RPMS Immunization Program OVERVIEW Scott Hamstra, MD Pediatrician, Sells Indian Hospital, Tucson Area Immunization Coordinator

What is the RPMS Immunization Package? RPMS computer software tool used to: –Provide care for individual patients –Provide public health for a community –Provide information (reports) –Account for vaccines Using the RPMS Immunization software improves: –Patient Care –Data Quality –Reporting

IMM software works for all ages across the Entire Life Spectrum

Public Health Function = Community Views/Reports Who Counts? MOGE ACTIVE

What we’ll cover today RPMS Immunization Package –Setting Site Parameters –Adding Data vaccines you give today past vaccines (history not in Electronic Record) –Running Reports Birds eye view: overall vaccine rate in community How to think about and use effectively –Best Practice – Pursuing Excellence Team members and functions

RPMS Immunization Package MENU SYSTEM –PATPatient Menu … –REPReport Menu … –MGR Manager Menu …

ERREdit Patient Errors CMG Add/Edit Case Manager CMTTransfer a Case Manager’s patients SCN Scan For Patients ESPSite Parameters Edit PKGPackage Setup Information LETForm Letters Add/Edit LOTLot Number Add/Edit VACVaccine Table Edit RESRestandardize vaccine table EXPExport Immunizations KEYAllocate/Deallocate Imm Menu Keys Manager’s Menu …

Site Parameters – 19! Edit Site Parameters for: SELLS HOSP 1) Default Case Manager : 2) Other Location : TUCSON, AZ 3) Standard Imm Due Letter.....: DUE 4) Official Imm Record Letter...: Official Immunization Letter 5) Facility Report Header : SELLS HOSP 6) Host File Server Path : c:\export\requests\ 7) Minimum Days Last Letter.....: 30 days 8) Minimum vs Recommended Age...: Recommended Age 9) ImmServe Forecasting Option.: #3, WITH 4-Day Grace, HPV thru 18 10) Lot Number Options : Required, Low Supply Alert=5 11) Age Appropriate for Pneumo..: 65 years old, one time only. 12) Forecasting (Imms Due)......: Enabled 13) Chart# with dashes : No Dashes (123456) 14) User as Default Provider....: Yes 15) ImmServe Directory : C:\Program Files\Immserve821\ 16) GPRA Communities : 60 Communities selected for GPRA 17) Inpatient Visit Check : Enabled 18) High Risk Factor Check......: Enabled 1 9) Import CPT-coded Visits....: Disabled

Version 8.3 Forecasting Options All options are VALID – meet the ACIP guidelines. Built options to meet standards AND give “wiggle” room to account for some regional/local practice variance. The month vaccines are ~standard to all options, do have option to begin at 6 weeks vs 2 months of age. Influenza between Sept & March for 6 mo–18 yo children. Option 11 = special case: does not forecast Hep A or Hep B in persons over 18 years, regardless of prior doses. All forecast Tdap, MCV4, and HPV for adolescents.

Version 8.3 Forecasting Options with and without the 4 day grace period Option 6 Mths 12 Mths 15 Mths ) IPV Hib, MMR, Pn, Var..... DTaP 2) Hib, IPV, MMR, Pn, Var DTaP 3) IPV DTaP, Hib, MMR, Pn, Var ) DTaP, Hib, IPV, MMR, Pn, Var. 5) IPV Hib, MMR, Var DTaP, Pn 7) Comvax IPV DTap, HepB, Hib, MMR, Pn, Var 9) Comvax IPV HepB, Hib, Var, MMR DTaP, Pn 11)..... IPV Hib, MMR, Pn, Var..... DTaP

Forecasting: Adult Pneumococcal Vaccine “Pneumovax” Automatically forecast at age 65 –except in Alaska – forecast early at age 55 Forecast another dose if... –dose #1 given before age 65 Forecasts for High Risk patients –19-65 year olds with 2 high risk condition visits in past 3 years Stop forecast if 2 doses given before age 65 (except in Alaska)

Flu (Influenza) Forecasting too! = Young (6m-18y) & Old (>65 y) and High Risk ICD-9 Taxonomy , 044.9HIV infection Diabetes Rheumatic Heart D Hypertensive H.D Hypertensive Heart/Renal Ischemic H.D Pulmonary H.D Other endocardial H.D Cardiomyopathy , 429.2CHF Chronic Bronchitis Emphysema Asthma Bronchiectasis, CLD, COPD Pneumoconioses Chronic Liver Dis Nephrotic Syndrome 585.Renal Failure Transplant V42.0-V42.89Kidney Transplant V58.1Chemotherapy V67.2Chemotherapy f/u

Setting Up Form Letters 2 templates: Standard Due & Official Form Letter: Standard Due Letter top: Anchorage Primary Care Center 4320 Diplomacy Dr. Anchorage, AK |BI TODAY| Date of Birth: |BI DATE OF BIRTH| Chart#: |BI CHART NUMBER| + Scroll down to view more. Type ?? for more action T Top F Forecast C Closing H History B Bottom P Print Sample Letter M Middle D Date/Loc X Delete Form Letter Select Action: Quit// *** Use Screen Editor – go to TBOX and change from Line Editor

Adding Lot Numbers EDIT IMMUNIZATION LOT NUMBERS * –At the prompts, enter the Lot #, Manufacturer, Status, and Vaccine. When a Lot Number is "Inactive“ you can’t select it. Select LOT NUMBER: Are you adding '11759' as a new IMMUNIZATION LOT (the 927TH)? No// y (Yes) IMMUNIZATION LOT MANUFACTURER: merck & CO. MSD * IMMUNIZATION LOT VACCINE: mmr MMR 3 IMMUNIZATION LOT VACCINE #2: IMMUNIZATION LOT VACCINE #3: IMMUNIZATION LOT VACCINE #4: LOT NUMBER: 11759// MANUFACTURER: MERCK & CO.// Note: The Manufacturer Table is standard –press ?? to see the list

# Vaccine HL7 Active Default Lot# VIS Default Forecast 6 DTaP (20)....Active Jul YES 7 HBIG (30)....Active YES 8 HEP A (85)....Active Aug YES 9 HEP B.NOS (45)....Inactive Jul YES 10 HEP B ADLT..(43)..Active Jul YES + Scroll down to view more. Type ?? for more actions E Edit a Vaccine P Print List F Forecast 1. This is a standard list with standard HL7 codes 2. Inactivate vaccines that you do not use makes it easier to see choices of available vaccines. 3. Set default VIS dates 4. Set default lot numbers Edit Vaccine Table

How does Immunization Data get into RPMS? –Types of Immunizations: Ambulatory (Clinic) Immunizations (#1) –Inpatient Immunizations, –PHN Immunizations, –Historical Immunizations (given elsewhere) –How does it get entered into RPMS? Paper record goes to Data Entry clerk Direct data entry by Nurse/CMA at “point of service” = BEST PRACTICE !

Point of Service Data Entry Nurse gives vaccines Nurse enters vaccine directly into computer : –Vaccine name –Date –Lot number/ manufacturer –Dose/amount –Injection site –Facility –Person administering vaccine –VIS date Advantages: 1.Accurate data 2.Accurate forecasting 3.Appropriate administration 4.Timely data entry 5.Ends duplicate data entry 6.Decreases charting 7.Print out Official Record 8.Increased data access

RPMS Immunization Package MENU SYSTEM –PATPatient Menu … –REPReport Menu … –MGR Manager Menu …

RPMS – Patient Menu PATPatient Menu SGLSingle Patient Immunization Record LETPrint Individual Patient Letter LLSDue Lists and Letters The immunization record with forecasting you need when you walk into a patient’s room. - also in the Health Summary - also is what you see in EHR

Patient: DEMO,PATIENT DOB: 27-Jul-2002 (6 months) Chart#: at ANCH MED CTR Inactive Female M HBsAg: U # Immunization History | Immunizations DUE on 01/22/ /30/2002 DTaPAnch| HIB past due 2 12/01/2002 DTaPAnch| IPV 3 09/30/2002 HEP B PED Anch | PNEUM-CONJ past due 4 12/01/2002 HEP B PEDAnch| DTaPpast due 5 09/30/2002 IPV Anch | 612/01/2002 IPVAnch Contraindications: VARICELLA +Scroll down to view more. Type ?? or Q to QUIT. A Add Immunization D Delete Visit P Patient Edit S Skin Test Add I ImmServe Profile C Contraindications E Edit Visit H Health Summary L Letter Print

IF DATE = TODAY – then Default Category is “Ambulatory” Recommend that ALL require lot #s for Ambulatory vaccines. Press F1-e to save and exit. Direct Data Entry of Immunizations * * * ADD IMMUNIZATION VISIT * * * Patient: SINGLETON,COLIN DOB: 05-Sep-1989 (14 yrs) Chart#: at ANCH MED CTR Active Male ______________________________________________________________ Date: JAN 29,2004 Category: Ambulatory Vaccine: Td Lot#: ***???*** Inj Site: R thigh IM Vol: 0.5 ml Location Type: IHS Location: ANCH MED CTR Provider: SINGLETON,ROSALYN J MD VIS Date: 6/19/2008 __________________________________________________________________________________________________

CONTRAIND (IMM v8.0) Mar 26, :21:12 Page: 1 of 1 Patient: DEMO, PATIENT DOB: 14-Feb-1986 (17 years) Chart#: at ANCH MED CTR Active Male # Vaccine Reason Date Noted VARICELLA: Hx of Chicken Pox 23-Aug Enter ?? for more actions. A Add Contraindication D Delete Contraindication ADDING CONTRAINDICATIONS

Adding Contraindications Choose from: –Anaphylaxis –Carrier –Convulsion –Egg Allergy –Fever>104F –Hx of Chicken Pox –Immune –Immune Deficiency ( adds contraindication to all live vaccines) –Immune Deficient Household –Lethargy/Hypotonic Episode –Neomycin Allergy –Other Allergy –Parent Refusal (vaccine will still be forecast) –Patient Refusal (vaccine will still be forecast) –Persistent Crying –Reason not recorded

RPMS Immunization Package PATPatient Menu… –SGLSingle Patient Record –LETPrint Individual Patient Letter rarely use in this IMM menu but used in EHR daily –LLSDue Lists and Letters

Patient Menu Lists and Letters Feature 1 Date of Forecast/Clinic.: TODAY (or date in future) 2 Age Range : Months (Can change to Years) 3 Patient Group : Active (Inactive, other choics) 4 Communities : ALL 5 Case Managers : ALL 6 Immunizations Received...: ALL 7 Immunizations Due : MMR 8 Health Care Facilities...: ALL 9 Lot Numbers : ALL 10 Additional Information...: Forecast (history, more) 11 Order of Listing : by Patient Age Select a left column number to change an item. List of Patients Print Due Letters To print a simple list choose Option 10 - “No additional info”.

Reports Menu Two Year Old Report Quarterly Report Vaccine Accountability Report Adult Report Adolescent Report Influenza Report

Two Year Old Report = month olds Designed to match –CDC National Immunization Survey –Healthy People 2010 format Used to compare to all other organizations! Provides Rates for –a single vaccine (2010 Goal is >90% for each one) DTaP –groups of vaccines 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB The standard in 2008 Moving to include –Varicella = –Pneumococcal conjugate This report’s measure is the used for 2008 GPRA in the CRS package..

Quarterly Report – “worksheet” Age-appropriate Vaccines 3-27 months –“snapshot” of the community –Doing well on this >80% -- will ~ENSURE that your Two Year Old month old report will be >90% STANDARD REPORT –breakdown by age groups – “Up to Date” changes –3-4 months#1 DTaP, IPV, Hib, HBV –5-6 months#2 DTaP, IPV, Hib, HBV –7-15 months#3 DTaP, #2 IPV, Hib, HBV –16-18 months#3 DTaP, Hib, #2 IPV, HBV #1 MMR –19-23 months#4 DTaP, #3 Polio, IPV, HBV #1 MMR –24-27 months#4 DTaP, #3 Polio, IPV, HBV #1 MMR

Adolescent Report denominator similar CRS logic includes those with 2 visits in past 3 years New --- for the United States – not really sure what the levels will be and how to best measure.

Adolescent Report IHS Adolescent Immunization Rates For patients 11 through 17 Years of Age As of: 20-Jan-2009 Total Patients: 724 Total Females: Age Group | 11-12yrs 13yrs 13-17yrs Denominators | =============================================================================== 1-HEPB | | 97% 99% 98% | HEPB | | 97% 99% 97% | HEPB | | 96% 99% 97% MMR | | 97% 100% 98% | MMR | | 97% 98% 97% VAR | | 85% 75% 47% | VAR | | 63% 51% 31% Hx of Chickenpox| (Immune) | 23% 38% 52%

Adolescent Report cont’ 1-Tdap | | 59% 89% 51% | Tdap/Td | | 64% 92% 96% HEPA | | 97% 100% 98% | HEPA | | 96% 99% 96% MEN | | 62% 88% 88% FLU | | 13% 12% 7% TD_B 3-HEPB | MMR 1-VAR | 63% 88% 87% TD_B 3-HEPB | MMR 1-MEN | 41% 45% 28% 2-VAR |

Adolescent – Female portion Female | 11-12yrs 13yrs 13-17yrs Denominators | HPV | | 60% 88% 87% | HPV | | 34% 66% 62% | HPV | | 17% 43% 35% TD_B 3-HEPB | MMR 1-MEN | 13% 23% 13% 2-VAR 3-HPV | (females) | Total Active Patients reviewed: 724 Total Active Females reviewed: 381 Total Patients reviewed who had Refusals on record: *Denominators are Active Clinical Users: 2 clinical visits in the past 3 years. *Patients considered "Current" have 1-Td_B, 3-HEPB, 2-MMR, 1-VAR/Hx_Varicella

Vaccine Accountability Report At most sites done by Pharmacy –order, store & account for vaccines. Report to your State’s VFC Program –overall number of vaccine doses used

Adult Report (Active = those with 2 visits in past 3 years) –Adults by age >65 >50 –Influenza in past year –Pneumovax in lifetime Also for Alaska - in past 6 years –Td in past 10 years GPRA measures > 65 years of age Influenza past year Pneumovax ever

Pediatric Influenza Report INFLUENZA IMMUNIZATION REPORT 1 - Report Year (Flu Season)...: 2008 (09/01/ /31/08) 2 - Community : ALL 3 - Health Care Facility : ALL 4 - Case Manager : ALL 5 - Beneficiary Type...: INDIAN/ALASKA NATIVE

Influenza Immunization Report 20-Jan Beneficiary Type: INDIAN/ALASKA NATIVE | Age in Months on 12/31/2008 | | | Totals | | Denominator | | Influenza | | Season | 50% 32% | 37% Fully | | 159 Immunized | 26% 22% | 23% Total Patients included who had Influenza Refusals on record 3