SARS-CoV-2 immunisation

Implementation Covid-19
#1

We are looking for a way to record SARS-CoV-2 immunisation. I found the following archetypes: https://ckm.openehr.org/ckm/archetypes/1013.1.1389/
https://ckm.openehr.org/ckm/archetypes/1013.1.1424
https://ckm.openehr.org/ckm/archetypes/1013.1.3727

But they are all drafts. We will need archetypes for this urgently, since immunisation may (hopefully) start next month. Is there an interest from the community to do this together? I’m thinking about an accelerated review process for those archetypes and creating SARS-CoV-2 immunisation templates.

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#2

Hi Joost,

Everyone wants vaccination archetype all of a sudden!!

It is actually more complex than first appears, especially when you get into vaccination scheduling.

This is the pattern that @Paulmiller worked up for Scotland

Note that it uses a specialisation of the ACTION.medication archetype, which I think is correct.

@heather.leslie took a different approach which was to template the ACTION.medication directly in the context of the IPS.

I think Vaccination merits a specific archetype but it is clearly ‘a medication action’ albeit with some extensions, so I think it is good candidate for a specialisation, even though it is not a pattern we use internationally all that often.

We can’t put off the debate any longer!!

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#3

I think vaccinations has multiple concepts, it’s an instruction/order (preventive) treatment procedure. It’s probably an action and/or activity. That concept is very similar to medication.

But there’s also the concept of immunisation status. Which is where I expect my use case to be: “who in my population is immune to COVID-19?”. Thit would better fit the EVALUATION.immunisation_summary archetype.
Conceptually immunisation status is different from vaccination procedure since you could also get immunisation from natural exposure to the agent (virus) or genetic variations or (medical/placental) transfer of antibodies apart from the procedure of artificial and controlled exposure to the agent (‘vaccination’).
The other way around is also possible: you can have completed the vaccination procedure, but no be immune.

For inspiration: the (Dutch) zib information models mostly care for the procedure concept: https://zibs.nl/wiki/Vaccinatie-v4.0(2020NL)

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#4

FYI: There’s an ‘editorial’ meeting planned for this Friday with @heather.leslie @ian.mcnicoll @varntzen.
And I’ll talk to @Paulmiller about his initiatives tomorrow:)

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#5

Yu - and sometimes this is expressly tested for, amd others typically childhood imss, it is just assumed.

The other axes are the need to handle the vaccine as a medication administration and potentially part of the full prescribing/supply cycle, and to handle the scheduling protocol process which is more like a procedure.

The FHIR Vaccination resource munges some of these together, which is appropriate for messaging but we also need to think about ‘inside systems’.

I agree re Immunisation summary but we would see this as somewhat separate, and probably easier. It is the nangle ment of vaccination as a process vs. vaccination as a meds administration which might be a bit more tricky.

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#6

The prevailing consensus up until now (personally, never comfortable with it) is that we should use Medication for vaccination and IV fluids. I welcome this time to review how best to model these three concepts and move them forward.

Covid-19 vaccination
#7

I see this as a care plan.
Vaccination requires a suite of archetypes to capture all the nuances…

  1. List item

Potentially when a child it born there is an Immunisation schedule added to their record. Each vaccine administration is recorded as an ACTION. The Immunisation summary can provide an overview about their immunisation status, and whether have they completed their primary course etc. Lab test results will indicate if antibodies are present at levels that will provide immunity, or not.

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#8

So (for pragmatic reasons) we are working on specialising https://ckm.openehr.org/ckm/archetypes/1013.1.4949
into ‘vaccine statement’.
What composition would be appropriate to base the template on?
I found:
vaccination list: https://ckm.openehr.org/ckm/archetypes/1013.1.1424/
health summary: https://ckm.openehr.org/ckm/archetypes/1013.1.1969
report: https://ckm.openehr.org/ckm/archetypes/1013.1.677
encounter: https://ckm.openehr.org/ckm/archetypes/1013.1.120
medication list: https://ckm.openehr.org/ckm/archetypes/1013.1.286

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