Id: IMMZD5DTMeaslesContraindications Url: IMMZ.D5.DT.Measles contraindications Version: 0.2.0 Title: IMMZ.D5.DT.Measles contraindications Status: draft Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule Date: 2026-03-03 13:07:11+0000 Publisher: WHO Description: IMMZ.D5.DT.Measles contraindications IMMZ.D5.DT.Measles contraindications Knowledge Capability: computable Related Artifacts: References WHO recommendations for routine immunization - summary tables (January 2025) Libraries: IMMZD5DTMeaslesContraindicationsLogic Actions: Check for contraindications before administering the vaccine(s) due: Contraindication for measles immunization If: Applicability: Measles vaccination contraindicated (Measles vaccination contraindicated) Then: Definition: IMMZD5DTMR Dynamic Values: id: (Draft Medication Request ID for Measles dose) medication: (Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE9', display: 'Measles-containing vaccines' } }, display: 'Measles-containing vaccines' }) Check for Guidance for the patient regarding IMMZ.D5.DT.Measles contraindications.: Show Guidance for the patient regarding IMMZ.D5.DT.Measles contraindications. If: Applicability: Has Guidance (Has Guidance) Then: Definition: IMMZ.D2.DT.CR Dynamic Values: status: ('active') payload.contentString: (Guidance) category.coding: (Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }) priority: (Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' })
/* @internal: Potential contraindications observations */ define "Potential contraindications": ([Observation: Concepts."Potential contraindications"]).complete()
/* @internal: Observation for currently pregnant */ define "CI Currently pregnant Observation": "Potential contraindications" O where O.value ~ Concepts."CI-Currently pregnant"
/* @internal: Observation for currently pregnant */ define "CI Currently pregnant Observation": Elements."CI Currently pregnant Observation" O where O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or after Today - 9 months
/* @internal: Condition for currently pregnant */ define "CI Currently pregnant Condition": [Condition: Concepts."CI-Currently pregnant"]
/* @internal: Condition for currently pregnant */ define "CI Currently pregnant Condition": Elements."CI Currently pregnant Condition" C where C.prevalenceInterval() includes Today
define "Pregnancy Status Observation": [Observation: Concepts."Pregnancy status"] O where O.status in { 'final', 'amended', 'corrected' }
define "Pregnant Observation": "Pregnancy Status Observation" O where O.value ~ Concepts."Pregnant"
define "Pregnant Observation": Elements."Pregnant Observation" O where O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or after AsOf - 9 months
/* @input: The client is pregnant @pseudocode: "Potential contraindications" = "Currently pregnant" */ define "The client is pregnant": exists "CI Currently pregnant Observation" or exists "CI Currently pregnant Condition" or exists WE."Pregnant Observation"
/* @input: The client is pregnant @pseudocode: "Potential contraindications" = "Currently pregnant" @code: The client is pregnant-52 @decision: IMMZ.D5.DT.Measles contraindications */ define "The client is pregnant": Encounter."The client is pregnant"
Measles vaccination contraindicated Case 1
/* @output: Measles vaccination contraindicated Case 1 @pseudocode: "Immunization recommendation status" = "Contraindicated" */ define "Measles vaccination contraindicated Case 1": Encounter."The client is pregnant"
CI Severely immunosuppressed Observation
/* @internal: Observation for Severely immunosuppressed */ define "CI Severely immunosuppressed Observation": "Potential contraindications" O where O.value ~ Concepts."CI-Severely immunosuppressed"
/* @internal: Observation for Severely immunosuppressed */ define "CI Severely immunosuppressed Observation": Elements."CI Severely immunosuppressed Observation".encounterOrOnBefore(EncounterId, Today)
/* @internal: Condition for Severely immunosuppressed */ define "CI Severely immunosuppressed Condition": [Condition: Concepts."CI-Severely immunosuppressed"]
/* @internal: Condition for Severely immunosuppressed */ define "CI Severely immunosuppressed Condition": Elements."CI Severely immunosuppressed Condition" C where C.prevalenceInterval() includes Today
/* @input: The client is severely immunosuppressed @pseudocode: "Potential contraindications" = "Severely immunosuppressed" */ define "The client is severely immunosuppressed": exists "CI Severely immunosuppressed Observation" or exists "CI Severely immunosuppressed Condition"
/* @input: The client is severely immunosuppressed @pseudocode: "Potential contraindications" = "Severely immunosuppressed" @code: The client is severely immunosuppressed-59 @decision: IMMZ.D5.DT.Measles contraindications */ define "The client is severely immunosuppressed": Encounter."The client is severely immunosuppressed"
Measles vaccination contraindicated Case 2
/* @output: Measles vaccination contraindicated Case 2 @pseudocode: "Immunization recommendation status" = "Contraindicated" */ define "Measles vaccination contraindicated Case 2": Encounter."The client is severely immunosuppressed"
/* @output: Measles vaccination contraindicated @pseudocode: "Immunization recommendation status" = "Contraindicated" */ define "Measles vaccination contraindicated": "Measles vaccination contraindicated Case 1" or "Measles vaccination contraindicated Case 2"
Measles vaccination contraindicated Guidance
/* @output: Measles vaccination contraindicated Guidance @guidance = Do not vaccinate client with measles as measles vaccination is contraindicated for pregnant client. @guidance = Do not vaccinate client with measles as measles vaccination is contraindicated for severely immunosuppressed client. */ define "Measles vaccination contraindicated Guidance": case when "Measles vaccination contraindicated Case 1" then 'Do not vaccinate client with measles as measles vaccination is contraindicated for pregnant client.' when "Measles vaccination contraindicated Case 2" then 'Do not vaccinate client with measles as measles vaccination is contraindicated for severely immunosuppressed client.' else '' end
CI History of anaphylactic reactions Observation
/* @internal: Observation for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Observation": "Potential contraindications" O where O.value ~ Concepts."CI-History of anaphylactic reactions"
/* @internal: Observation for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Observation": Elements."CI History of anaphylactic reactions Observation".encounterOrOnBefore(EncounterId, Today)
CI History of anaphylactic reactions Condition
/* @internal: Condition for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Condition": [Condition: Concepts."CI-History of anaphylactic reactions"]
/* @internal: Condition for History of anaphylactic reactions */ define "CI History of anaphylactic reactions Condition": Elements."CI History of anaphylactic reactions Condition" C where C.prevalenceInterval() includes Today
The client has history of anaphylactic reactions
/* @input: The client has history of anaphylactic reactions @pseudocode: "Potential contraindications" = "History of anaphylactic reactions" */ define "The client has history of anaphylactic reactions": exists "CI History of anaphylactic reactions Observation" or exists "CI History of anaphylactic reactions Condition"
/* @input: The client has history of anaphylactic reactions @pseudocode: "Potential contraindications" = "History of anaphylactic reactions" @code: The client has history of anaphylactic reactions-67 @decision: IMMZ.D5.DT.Measles contraindications */ define "The client has history of anaphylactic reactions": Encounter."The client has history of anaphylactic reactions"
Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note
/* @output: Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note @pseudocode: "Immunization recommendation status" = "Further evaluation needed" */ define "Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note": Encounter."The client has history of anaphylactic reactions"
Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note Guidance
/* @output: Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note Guidance @guidance: Do not vaccinate client with measles if client has history of anaphylactic reaction to any component of the vaccine (e.g. neomycin or gelatin). */ define "Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note Guidance": 'Do not vaccinate client with measles if client has history of anaphylactic reaction to any component of the vaccine (e.g. neomycin or gelatin).'
CI Severe allergic reactions Observation
/* @internal: Observation for Severe allergic reactions */ define "CI Severe allergic reactions Observation": "Potential contraindications" O where O.value ~ Concepts."CI-Severe allergic reactions"
/* @internal: Observation for Severe allergic reactions */ define "CI Severe allergic reactions Observation": Elements."CI Severe allergic reactions Observation".encounterOrOnBefore(EncounterId, Today)
/* @internal: Condition for Severe allergic reactions */ define "CI Severe allergic reactions Condition": [Condition: Concepts."CI-Severe allergic reactions"]
/* @internal: Condition for Severe allergic reactions */ define "CI Severe allergic reactions Condition": Elements."CI Severe allergic reactions Condition" C where C.prevalenceInterval() includes Today
The client has history of severe allergic reactions
/* @input: The client has history of severe allergic reactions @pseudocode: "Potential contraindications" = "Severe allergic reactions" */ define "The client has history of severe allergic reactions": exists "CI Severe allergic reactions Observation" or exists "CI Severe allergic reactions Condition"
/* @input: The client has history of severe allergic reactions @pseudocode: "Potential contraindications" = "Severe allergic reactions" @code: The client has history of severe allergic reactions-59 @decision: IMMZ.D5.DT.Measles contraindications */ define "The client has history of severe allergic reactions": Encounter."The client has history of severe allergic reactions"
Clinical judgement required. Create a clinical note Case 1
/* @output: Clinical judgement required. Create a clinical note Case 1 @pseudocode: "Immunization recommendation status" = "Further evaluation needed" */ define "Clinical judgement required. Create a clinical note Case 1": Encounter."The client has history of severe allergic reactions"
CI Symptomatic HIV infection Observation
/* @internal: Observation for Symptomatic HIV infection */ define "CI Symptomatic HIV infection Observation": "Potential contraindications" O where O.value ~ Concepts."CI-Symptomatic HIV infection"
/* @internal: Observation for Symptomatic HIV infection */ define "CI Symptomatic HIV infection Observation": Elements."CI Symptomatic HIV infection Observation".encounterOrOnBefore(EncounterId, Today)
/* @internal: Condition for Symptomatic HIV infection */ define "CI Symptomatic HIV infection Condition": [Condition: Concepts."CI-Symptomatic HIV infection"]
/* @internal: Condition for Symptomatic HIV infection */ define "CI Symptomatic HIV infection Condition": Elements."CI Symptomatic HIV infection Condition" C where C.prevalenceInterval() includes Today
The client has a symptomatic HIV infection
/* @input: The client has a symptomatic HIV infection @pseudocode: "Potential contraindications" = "Symptomatic HIV infection" */ define "The client has a symptomatic HIV infection": exists "CI Symptomatic HIV infection Observation" or exists "CI Symptomatic HIV infection Condition"
/* @input: The client has a symptomatic HIV infection @pseudocode: "Potential contraindications" = "Symptomatic HIV infection" @code: The client has a symptomatic HIV infection-59 @decision: IMMZ.D5.DT.Measles contraindications */ define "The client has a symptomatic HIV infection": Encounter."The client has a symptomatic HIV infection"
Clinical judgement required. Create a clinical note Case 2
/* @output: Clinical judgement required. Create a clinical note Case 2 @pseudocode: "Immunization recommendation status" = "Further evaluation needed" */ define "Clinical judgement required. Create a clinical note Case 2": Encounter."The client has a symptomatic HIV infection"
Clinical judgement required. Create a clinical note
/* @output: Clinical judgement required. Create a clinical note @pseudocode: "Immunization recommendation status" = "Further evaluation needed" */ define "Clinical judgement required. Create a clinical note": "Clinical judgement required. Create a clinical note Case 1" or "Clinical judgement required. Create a clinical note Case 2"
Clinical judgement required. Create a clinical note Guidance
/* @output: Clinical judgement required. Create a clinical note Guidance @guidance = Do not vaccinate client with measles if client has history of severe allergic reactions to any component of the vaccine (e.g. neomycin or gelatin). @guidance = Client has symptomatic HIV infection. Measles vaccination may be considered if the client is not severely immunosuppressed according to conventional definitions, consider risks of vaccination and make a clinical judgement. */ define "Clinical judgement required. Create a clinical note Guidance": case when "Clinical judgement required. Create a clinical note Case 1" then 'Do not vaccinate client with measles if client has history of severe allergic reactions to any component of the vaccine (e.g. neomycin or gelatin).' when "Clinical judgement required. Create a clinical note Case 2" then 'Client has symptomatic HIV infection. Measles vaccination may be considered if the client is not severely immunosuppressed according to conventional definitions, consider risks of vaccination and make a clinical judgement.' else '' end
/* @dynamicValue: Guidance */ define "Guidance": case when "Measles vaccination contraindicated" then "Measles vaccination contraindicated Guidance" when "Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note" then "Measles vaccination could be contraindicated. Clinical judgement required. Create a clinical note Guidance" when "Clinical judgement required. Create a clinical note" then "Clinical judgement required. Create a clinical note Guidance" else '' end
/* @dataElement: Draft Medication Request for Patient */ define "Draft Medication Request for Patient": [MedicationRequest] MR where MR.status = 'draft' and MR.intent = 'proposal' sort by date from (authoredOn as FHIR.dateTime) desc
/* @dataElement: Draft Medication Request for Patient */ define "Draft Medication Request for Patient": Elements."Draft Medication Request for Patient" MR where MR.encounter.references(EncounterId) or MR.authoredOn.toInterval() same day or before Today sort by date from (authoredOn as FHIR.dateTime) desc
Draft Medication Request for Measles dose
/* @internal: Draft Medication Request for Measles dose */ define "Draft Medication Request for Measles dose": Encounter."Draft Medication Request for Patient" MR where MR.medication in Concepts."Measles-containing vaccines"
Draft Medication Request ID for Measles dose
/* @dynamicValue: Draft Medication Request ID for Measles dose */ define "Draft Medication Request ID for Measles dose": First(Encounter."Draft Medication Request for Measles dose").id
define "Has Guidance": "Guidance" is not null and "Guidance" != ''
define fluent function complete(observations List<Observation>): observations O where O.status in { 'final', 'amended', 'corrected' }
define function ToString(value ObservationStatus): value.value
define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
/* @description: Returns true if the given reference is to the given resourceId @comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference. NOTE: This function assumes resources from the same source server. */ define fluent function references(reference FHIR.Reference, resourceId String): resourceId = Last(Split(reference.reference, '/'))
define function ToString(value string): value.value
/* @description: Returns an interval representing the normalized prevalence period of a given Condition resource. @comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate]
// Was getting error on this for this particular choice set not being found /* @description: Returns an interval representing the normalized Abatement of a given Condition resource. @comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw a run-time exception if used with a Condition instance that has a String as the abatement value. */ define fluent function abatementInterval(condition Condition): if condition.abatement is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)] else if condition.abatement is FHIR.Period then FHIRHelpers.ToInterval(condition.abatement as FHIR.Period) else if condition.abatement is FHIR.string then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported') else if condition.abatement is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year) else if condition.abatement is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year) else if condition.abatement is FHIR.boolean then Interval[end of condition.onset.toInterval(), condition.recordedDate) else null
define function ToDateTime(value dateTime): value.value
define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
define function ToDate(value date): value.value
define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end
define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end
/** * @description: Gets observation from an encounter or on or before a date */ define fluent function encounterOrOnBefore(observations List<Observation>, EncounterId String, beforeDate Date): observations O where (O.encounter.references(EncounterId) or O.effective.toInterval() starts same day or before beforeDate)
define function ToString(value MedicationRequestStatus): value.value
define function ToString(value MedicationRequestIntent): value.value
/* From FHIRCommon 4.1.0: */ /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in FHIR, allowing this function to be used across any resource. The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime. If the input is a Period, the result is a DateTime Interval. If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing. If the input is an instant, the result is a DateTime Interval beginning and ending on that instant. If the input is a string, an error is raised indicating a single interval cannot be computed from a string. If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age, and ending immediately prior to when the patient was the given Age plus one year. If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given by the low end of the Range, and ending immediately prior to when the patient was the Age given by the high end of the Range plus one year. NOTE: Due to the complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used with a Timing or String. */ define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>): case when choice is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] when choice is FHIR.Period then FHIRHelpers.ToInterval(choice as FHIR.Period) when choice is FHIR.instant then Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)] when choice is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year) when choice is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year) when choice is FHIR.Timing then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') when choice is FHIR.string then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported') else null as Interval<DateTime> end
define function ToDateTime(value instant): value.value
Code system ConditionClinicalStatusCodes
IMMZ.D5.DT.Measles contraindications IMMZ.D5.DT.Measles contraindications
WHO recommendations for routine immunization - summary tables (January 2025)
Check for contraindications before administering the vaccine(s) due
Contraindication for measles immunization
Concept { codes: { Code { system: 'http://smart.who.int/immunizations/CodeSystem/IMMZ.Z', code: 'DE9', display: 'Measles-containing vaccines' } }, display: 'Measles-containing vaccines' }
Check for Guidance for the patient regarding IMMZ.D5.DT.Measles contraindications.
Show Guidance for the patient regarding IMMZ.D5.DT.Measles contraindications.
Code { system: 'http://terminology.hl7.org/CodeSystem/communication-category', code: 'alert' }
Code { system: 'http://hl7.org/fhir/request-priority', code: 'routine' }