Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION
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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