Finished plandefinition and activity defintion for contraindications.

WorldHealthOrganization · Oct 16, 2023 · 6f6efcc · 6f6efcc
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Showing 24 changed files with 379 additions and 33 deletions.
diff --git a/input/cql/IMMZCommon.cql b/input/cql/IMMZCommon.cql
@@ -70,7 +70,7 @@ define "Patient Has Active Sickle-cell disease":
 
 define "Pregnant Condition":
   [Condition] C
-    where (C.code as CodeableConcept) in Wcon."Pregnancy Status Pregnant"
+    where (C.code as CodeableConcept) in Wcon."Pregnancy Status Pregnant" or (C.code as CodeableConcept) ~ IMMZc."Currently Pregnant"
 
 define "Pregnant": 
   exists
@@ -134,6 +134,20 @@ define "Doses Administered to Patient":
   [Immunization] I
     where I.status = 'completed'
     sort by date from (occurrence as FHIR.dateTime) desc
+/**
+ * Contraindications 
+ */
+define "Severely Immunosuppressed Condition":
+  [Condition: IMMZc."Severely immunosuppressed"]
+
+define "History of Anaphylactic Reactions Condition":
+  [Condition: IMMZc."History of anaphylactic reactions"]
+
+define "Severe Allergic Reactions Condition":
+  [Condition: IMMZc."Severe allergic reactions"]
+
+define "Symptomatic HIV Infection Condition":
+  [Condition: IMMZc."Symptomatic HIV infection"]
 
 
 /******************************

diff --git a/input/cql/IMMZConcepts.cql b/input/cql/IMMZConcepts.cql
@@ -12,6 +12,10 @@ codesystem "ICHI": 'https://mitel.dimi.uniud.it/ichi/#http://id.who.int/ichi'
 codesystem "ICF": 'http://hl7.org/fhir/sid/icf-nl'
 codesystem "Extended Codes CodeSystem codes": 'http://fhir.org/guides/who/anc-cds/CodeSystem/anc-custom-codes'
 
+codesystem "IMMZ.C": 'http://smart.who.int/ig/smart-immunizations/CodeSystem/IMMZ.C'
+codesystem "IMMZ.D1": 'http://smart.who.int/ig/smart-immunizations/CodeSystem/IMMZ.D1'
+codesystem "IMMZ.D4": 'http://smart.who.int/ig/smart-immunizations/CodeSystem/IMMZ.D4'
+
 //WHO ATC IPS Valueset
 valueset "WHO ATC": 'http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips'
 
@@ -44,3 +48,8 @@ valueset "Cholera Vaccine": 'http://smart.who.int/ig/smart-immunizations/ValueSe
 code "Adverse Event Severity": '246112005' from "SNOMED-CT" display 'Severity (attribute)'
 code "Adverse Event Manifestation": '246112005' from "SNOMED-CT" display 'Severity (attribute)'
 
+code "Currently Pregnant": 'DE161' from "IMMZ.D4" display 'Currently Pregnant'
+code "Severely immunosuppressed": 'DE165' from "IMMZ.D4" display 'Severely immunosuppressed' 
+code "History of anaphylactic reactions": 'DE166' from "IMMZ.D4" display 'History of anaphylactic reactions'
+code "Severe allergic reactions": 'DE167' from "IMMZ.D4" display 'Severe allergic reactions'
+code "Symptomatic HIV infection": 'DE168' from "IMMZ.D4" display 'Symptomatic HIV infection'
diff --git a/input/cql/IMMZD2DTMeasles.cql b/input/cql/IMMZD2DTMeasles.cql
@@ -98,10 +98,15 @@ define "Should vaccinate patient for MCV":
 
 define "MCV Dose Contraindicated":
 	IMMZCom."Pregnant"
+	or exists(IMMZCom."Severely Immunosuppressed Condition")
 
 define "Contraindication Evaluation of the MCV dose":
-	IMMZCom."Pregnant"
-
+	not("MCV Dose Contraindicated") and (
+		exists(IMMZCom."History of Anaphylactic Reactions Condition")
+		or exists(IMMZCom."Severe Allergic Reactions Condition")
+		or exists(IMMZCom."Symptomatic HIV Infection Condition")
+	)
+
 /**
  * @dataElement MCV containing Doses Administered to Patient
  */
@@ -221,6 +226,14 @@ define "Supplementary MCV Dose Administered to Patient":
 define "Date Supplementary MCV Dose Administered to Patient":
   date from ("Supplementary MCV Dose Administered to Patient".occurrence as FHIR.dateTime)
 
+
+define "Draft Medication Request for MCV dose":
+	[MedicationRequest] MR where MR.status = 'draft' and MR.intent = 'proposal'
+	sort by date from (authoredOn as FHIR.dateTime) desc
+
+define "Draft Medication Request ID for MCV dose":
+	First("Draft Medication Request for MCV dose").id
+
 /*
  * Rule: Should vaccinate patient for measles (Supplementary) because no doses
  * Annotations:

diff --git a/input/fsh/definitions/measles.fsh b/input/fsh/definitions/measles.fsh
@@ -137,9 +137,9 @@ Usage: #definition
 * dynamicValue[+]
   * path = "id"
   * expression
-    * description = "Draft Medication Request for MCV dose"
+    * description = "Draft Medication Request ID for MCV dose"
     * language = #text/cql-identifier
-    * expression = "Draft Medication Request for MCV dose"
+    * expression = "Draft Medication Request ID for MCV dose"
 
 Instance: IMMZD2DTMeaslesEval
 InstanceOf: http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-servicerequestactivity
@@ -163,4 +163,10 @@ Usage: #definition
     * value = "https://who.int"
 * kind = #ServiceRequest
 * intent = #proposal
-* doNotPerform = false
+* doNotPerform = false
+* dynamicValue[+]
+  * path = "code.coding"
+  * expression
+    * description = "Measles Code"
+    * language = #text/cql
+    * expression = "Code { system: 'http://hl7.org/fhir/sid/icd-11', code: 'XM28X5' }"
diff --git a/input/maps/IMMZ-D4-LMToResources.fml b/input/maps/IMMZ-D4-LMToResources.fml
@@ -9,6 +9,7 @@ group IMMZD4ToBundle (source immz : IMMZD4, target bundle: Bundle) {
   immz.patient as patient then {
     immz.contraindications as ci -> bundle.entry as entry, entry.resource = create('Condition') as condition then {
       patient -> condition.subject = patient "SetPatient";
+      ci -> condition.clinicalStatus = 'active' "SetStatus";
       ci -> condition.code as code then {
         ci -> code.coding = ci "SetCoding";
       } "SetCode";

diff --git a/input/resources/library/FHIRCommon.json b/input/resources/library/FHIRCommon.json
diff --git a/input/resources/library/FHIRHelpers.json b/input/resources/library/FHIRHelpers.json
diff --git a/input/resources/library/IMMZCommon.json b/input/resources/library/IMMZCommon.json
diff --git a/input/resources/library/IMMZCommonIzDataElements.json b/input/resources/library/IMMZCommonIzDataElements.json
diff --git a/input/resources/library/IMMZConcepts.json b/input/resources/library/IMMZConcepts.json
diff --git a/input/resources/library/IMMZConfig.json b/input/resources/library/IMMZConfig.json
diff --git a/input/resources/library/IMMZD2DTMeasles.json b/input/resources/library/IMMZD2DTMeasles.json
diff --git a/input/resources/library/IMMZINDMeasles.json b/input/resources/library/IMMZINDMeasles.json
diff --git a/input/resources/library/IMMZIndicatorCommon.json b/input/resources/library/IMMZIndicatorCommon.json
diff --git a/input/resources/library/IMMZVaccineLibrary.json b/input/resources/library/IMMZVaccineLibrary.json
diff --git a/input/resources/library/WHOCommon.json b/input/resources/library/WHOCommon.json
diff --git a/input/resources/library/WHOConcepts.json b/input/resources/library/WHOConcepts.json
diff --git a/...s/IMMZ-Patient-NoVaxeninfant-f-allergic/Condition/Condition-NoVaxeninfant-f-allergic.json b/...s/IMMZ-Patient-NoVaxeninfant-f-allergic/Condition/Condition-NoVaxeninfant-f-allergic.json
@@ -0,0 +1,17 @@
+{
+  "resourceType": "Condition",
+  "id": "NoVaxeninfant-f-allergic",
+  "clinicalStatus": "active",
+  "code": {
+    "coding": [
+      {
+        "code": "DE167",
+        "system": "http://smart.who.int/ig/smart-immunizations/CodeSystem/IMMZ.D4",
+        "display": "Severe allergic reactions"
+      }
+    ]
+  },
+  "subject": {
+    "reference": "Patient/IMMZ-Patient-NoVaxeninfant-f-allergic"
+  }
+}
diff --git a/...t-NoVaxeninfant-f-allergic/Observation/Observation-birthweightnormal-NoVaxeninfant-f.json b/...t-NoVaxeninfant-f-allergic/Observation/Observation-birthweightnormal-NoVaxeninfant-f.json
@@ -0,0 +1,24 @@
+{
+  "resourceType": "Observation",
+  "id": "birthweightnormal-NoVaxeninfant-f-allergic",
+  "status": "final",
+  "code": {
+    "coding": [
+      {
+        "code": "276610007",
+        "system": "http://snomed.info/sct",
+        "display": "Birthweight"
+      }
+    ]
+  },
+  "subject": {
+    "reference": "Patient/IMMZ-Patient-NoVaxeninfant-f-allergic"
+  },
+  "effectiveDateTime": "2023-03-02",
+  "valueQuantity": {
+    "value": 2123,
+    "code": "g",
+    "system": "http://unitsofmeasure.org",
+    "unit": "gram"
+  }
+}
diff --git a/...tient-NoVaxeninfant-f-allergic/Patient/Patient-IMMZ-Patient-NoVaxeninfant-f-allergic.json b/...tient-NoVaxeninfant-f-allergic/Patient/Patient-IMMZ-Patient-NoVaxeninfant-f-allergic.json
@@ -0,0 +1,17 @@
+{
+  "resourceType": "Patient",
+  "id": "IMMZ-Patient-NoVaxeninfant-f-allergic",
+  "meta": {
+    "profile": [
+      "http://worldhealthorganization.github.io/ddcc/StructureDefinition/Patient-uv-ips"
+    ]
+  },
+  "name": [
+    {
+      "text": "NoVaxeninfant-f-allergic",
+      "use": "official"
+    }
+  ],
+  "birthDate": "2023-03-02",
+  "gender": "female"
+}
diff --git a/...oVaxeninfant-f-immunosuppressed/Condition/Condition-NoVaxeninfant-f-immunosuppressed.json b/...oVaxeninfant-f-immunosuppressed/Condition/Condition-NoVaxeninfant-f-immunosuppressed.json
@@ -0,0 +1,17 @@
+{
+  "resourceType": "Condition",
+  "id": "NoVaxeninfant-f-immunosuppressed",
+  "clinicalStatus": "active",
+  "code": {
+    "coding": [
+      {
+        "code": "DE165",
+        "system": "http://smart.who.int/ig/smart-immunizations/CodeSystem/IMMZ.D4",
+        "display": "Severely immunosuppressed"
+      }
+    ]
+  },
+  "subject": {
+    "reference": "Patient/IMMZ-Patient-NoVaxeninfant-f-immunosuppressed"
+  }
+}
diff --git a/...mmunosuppressed/MedicationRequest/MedicationRequest-NoVaxeninfant-f-immunosuppressed.json b/...mmunosuppressed/MedicationRequest/MedicationRequest-NoVaxeninfant-f-immunosuppressed.json
@@ -0,0 +1,25 @@
+{
+  "resourceType": "MedicationRequest",
+  "id": "MRNoVaxeninfant-f-immunosuppressed",
+  "meta": {
+    "profile": [ "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-immunizationrequest" ]
+  },
+  "status": "draft",
+  "intent": "proposal",
+  "doNotPerform": false,
+  "medicationCodeableConcept": {
+    "coding": [ {
+      "system": "http://hl7.org/fhir/sid/icd-11",
+      "code": "XM28X5",
+      "display": "Measles vaccines"
+    } ]
+  },
+  "subject": {
+    "reference": "Patient/IMMZ-Patient-NoVaxeninfant-f-immunosuppressed"
+  },
+  "dispenseRequest": {
+    "validityPeriod": {
+      "start": "2024-03-02T00:00:00.000Z"
+    }
+  }
+}
diff --git a/...uppressed/Observation/Observation-birthweightnormal-NoVaxeninfant-f-immunosuppressed.json b/...uppressed/Observation/Observation-birthweightnormal-NoVaxeninfant-f-immunosuppressed.json
@@ -0,0 +1,24 @@
+{
+  "resourceType": "Observation",
+  "id": "birthweightnormal-NoVaxeninfant-f-immunosuppressed",
+  "status": "final",
+  "code": {
+    "coding": [
+      {
+        "code": "276610007",
+        "system": "http://snomed.info/sct",
+        "display": "Birthweight"
+      }
+    ]
+  },
+  "subject": {
+    "reference": "Patient/IMMZ-Patient-NoVaxeninfant-f-immunosuppressed"
+  },
+  "effectiveDateTime": "2023-03-02",
+  "valueQuantity": {
+    "value": 2123,
+    "code": "g",
+    "system": "http://unitsofmeasure.org",
+    "unit": "gram"
+  }
+}
diff --git a/...ant-f-immunosuppressed/Patient/Patient-IMMZ-Patient-NoVaxeninfant-f-immunosuppressed.json b/...ant-f-immunosuppressed/Patient/Patient-IMMZ-Patient-NoVaxeninfant-f-immunosuppressed.json
@@ -0,0 +1,17 @@
+{
+  "resourceType": "Patient",
+  "id": "IMMZ-Patient-NoVaxeninfant-f-immunosuppressed",
+  "meta": {
+    "profile": [
+      "http://worldhealthorganization.github.io/ddcc/StructureDefinition/Patient-uv-ips"
+    ]
+  },
+  "name": [
+    {
+      "text": "NoVaxeninfant-f-immunosuppressed",
+      "use": "official"
+    }
+  ],
+  "birthDate": "2023-03-02",
+  "gender": "female"
+}