ‘assures’ the certification.

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Hi Joost,
I’ve been down with a airway infection some days, haven’t seen your reply until now. Sorry. Regarding:

Yes, you are of course right, with the primary goal of the EHR. However, information from the EHR serves, or can serve, more purposes, Secondary use, i.e. local or national registries, de- or pseudoanonymized data for research, and - in some countries for different types of “certificates”. What the owner of the data actually uses the data for, is up to local regulations and implementations to decide. I really don’t see the problem of facilitating compositions for certificate-like usecases.

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Yep. Data of both vaccination and test results are “born” in various EHR-systems in Norway as well, and fed to a central hub (“Core EHR”), and the certificate is issued by it. I guess it will be something similar in other countries as well.

I think this COMPOSITION archetype has a potential for broad re-use in all sorts of certificates, for example death certificates. My only real question about it is about the ‘Vaccinated individual’ SLOT which I don’t understand the purpose of.

@siljelb it was created to facilitate a mock up (for us) , but would not be necessary in real world usage in the CDR.