Immunization Create - Missing Required Fields

[jaym]

Hello again,

I'm trying to perform a more complicated Immunization Create, but can't figure out which field(s) I'm missing. Can you please help me narrow it down?

X-Request-Id: e677b0e7-71da-4aa2-97c7-070ba9321067

{

  "resourceType": "Immunization",

  "status": "completed",

  "occurrenceDateTime": "2020-07-30T15:13:24.000Z",

  "vaccineCode": {

    "coding": [

      {

        "system": "http://hl7.org/fhir/sid/cvx",

        "code": "143",

        "display": "Adenovirus types 4 and 7",

        "userSelected": true

      }

    ],

    "text": "Adenovirus types 4 and 7"

  },

  "reportOrigin": {

    "coding": [

      {

        "system": "https://fhir.cerner.com/0b8a0111-e8e6-4c26-a91c-5069cbc6b1ca/codeSet/30200",

        "code": "20738688",

        "display": "Primary Care Provider",

        "userSelected": false

      }

    ],

    "text": "Primary Care Provider"

  },

  "patient": { "reference": "Patient/4342012" },

  "encounter": { "reference": "Encounter/5239911" },

  "performer": [

    {

      "function": {

        "coding": [

          {

            "system": "http://terminology.hl7.org/CodeSystem/v2-0443",

            "code": "AP",

            "display": "Administering Provider"

          }

        ],

        "text": "Administering Provider"

      },

      "actor": { "reference": "Practitioner/4874007" }

    }

  ],

  "primarySource": true,

  "site": {

    "coding": [

      {

        "system": "http://snomed.info/sct",

        "code": "74262004",

        "display": "Oral cavity structure (body structure)",

        "userSelected": true

      }

    ],

    "text": "Oral"

  },

  "route": {

    "coding": [

      {

        "system": "http://snomed.info/sct",

        "code": "26643006",

        "display": "Oral route (qualifier value)",

        "userSelected": true

      }

    ],

    "text": "PO"

  },

  "doseQuantity": {

    "value": "1",

    "unit": "{tbl}",

    "system": "http://unitsofmeasure.org",

    "code": "{tbl}"

  },

  "education": [

    {

      "documentType": "Adenovirus Vaccine VIS",

      "publicationDate": "2020-01-08 00:00:00"

    }

  ]

}

Thanks!

Jay

[jaym]

Hi guys,

Any thoughts?

Thanks,

Jay

[Benjamin Eichhorn (Cerner)]

Hi Jay,

Please be aware we are currently investigating and we will get back to you soon.

Thanks,

Ben (Cerner)

[jaym]

Cerner Folks,

I've investigated this further. The "Missing Required Fields" response can occur if the Immunization.VaccineCode.coding.code (CVX) either has a preceding "0" or... doesn't appear to be in Cerner's database (e.g. "143")?

Do you have a list of CVX, Site, and Route values that are accepted by Millennium?

Thanks,

Jay

[jaym]

Hi,

Just a gentle reminder that I'd really like to know which CVX codes, routes, and sites are accepted please. It's pretty easy to throw a "Missing Required Fields" error and I'd like to be able to avoid that.

Thanks,

Jay

[Max Philips (Cerner)]

Hi Jay,

Please accept my apologies for the delay in response. We are continuing to investigate the issue internally, but I have a few updates to share.

You are correct that only specific codes are available for use in vaccineCode.coding in Cerner's sandbox environment. We've documented terminology bindings for the field here: http://fhir.cerner.com/millennium/r4/medications/immunization/#terminology-bindings

But as you've noticed not all CVX or NDC codes are available. If you prefer, we support proprietary codings on that field as well. Any Cerner Millennium code value from code set 72 is available for use: https://fhir.cerner.com/millennium/r4/proprietary-codes-and-systems/#code-set-72-clinical-event-codes

Some example code values that you could use are the following. Note that the system for these proprietary codings will be https://fhir.cerner.com/0b8a0111-e8e6-4c26-a91c-5069cbc6b1ca/codeSet/72

Lyme disease vaccine 2799031

cholera vaccine 2799028

hepatitis A adult vaccine 3366119

hepatitis A pediatric vaccine 3366120

human papillomavirus vaccine 4164821

measles virus vaccine 2798178

plague vaccine 2799035

rabies vaccine 2798591

rotavirus vaccine 4164809

rubella virus vaccine 2798630

Additionally, if you are needing to use CVX mappings, please let us know which standard codes you are having trouble with. We can work to enable them in the sandbox environment.

And finally, I'll note that any specific mappings that you do land on in Cerner's sandbox environment may or may not be the same at client sites, so I'd recommend testing in the sandbox environment with test mappings and fully nailing down codes to use later on.

Thanks,

Max (Cerner)

[Max Philips (Cerner)]

Oops, I missed your question about Site and Route values as well.

Proprietary codes are supported on those fields too. You can give these values a shot:

Site - system https://fhir.cerner.com/0b8a0111-e8e6-4c26-a91c-5069cbc6b1ca/codeSet/97

Bilateral Ears 570

Bilateral Eyes 571

Bilateral Nares 572

Buttock 573

Chest Tube 574

Left Arm 576

Left Foot 581

Nebulized 598

Right Arm 603

Right Foot 608

Route - system https://fhir.cerner.com/0b8a0111-e8e6-4c26-a91c-5069cbc6b1ca/codeSet/4001

Ear-Right 318156

Ear-Left 318157

Ear-both 318158

Buccal 318159

Caudal 318160

ENDO 318162

EPI 318163

IA 318165

ID 318166

IM 318167

[jaym]

Max,

Thank you so very much for passing all of that along.

Jay