[Immunization] Defining Immunization dosages and propagating them to all the relevant resources | Content Changes

[dubdabasoduba]

Context

• We need to record immunization dosages in a way that allows for proper querying and indicator calculation. Currently, we use the Task description field for filters when calculating indicators, but this is prone to breaking if the field's text changes.
• To address this, we will use the Immunization.protocolApplied[x].doseNumber field to store dosage information. This requires a few steps:
  • Adding dosage information to the Task resource.
  • Passing the dosage information from the Task to the StructureMap (SM) that generates the Immunization resource.
  • Adding the dosage to the Immunization resource.

How to Add Dosage Information to the Task

• Obtain the dosage from the Immunization PlanDefinition. Here is an example of how to use this dosage in a StructureMap (SM):
  task.description = evaluate(definition, $this.product.text + ' ' + currentDose.select(sequence.toString()))
• Update the SM that generates the tasks by adding an entry in the Task.input attribute. This input will hold the dose number. Here is an example:

  {
    "type": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "260911001",
          "display": "Dosage (attribute)"
        }
      ]
    },
    "value": "<dosage>"
  }
  

• Make sure to replace <dosage> with the actual dosage number.

How to pass dosage information from the Task to the Immunization Resource

Through the Record Single Immunization Questionnaire

• Retrieve the Task.input created above from the patient profile using the following rule: Task.input.where(type.coding.select(code) = '260911001').value
• Pass this information to the Questionnaire through the PREPOPULATE functionality, as shown in [this example](https://github.com/onaio/fhir-resources/blob/8b429e51f94f10078d294ccf1b6f74e4d3751ed8/ecbis_liberia/app_configurations/ecbis_cha_preview/profiles/default_profile_config.json#L1937-L1966).
• The dosage information will be added to a hidden field in the Questionnaire, as demonstrated in [this example](https://github.com/onaio/fhir-resources/blob/8b429e51f94f10078d294ccf1b6f74e4d3751ed8/ecbis_liberia/questionnaire/follow_up_visits/child_immunization_record_sinlge.json#L93-L104).
• Once the form is filled out, the dosage value will be available on the QuestionnaireResponse and can be used on the extraction SM.

Through the Record All Questionnaire

• This questionnaire contains a Date question for each immunization at each dose.
• Update the questionnaire to add a dosage question. Each of the dosage questions should have the dosage as a default value.
• This field should not be editable or visible to the user.

How to add dosage to the Immunization Resource

• Extract the dosage information from the respective QRs and use it to update the immunization resource after recording an immunization on the app.
• Add the dosage information to the Immunization.protocolApplied[x].doseNumber attribute. For example: {"protocolApplied":[{"doseNumber":2}]}

Resource examples

Tasks resource

{
  "resourceType": "Task",
  "id": "a9100c01-c84b-404f-9d24-9b830463a152",
  "identifier": [
    {
      "use": "official",
      "value": "a20e88b4-4beb-4b31-86cd-572e1445e5f3"
    }
  ],
  "basedOn": [
    {
      "reference": "CarePlan/28d7542c-ba08-4f16-b6a2-19e8b5d4c229"
    }
  ],
  "partOf": {
    "reference": "Task/650203d2-f327-4eb4-a9fd-741e0ce29c3f"
  },
  "status": "requested",
  "intent": "plan",
  "priority": "routine",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "33879002",
        "display": "Administration of vaccine to produce active immunity (procedure)"
      }
    ]
  },
  "description": "OPV 1 at 6 wk vaccine",
  "for": {
    "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
  },
  "executionPeriod": {
    "start": "2021-11-12T00:00:00+00:00",
    "end": "2026-11-11T00:00:00+00:00"
  },
  "authoredOn": "2023-03-28T10:46:59+00:00",
  "requester": {
    "reference": "Practitioner/3812"
  },
  "owner": {
    "reference": "Practitioner/3812"
  },
  "reasonCode": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "111164008",
        "display": "Poliovirus vaccine"
      }
    ],
    "text": "OPV"
  },
  "reasonReference": {
    "reference": "Questionnaire/9b1aa23b-577c-4fb2-84e3-591e6facaf82"
  },
  "input": [
    {
      "type": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "900000000000457003",
            "display": "Reference set attribute (foundation metadata concept)"
          }
        ]
      },
      "value": {
        "reference": "Task/650203d2-f327-4eb4-a9fd-741e0ce29c3f"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "371154000",
            "display": "Dependent (qualifier value)"
          }
        ]
      },
      "value": 28
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "260911001",
            "display": "Dosage (attribute)"
          }
        ]
      },
      "value": "1"
    }
  ],
  "output": [
    {
      "type": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "41000179103",
            "display": "Immunization record (record artifact)"
          }
        ]
      },
      "value": {
        "reference": "Encounter/14e2ae52-32fc-4507-8736-1177cdaafe90"
      }
    }
  ]
}

Immunization resource

{
  "resourceType": "Immunization",
  "id": "41921cfe-5074-4eec-925f-2bc581237660",
  "identifier": {
    "use": "official",
    "value": "6a637a79-df7b-4cc9-93b2-f73f965c31ab"
  },
  "status": "completed",
  "patient": {
    "reference": "Patient/3e3d698a-4edb-48f9-9330-2f1adc0635d1"
  },
  "encounter": {
    "reference": "Encounter/14e2ae52-32fc-4507-8736-1177cdaafe90"
  },
  "occurrenceDateTime": "2021-10-01T00:00:00+00:00",
  "protocolApplied": [
    {
      "doseNumber": 2
    }
  ]
}

[qiarie]

@dubdabasoduba @f-odhiambo In the description below, does dosage mean the same as sequence number (e.g. 0) for the vaccine or does it include the vaccine name such as OPV 0

Update the SM that generates the tasks by adding an entry in the Task.input attribute. This input will hold the dose number. Here is an example:
{"type":{"coding":[{"system":"http://snomed.info/sct","code":"260911001","display":"Dosage (attribute)"}]},"value":""}
Make sure to replace with the actual dosage number.

[f-odhiambo]

IMO I think that would be a yes , as this is the same variable we use in the SM

[Lentumunai-Mark]

@dubdabasoduba @f-odhiambo
On the record all questionnaire we have this field vaccines code group which handles Update the questionnaire to add a dosage question. Each of the dosage questions should have the dosage as a default value.

Here is a sample JSON response

{
      "linkId": "vaccines codes group",
      "text": "Vaccine codes",
      "item": [
        {
          "linkId": "oral polio 1",
          "answer": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "111164008",
                "display": "Poliovirus vaccine"
              }
            }
          ]
        },
        {
          "linkId": "penta 1",
          "answer": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "429511000124109",
                "display": "Tetanus + diphtheria + acellular pertussis vaccine"
              }
            }
          ]
        },
        {
          "linkId": "pneumo 1",
          "answer": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "12866006",
                "display": "Pneumococcal vaccine"
              }
            }
          ]
        },
        {
          "linkId": "rota 1",
          "answer": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "415354003",
                "display": "Rotavirus vaccine"
              }
            }
          ]
        }
      ]
    }

My question is if we can possibly utilize this on the record all?