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 Mnch

This story outlines how maternal, newborn, and child health (MNCH) data is captured and exchanged using FHIR resources in the EHMIS system.

### Objective

To support longitudinal tracking and reporting of services provided during the continuum of care—from pregnancy to postnatal and child health—using standardized FHIR resources.

### Actors

- Pregnant Woman (Patient)
- Family Members (RelatedPerson)
- Female Community Health Volunteer (FCHV)
- Auxiliary Nurse Midwife (ANM)
- Health Facility Staff (e.g., HA, Medical Officer)

### Workflow Steps

1. Registration of Pregnant Woman
   - Collect personal and demographic information
   - FHIR Resource: `Patient`
   - Link to household members if needed (`RelatedPerson`)
2. Antenatal Care (ANC) Visits
   - Record each ANC visit (`Encounter`)
   - Capture vitals, test results, symptoms (`Observation`)
   - Risk conditions (`Condition`)
   - Counseling provided (`Procedure` or `ServiceRequest`)
3. Delivery Event
   - Record delivery details: date, place, method, outcome
   - FHIR Resource: `Procedure` (for delivery)
   - Birth outcome, complications: `Observation`, `Condition`
4. Postnatal Care (PNC)
   - Newborn registration (`Patient`)
   - Postnatal visits for mother and baby (`Encounter`)
   - Observations (e.g., temperature, breastfeeding, danger signs)
   - Immunizations recorded (`Immunization`)
5. Child Health Follow-up
   - Child growth monitoring (`Observation`)
   - Vitamin A, deworming (`Procedure`)
   - Illness episodes and treatment (`Condition`, `MedicationRequest`)

### FHIR Resources Used

Resource | Purpose
--- | ---
`Patient` | Mother and newborn identification
`RelatedPerson` | Family linkage
`Encounter` | ANC, PNC, delivery, child visits
`Observation` | Vitals, test results, birth weight
`Condition` | Risk factors, complications
`Procedure` | Delivery, counseling, supplements
`Immunization` | Child vaccinations
`MedicationRequest` | Prescriptions for mother or child

### Example: First ANC Visit for Pregnant Woman

- Patient: 25-year-old woman, registered at rural health post
- Encounter: First ANC visit on 2025-08-01
- Observation:
  - Blood pressure: 110/70
  - Hemoglobin: 11.5 g/dL
- Condition: No risk factors identified
- Procedure: Counseling on danger signs
- ServiceRequest: Laboratory test for HIV and syphilis

### Reporting Considerations

- ANC visit coverage (ANC1, ANC4)
- Delivery by skilled birth attendant
- Postnatal visit within 48 hours
- Newborn weight and immunization coverage
- Monthly reporting to DHIS2 or national HMIS