Ontario Immunization Repository Implementation Guide -v1.0.0-draft2
For a full list of available versions, see the Directory of published versions
This model is linked to Ontario’s Electronic Health Record (EHR) Conceptual Information Model 2.0 (CIM 2.0). See: https://ehealthontario.on.ca/files/public/support/Architecture/Ontario_EHR_CIM_2.0.pdf
To support the use of structured data through the adoption of data content and health terminology standards in the solution, this CDM also includes high-level entity relationships and attributes discovered in versions of the FHIR R4.0.1 interoperability standard. The model does not repeat the structure of the messages laid out in FHIR. Links to FHIR specs are included for entity definitions and field code values. In any difference of meaning between cited FHIR elements and this model, FHIR is the authoritative voice. This model relies on the following specifications:
Note: The entity names and descriptions below are sourced from CIM 2.0. Minor wording updates were made in certain sections to adapt the content to the context of this IG and ensure alignment with the terms used under the DHIEX framework.
Entity Relationship Diagrams (ERDs) follow. These include:
"Entity Relationship exactly one Entity 1").The Conceptual Data Model that follows describes the concepts that are available via the Immunization Repository (IR), but are general descriptions of the concept within the context of the broader health care system and Ontario’s Electronic Health Record (EHR). The definitions of the entities are taken specifically from the EHR Conceptual Information Model and are meant to cover the broad spectrum of the data across Ontario’s EHR. The information that is available via the IR interface may only contain a subset of the concepts described in the definition of the Entity.
| Entity Name | Description | Reference to Target |
|---|---|---|
| Healthcare Client | An individual participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. (U.S. National Library of Medicine - Medical Subject Headings) A natural person (i.e. a human being) who:
This entity covers personal health information. It includes information about:
The health care client's identity may be unknown e.g. for a protected person or if the identity of the health care client is unknown. A health care client may be a VIP whose identity must be omitted from reporting. A health care client may be identified by an alias. Personal health information could include a photograph. May be related genetically or by physical co-location (e.g. residential, occupational, travel, etc.) to another person not necessarily a health care client. Depending on care setting, a health care client may be referred to as:
|
Patient |
| Organization | An organization that provides health care or other health-related services or products. Includes e.g. insurers and transcription services. May have information on service classification e.g. Regional Cancer Centre. (For Single Sign on application, a Provider Organization may be a Sponsoring Organization, a Health Care organization that has users that require access to at least one Federated Service. 2015-6-15) |
Organization |
| Provider Person | Describes a health care provider involved in the delivery of healthcare services. Encompasses both professional and non-professional members. Has professions, areas of practice for which the provider is qualified. May have information on clinician credentialing and privileging as defined by the applicable professional and governing organizations. This includes remote participation (e.g., via tele-health activities such as tele-consultation, home health monitoring.) Includes any information about licensing status and license suspension. May be an author, authenticator or scribe/transcriber of clinical documentation. Has a Unique Provider Identifier, a key assigned by eHealth to uniquely identify each Provider. May have a health system universal ID. May have a license number or national provider identifier (U.S.). May have multiple unique identifiers. |
Practitioner |
| Provider Role | A part played by a health care provider (regulated or unregulated) that provides a type of care to a particular health care client. Examples: Acupuncturist Advanced Care Paramedic Audiologist Certified Graduate Nurse Chiropractic Clinical Counsellor Combined Lab and X-Ray Technologist Communicable Disease Case Investigator Counsellor Critical Care Paramedic Dental Assistant Dental Hygienist Dental Technician Dentist Denturist Emergency Medical Responder Homeopath Home Support Worker Kinesiologist Lab Technician Licensed Practical Nurse Marriage and Family Therapist Medical Doctor Medical Laboratory Technologist Medical Officer of Health Midwife Nuclear Medicine Technologist Occupational Therapist Optician Optometrist Paramedic Practitioner Pharmacist Pharmacy Technician Physiotherapist Personal Support Worker Podiatrist Primary Care Paramedic Psychiatrist Psychologist Psychotherapist Radiation Technologist in Magnetic Resonance Radiation Technologist in Radiation Radiation Technologist in Therapy Recreation Therapist Registered Acupuncturist Registered Clinical Social Worker Registered Dietitian Registered Massage Therapist Registered Midwife Registered Nurse Registered Nurse Practitioner Registered Psychiatric Nurse Respiratory Therapist Social Services Worker Social Worker Speech Language Pathologist Speech Therapist |
PractitionerRole |
| Health Care Provider Product Location aka. Location (Service Delivery) | An address or other identifiable locale at which health products have been provided to an individual health care client in a Health Care Encounter, often by a particular provider playing a particular role. It may also be:
Locations and contact information may refer to the location of the provider within a health care facility's premises e.g. a hospital unit. Products and services can be provided by non-licensed providers e.g. care-givers. |
Location |
| Substance Intake (Immunization Event) | The administration of a substance into the body key to the management of a health care client's condition(s). May be self-administered or administered by a Health Care Provider. May be administered by a device. Intake can be medication or nutrition, e.g. daily consumption of food items, beverages, or oral medication, injected medication such as a pain killer or the topical application of a patch. It can be a meal type (e.g. breakfast), and can have a specific time or date associated with it. It can be PRN i.e. taken as needed, including adjustment of dosage to suit needs. An example of an intake is an immunization: an application of a technique (e.g. vaccination), that induces immune resistance to a specific disease by exposing the individual to an antigen in order to raise the level of antibodies to that antigen. May record: • the immunization name/type, sequence number in the series & series identifier, strength and dose • the date and time of administration • manufacturer, lot number, expiration date • route and site of administration • administering provider • observations, reactions and complications • reason immunization not given, and/or immunization related activity not performed (e.g., due to a contraindication or a health care client's refusal), and identity of immunization-withholding provider. • if the immunization is recorded or occasioned by a population-based schedule from a relevant public health immunization authority. May include: • drug name • strength and dose • site and route • date, time and frequency of administration • observations, reactions and complications • reason medication not given (e.g. delay, refused, unavailable) • medication related activity not performed. • annotation, e.g., describing the dose to be administered based upon specific clinical indicators such as a sliding scale insulin order where the dose is based on the health care client's current blood sugar level. |
Immunization |
| Health Product (Vaccine Product) | Material (i.e. medication or devices) or service provided for a particular health care client for the treatment or prevention of disease or injury or the promotion of wellness. Product examples include insulin test strips, adult briefs. Also includes a human-product donation received by a health care client e.g. blood or biological products. May include radiation such as X-rays. May include a reason for use of the product. |
Immunization.vaccineCode |
| Medication Order (Requisition) | A request for a Health Product, fulfilled by providers. A requisition may come with instructions, which may come from the provider, a pharmacist, or a manufacturer. May have:
|
MedicationDispense / MedicationRequest/MedicationAdministration |
This subject area defines the core demographic and administrative entities involved in an Encounter, including the patient receiving the immunization product, the providers administering it, and the locations/organizations where the event takes place.
Metadata for the attributes in this subject area are available at the following location(s):
This subject area defines the clinical event of an immunization, capturing the details of the vaccine administered, the dosage, the site and route of administration, and the linkages back to the relevant client and providers.
Metadata for the attributes in this subject area are available at the following location(s):