[Gnumed-devel] Vaccination as a starting point

[richard terry]

> For each immun. a timestamp, the immun.type (reason:
> prevention, travel, exposure, ...), the exact name of the
> vaccine, the charge/lot/batch ID, the injection site/type
> should be recorded.

+should we have a line for 'reacton' in case patient has a problem with a 
particular vaccine.
>
> Certain vaccination types should be able to trigger GNUmed
> "request" events (check HepB titer 10 years post vacc., prompt
> for boosters/repeat vacc. on multiple base immunisations, alert
> for overdue vacc.s)

Agree. In my program I linked age to the schedules and did a check when the 
patient was first loaded. The flashed up a sign if immunizations were 
missing. Got a little messy because of
a)Doctors putting vaccines in incorrect schedules
b)vaccine equivalency problems
And I never quite got it right but it sort of worked (see the png dumps)

> Those mechanisms should be based on pluggable guidelines.

This raises many issues. In australia we have immunization schedules (as I 
presume all countries do). The schedules however are constantly being 
modified e.g we had a situation not long back where kids born prior to 
01/05/2000 were on one schedule, and those after 01/05/2000 on another. This 
is not a problem if you present vaccines as either a schedule or a disease 
target;
eg in my edit area:
Target
Vaccine
Date given
Serial no
Site
(reaction)  - not there but perhaps we should

The Target can be a disease, combinations of diseases or schedules eg:
see the attatched png for examples.
One a schedule is chosen, all the vaccines in this schedule are automatically 
presented, or or a disease is chosen, here meningococcal, ditto.
Hitting enter on a vaccine them puts in a default date(today) which you can 
change if entering past vaccine information, and the last vaccine_serial 
number used for this brand of vaccine (which again you can edit).
To put in the site, I just enter by hand, but one should have quick 
abbreviations built into this line eg ld  would autoexpand to left deltoid 
etc.

See the display or previous vaccinations by the schedule/target disease list 
below the editing area.

>
> It may be beneficial to be able to "link" vaccinations to
> particular lab results.

Agreed, but looking into the future here
>
> Vacccine type <-> patient age should be checked if possible.

I did this in my program (see the png which for this 5year old lists vaccines 
the system says she should have had but are not recorded (plus see my note 
above).
>
> Recording a vaccination should create an event in the patient
> state tracking time line (where major things like hospital
> admissions, major diagnoses, off-work, pregnancies, etc. are
> linked together to form a coherent picture).

Yes, but again we need to walk before we run.

See some table definitions to start the ball rolling:

Table: Data_Immunisations
        Name    Type    Size
        consult_ID      Number (Long)   4
        Date_given      Text    10
        Vaccine_ID      Number (Integer)        2
        Schedule_ID     Number (Integer)        2
        Serial_No       Text    20
        Site    Text    25
        Deleted Yes/No  1

Table: lu_Vaccine_Equivalents
        Name    Type    Size
        Vaccine_ID      Number (Long)   4
        Equivalent_ID   Number (Long)   4

 Table: lu_Vaccine_Schedules
        Name    Type    Size
        Schedule_ID     Number (Integer)        2
        Age_Due_Months  Number (Integer)        2
        Age_Due_From    Number (Integer)        2
        Age_Due_To      Number (Integer)        2
        Age_Due_Units   Number (Integer)        2
        Schedule_Text   Text    55
        Archived        Yes/No  1
        Female_Only     Yes/No  1
        Display_Schedule_only   Yes/No  1
        Aboriginal_TSI_only     Yes/No  1
        Seasonal_ID     Number (Long)   4

Table: lu_vaccines      
        Name    Type    Size
        Vaccine_ID      Number (Long)   4
        Description     Text    75
        Trade_Name      Text    75
        Abbreviation    Text    50
        Disease_target  Text    50
        Live_vaccine    Yes/No  1
        formulation     Text    50
        Last_Batch_No   Text    15
        Archived        Yes/No  1
        Updated Date/Time       8

Table: lu_vaccines_in_schedule
        Name    Type    Size
        Vaccine_ID      Number (Integer)        2
        Schedule_ID     Number (Integer)        2
        Booster_Interval_from   Number (Integer)        2
        Booster_interval_to     Number (Integer)        2
        Booster_inteval_units   Number (Integer)        2
        Sequence        Number (Byte)   1
        Seasonal_month_Due      Number (Integer)        2


>
> Vaccinations should be linkable to Episodes (PneumoVax well
> after hospital admission in order to prevent recurrence).
>
> Anything else comes to mind ? Comments ? Additions ? We will
> get tables going for this but we need input. _This_ is your
> time to make yourself heard.
>
> Karsten

target_as_disease.png
Description: PNG image

targetasschedule.png
Description: PNG image

vaccineselection_inshedule.png
Description: PNG image