Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION
0.0.1-ballot - ci-build

Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION - Local Development build (v0.0.1-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Health Journey Immunization

This story describes how immunization services are recorded and shared using FHIR resources in the context of Nepal’s Electronic Health Management Information System (EHMIS).

### Objective

To document and exchange data about childhood and routine immunizations to support continuity of care, reduce missed vaccinations, and improve national reporting.

### Actors

- Child (Patient)
- Caregiver/Parent (RelatedPerson)
- Health Worker (e.g., ANM, HA)
- Outreach Worker (e.g., FCHV during EPI clinics)

### Workflow Steps

1. Child Registration
   - Capture child’s demographic info
   - FHIR Resource: `Patient`
   - Link to mother/caregiver using `RelatedPerson`
   - Assign EPI ID if applicable
2. Immunization Encounter
   - Record immunization session
   - FHIR Resource: `Encounter` (optional but useful for grouping)
3. Vaccine Administration
   - FHIR Resource: `Immunization`
   - Include:
     - Vaccine code (e.g., BCG, Penta, MR)
     - Date administered
     - Lot number
     - Expiration date
     - Body site
     - Route
     - Performer (Health Worker)
     - Location (Facility, Outreach Clinic)
4. Adverse Events (if any)
   - FHIR Resource: `AdverseEvent` (optional)
   - Used to record any AEFI (Adverse Events Following Immunization)
5. Follow-up or Reminders
   - Track missed doses or next appointments
   - FHIR Resource: `CarePlan` or `Task` (optional)

### FHIR Resources Used

Resource | Purpose
--- | ---
`Patient` | Identification of child
`RelatedPerson` | Linking to parent/caregiver
`Encounter` | Grouping vaccinations on a single day
`Immunization` | Vaccine dose administration
`Location` | Immunization session site
`Practitioner` | Health worker administering vaccine
`AdverseEvent` | Recording post-vaccine reactions

### Example: BCG and OPV0 for a Newborn

- Patient: Male newborn, 3 days old
- Encounter: Immunization session on 2025-08-08 at Outreach Clinic
- Immunization:
  - BCG vaccine: Given on left upper arm
  - OPV0: Oral drops
  - Lot number: BCG-2025-01
  - Performer: ANM at Rural Health Post
- RelatedPerson: Linked to mother

### Reporting Considerations

- Coverage by antigen (e.g., Penta1, MR1)
- Dropout rates (e.g., Penta1 → Penta3)
- Age at vaccination (timeliness)
- Disaggregation by:
  - Age group
  - Sex
  - Geographic area (palika/district)
- Integration with national EPI reporting via DHIS2 Tracker or aggregate datasets