WHO Immunization Implementation Guide
0.1.0 - CI Build
WHO Immunization Implementation Guide
0.1.0 - CI Build
WHO Immunization Implementation Guide, published by World Health Organization (WHO). This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of https://github.com/WorldHealthOrganization/smart-immunizations and changes regularly. See the Directory of published versions
| Draft as of 2022-05-12 |
<Measure xmlns="http://hl7.org/fhir">
<id value="IMMZIND30"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Measure</b><a name="IMMZIND30"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Measure "IMMZIND30" </p><p style="margin-bottom: 0px">Profile: <code>http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm</code></p></div><p><b>url</b>: <code>http://fhir.org/guides/who/smart-immunization/Measure/IMMZIND30</code></p><p><b>version</b>: 0.1.0</p><p><b>name</b>: IMMZIND30</p><p><b>title</b>: IMMZ.IND.30 Adverse Event Following Immunization (AEFI) case rate.</p><p><b>status</b>: draft</p><p><b>date</b>: 2022-05-12 15:36:35-0400</p><p><b>publisher</b>: World Health Organization (WHO)</p><p><b>description</b>: Clinics should report adverse events (reported and confirmed) to the central authority.
This should be tracked as an aggregate tally (which should indicate the severity, and optionally the manifestation such as rash, vomiting, etc.), with severe cases being reported using case reporting forms, and should include an analysis of whether the AEFI was a direct result (confirmed) of vaccination or not (suspected). Serious cases are those which involved hospitalization, disability, or death.
Investigation of AEFI events can lead to withdrawal of the vaccine from the market, or inform further guidance on administration of a particular antigen/product.</p><p><b>jurisdiction</b>: Global (Whole world) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (m49.htm#001)</span></p><p><b>library</b>: <a href="Library-IMMZIND30.html">IMMZIND30</a></p><p><b>scoring</b>: Proportion <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-measure-scoring.html">MeasureScoring</a>#proportion)</span></p><p><b>type</b>: Process <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-measure-type.html">MeasureType</a>#process)</span></p><p><b>improvementNotation</b>: Increased score indicates improvement <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-measure-improvement-notation.html">MeasureImprovementNotation</a>#increase)</span></p><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>IMMZIND30</blockquote><blockquote><p><b>population</b></p><blockquote><p><b>id</b></p>numerator</blockquote><p><b>code</b>: Numerator <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#numerator)</span></p><p><b>description</b>: Number of persons which have received a vaccine dose, and have reported an adverse event</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>numerator</td></tr></table></blockquote><blockquote><p><b>population</b></p><blockquote><p><b>id</b></p>denominator</blockquote><p><b>code</b>: Denominator <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#denominator)</span></p><p><b>description</b>: The total number of doses administered to patients of the product.</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>denominator</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><blockquote><p><b>id</b></p>vaccine-stratifier</blockquote><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Vaccine Stratifier</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><blockquote><p><b>id</b></p>product/manufacturer-stratifier</blockquote><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Product/Manufacturer Stratifier</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><blockquote><p><b>id</b></p>severity-stratifier</blockquote><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Severity Stratifier</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><blockquote><p><b>id</b></p>geographic-region-stratifier</blockquote><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Geographic Region Stratifier</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><blockquote><p><b>id</b></p>manifestation-/-event-stratifier</blockquote><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Manifestation / Event Stratifier</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><blockquote><p><b>id</b></p>-stratifier</blockquote><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Stratifier</td></tr></table></blockquote></blockquote></div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="246112005"/>
<display value="Severity (attribute)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZCommon"/>
</extension>
<extension url="name">
<valueString value="Doses Administered to Patient"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @dataElement All Doses Administered to Patient to patient ordered newest to oldest
*/
define "Doses Administered to Patient":
[Immunization] I
where I.status = 'completed'
sort by date from (occurrence as FHIR.dateTime) desc"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIndicatorCommon"/>
</extension>
<extension url="name">
<valueString
value="Immunizations with Adverse Events During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @define Adverse events for immunizations which occurred during (or observed) during measurement period
*/
define "Immunizations with Adverse Events During Measurement Period":
IMMZCom."Doses Administered to Patient" I
with [Observation: code in WC."Adverse Events"] O
such that exists(I.reaction R where O.id = Last(Split(R.detail.reference, '/')))
and FC.ToInterval(O.effective) during "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="Vaccine Stratifier"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Disaggregator: Vaccine (BCG, OPV, etc.)
*/
define "Vaccine Stratifier":
IMMZIndCom."Immunizations with Adverse Events During Measurement Period" A
return A.vaccineCode"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIndicatorCommon"/>
</extension>
<extension url="name">
<valueString
value="Adverse Event Reactions During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @define Adverse events for immunizations which occurred during (or observed) during measurement period
*/
define "Adverse Event Reactions During Measurement Period":
[Observation: code in WC."Adverse Events"] O
with IMMZCom."Doses Administered to Patient" I
such that exists(I.reaction R where O.id = Last(Split(R.detail.reference, '/')))
where FC.ToInterval(O.effective) during "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="Severity Stratifier"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Disaggregator: Severity (Severe, Non-Severe)
*/
define "Severity Stratifier":
IMMZIndCom."Adverse Event Reactions During Measurement Period" A
return First(A.component C where C.code = IMMZc."Adverse Event Severity").value as FHIR.CodeableConcept"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="Manifestation / Event Stratifier"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Disaggregator: Manifestation / Event (optional - Rash, Vomiting, etc.)
*/
define "Manifestation / Event Stratifier":
IMMZIndCom."Adverse Event Reactions During Measurement Period" A
return A.value as FHIR.CodeableConcept"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIndicatorCommon"/>
</extension>
<extension url="name">
<valueString value="By Geographic Region Stratifier"/>
</extension>
<extension url="statement">
<valueString
value="/**
* By Administrative Gender of Patient Stratifier
*/
define "By Geographic Region Stratifier":
First(Patient.address A where A.use in { 'home' }).state"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="Geographic Region Stratifier"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Disaggregator: Geographic Region
*/
define "Geographic Region Stratifier":
IMMZIndCom."By Geographic Region Stratifier""/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="Product/Manufacturer Stratifier"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Disaggregator: Product/Manufacturer
*/
define "Product/Manufacturer Stratifier":
IMMZIndCom."Immunizations with Adverse Events During Measurement Period" A
// TODO: Find a better way to do this
return Tuple { Manufacturer : First([Organization] O where O.id = Last(Split(A.manufacturer.reference, '/'))), LotNumber : A.lotNumber, VaccineType: A.vaccineCode }"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="numerator"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Numerator: Number of persons which have received a vaccine dose, and have reported an adverse event
* Numerator Computation: COUNT immunization HAVING reaction reported during reporting period
*/
define "numerator":
exists(IMMZIndCom."Immunizations with Adverse Events During Measurement Period")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIndicatorCommon"/>
</extension>
<extension url="name">
<valueString
value="Doses Administered to Patient During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="/**
* @define Doses which were
*/
define "Doses Administered to Patient During Measurement Period":
IMMZCom."Doses Administered to Patient" I
where IMMZCom.ToDate(I.occurrence) during "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="IMMZIND30"/>
</extension>
<extension url="name">
<valueString value="denominator"/>
</extension>
<extension url="statement">
<valueString
value="/*
* Denominator: The total number of doses administered to patients of the product.
* Denominator Computation: COUNT number of doses administered during reporting period
*/
define "denominator":
exists(IMMZIndCom."Doses Administered to Patient During Measurement Period")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library IMMZIndCom"/>
<resource
value="http://fhir.org/guides/who/smart-immunization/Library/IMMZIndicatorCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library IMMZCom"/>
<resource
value="http://fhir.org/guides/who/smart-immunization/Library/IMMZCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/who/smart-immunization/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WC"/>
<resource
value="http://fhir.org/guides/who/smart-immunization/Library/WHOConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FC"/>
<resource
value="http://fhir.org/guides/who/smart-immunization/Library/FHIRCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library IMMZc"/>
<resource
value="http://fhir.org/guides/who/smart-immunization/Library/IMMZConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMED-CT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Adverse Events"/>
<resource value="http://hl7.org/fhir/ValueSet/adverse-event-type"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="Vaccine Stratifier"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="CodeableConcept"/>
</parameter>
<parameter>
<name value="Severity Stratifier"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="CodeableConcept"/>
</parameter>
<parameter>
<name value="Manifestation / Event Stratifier"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="CodeableConcept"/>
</parameter>
<parameter>
<name value="Geographic Region Stratifier"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name value="Product/Manufacturer Stratifier"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="numerator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="denominator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Immunization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Immunization"/>
<mustSupport value="status"/>
<mustSupport value="reaction"/>
<mustSupport value="occurrence"/>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="id"/>
<mustSupport value="effective"/>
<codeFilter>
<path value="code"/>
<valueSet value="http://hl7.org/fhir/ValueSet/adverse-event-type"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
<mustSupport value="use"/>
</dataRequirement>
<dataRequirement>
<type value="Organization"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/Organization"/>
<mustSupport value="id"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="http://fhir.org/guides/who/smart-immunization/Measure/IMMZIND30"/>
<version value="0.1.0"/>
<name value="IMMZIND30"/>
<title
value="IMMZ.IND.30 Adverse Event Following Immunization (AEFI) case rate."/>
<status value="draft"/>
<date value="2022-05-12T15:36:35.009-04:00"/>
<publisher value="World Health Organization (WHO)"/>
<description
value="Clinics should report adverse events (reported and confirmed) to the central authority.
This should be tracked as an aggregate tally (which should indicate the severity, and optionally the manifestation such as rash, vomiting, etc.), with severe cases being reported using case reporting forms, and should include an analysis of whether the AEFI was a direct result (confirmed) of vaccination or not (suspected). Serious cases are those which involved hospitalization, disability, or death.
Investigation of AEFI events can lead to withdrawal of the vaccine from the market, or inform further guidance on administration of a particular antigen/product."/>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
</coding>
</jurisdiction>
<library
value="http://fhir.org/guides/who/smart-immunization/Library/IMMZIND30"/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
</coding>
</scoring>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
</coding>
</type>
<improvementNotation>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="increase"/>
</coding>
</improvementNotation>
<group id="IMMZIND30">
<population id="numerator">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
</coding>
</code>
<description
value="Number of persons which have received a vaccine dose, and have reported an adverse event"/>
<criteria>
<language value="text/cql"/>
<expression value="numerator"/>
</criteria>
</population>
<population id="denominator">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
</coding>
</code>
<description
value="The total number of doses administered to patients of the product."/>
<criteria>
<language value="text/cql"/>
<expression value="denominator"/>
</criteria>
</population>
<stratifier id="vaccine-stratifier">
<criteria>
<language value="text/cql"/>
<expression value="Vaccine Stratifier"/>
</criteria>
</stratifier>
<stratifier id="product/manufacturer-stratifier">
<criteria>
<language value="text/cql"/>
<expression value="Product/Manufacturer Stratifier"/>
</criteria>
</stratifier>
<stratifier id="severity-stratifier">
<criteria>
<language value="text/cql"/>
<expression value="Severity Stratifier"/>
</criteria>
</stratifier>
<stratifier id="geographic-region-stratifier">
<criteria>
<language value="text/cql"/>
<expression value="Geographic Region Stratifier"/>
</criteria>
</stratifier>
<stratifier id="manifestation-/-event-stratifier">
<criteria>
<language value="text/cql"/>
<expression value="Manifestation / Event Stratifier"/>
</criteria>
</stratifier>
<stratifier id="-stratifier">
<criteria>
<language value="text/cql"/>
<expression value="Stratifier"/>
</criteria>
</stratifier>
</group>
</Measure>
IG © 2021+ World Health Organization (WHO). Package who.fhir.immunization#0.1.0 based on FHIR 4.0.1. Generated 2023-08-02
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