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.

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Actors

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

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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)

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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

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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

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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