1. KIDSNET: A TOOL TO HELP US ACHIEVE A 100% CHILDHOOD IMMUNIZATION RATE WellOne Primary Medical and DentalCare

2. STEPS TO ACHIEVING 100% IMMUNIZATION RATES 1. Use every visit as an opportunity to assess vaccination status Every visit ….is an opportunity to assess and possibly give vaccine/s Important to assess at sick as well as well child visits since: Well child examinations may be missed Opportunity to assess for invalid doses and intervene as well as remind of upcoming doses due 2. Observe only true contraindications for vaccination 3. Follow ACIP recommendations and vaccine rules (including administration technique/needle size, minimum age and intervals, etc.) 4. Utilize KIDSNET

3. What is KIDSNET?  KIDSNET is the State of Rhode Island Immunization Registry  All children born in Rhode Island from 1997 and on have a file in KIDSNET  As of January 2005, KIDSNET also began collecting immunizations given to children born before 1997, up through age 18. KIDSNET contains only recent immunizations given for this age group.

4. Where does the data come from? Hospitals: After birth, a child born in a Rhode Island Hospital and any available information is entered into KIDSNET Providers: Providers of immunizations in Rhode Island provide immunization data to KIDSNET The State: The RI DOH coordinates lead screening results into the KIDSNET database Other: WIC, Hearing Testing Centers, Home Visits, and more

5. Which children and information will not be in KIDSNET? A child born out of state will not be included in the registry unless he or she visits a Rhode Island provider who submits immunization data to KIDSNET Children born before 1997 may not be enrolled in KIDSNET Vaccines administered from non-KIDSNET participating providers will not be in KIDSNET unless submitted by another provider (note that most RI providers participate in KIDSNET) KIDSNET does not recognize when a child is no longer due for vaccination due to past disease (i.e.. Varicella).

6. Is the data reliable?  The data is only as reliable as an immunization record  The data is submitted by the provider of the immunization delivery and therefore, if the data is submitted incorrectly, it will be incorrect in KIDSNET  If a provider administers a vaccine and the information is not provided to KIDSNET, the immunization record will not be complete  In most instances, the data is better than not having any data at all

7. What can KIDSNET do for our patients and our practice?  Our goal at WellOne is a 100% immunization rate  KIDSNET can help us achieve this goal, but only if we use KIDSNET and all that it has to offer

8. How should we use KIDSNET?  Run and review a KIDSNET immunization report (and lead poisoning data for children 6 and under) at EVERY visit (both sick and well visits)  Designate individuals in the practice to generate, investigate and follow up on the “past due/missing immunization” report and lead screening report monthly.

9. Our KIDSNET Responsibilities  We want to be able to see which children are past due for vaccination by running the immunization report. Therefore, it is critical that all children are enrolled in KIDSNET with our site as their PCP even if they have not received immunizations at our office.  Notify KIDSNET of children for whom we are no longer the PCP so that these children will not appear in our follow up reports.  The MA/PCC is responsible for running a KIDSNET immunization report (and lead poisoning report for children 6 and under) at every visit- both sick and well. Any updated vaccines found on the KIDSNET report must be updated in EMR. We must also submit each and every vaccine administered to KIDSNET.

10. The log in page You have or will be assigned a user ID and password- never use another employee’s ID to access KIDSNET data. The system will prompt you to change your password every 90 days. Any changes or expected interruptions to the KIDSNET site will be announced here

11. Performing a Child Search  Searching for a child can be done by using the child’s information (first name, last name, and/or DOB);  the Mother’s information  or the KIDSNET ID if known

13. Here I have entered the first name and last name, KIDSNET TELLS ME THERE ARE NO MATCHING CHILDREN. In this case, try the date of birth (child’s name may have been changed)

14. From the search page, you can define which information I want to see once the child’s record is located. I must select this before searching for the child.. The field automatically defaults to show demographic information if no other selection is made.

15. I can also search for a child from the patient list  CLICK ON PATIENT LIST

16. The patient list Using this feature, a list of patients registered to the practice location site (Pascoag, North Kingstown or Foster) will appear. You can sort the list alphabetically or by date of birth for the child/children by clicking on the corresponding header. Note that this feature will only show a display of names of children who are registered in our practice with KIDSNET

17. TRUE OR FALSE: To search for a child who is new to the practice, the user must search from the Patient List True False Click here to select this answer Click here to select this answer

18. The correct answer is……… Using the Patient List search feature will only generate a listing of children enrolled in our practice with KIDSNET.

19. After locating a child, the options include viewing and printing any of the options listed here on the side bar

20. Demographics  The demographics screen shows data such as the child’s previous health care provider/s, birth hospital, parent/guardian information, and the address history

21. Child Summary  The Child Summary section provides an overview of information.  Click on the child summary to see a sample report

22. The child summary provides a brief overview of several items

23. The personal school form…..  Provides a word document with all submitted immunization data that can be printed and provided to the school Click here to go back Click here to move on

24. Lead Poisoning Here shows the sample type: venous (V) or finger stick (F) And the lead level If an environmental inspection was done, it will show here

25. Click here to go back Click here to move on WIC information will be here including last visit date, height/weight and Hemoglobin results- NOTE WIC DOES NOT CONDUCT LEAD SCREENING

26. Click here to go back Click here to move on  Click here to see the hearing assessment screening results

27. Click here to go back Click here to move on

28. Click here to go back  Click here to see the newborn developmental risk assessment

29. Click here to go back Click here to move on Shows the Hepatitis B status of the mother, as well as the birth weight of the child

30. Click here to go back Information can also be viewed on home visits and the results of the newborn Bloodspot that screens for certain genetic diseases. Click here to move on

31. Which heading on the side bar when clicked will show the child’s birth weight? WIC Newborn Bloodspot Newborn Developmental Risk Assessment Click here to select this answer Click here to select this answer Click here to select this answer Click here to go back

32. The correct answer is……. Click here to go back Click here to move on

33. Which heading on the side bar when clicked will show lead screening results? Lead Poisoning Newborn Bloodspot Newborn Developmental Risk Assessment Click here to select this answer Click here to select this answer Click here to select this answer Click here to go back

34. The correct answer is………Lead Poisoning Click here to go back Click here to move on

35. The Immunization Record Click here to go back Click on Immunization to go to an immunization report; try it now

36. The Immunization Record Click here to go back Click here to move on

37. The total number of valid doses for each vaccine is shown under each vaccine For each vaccine given, the date of admin, the vaccine name and the age of the child at time of vaccination will appear under each dose In this column we see for each vaccine if the series has been completed, if the dose is past due, if the dose is due now, or if the dose is due in the future- examine each one closely Click here to move on Click here to go back

38. As you can see in this example, the child received 3 valid doses of Hepatitis B in the form of Comvax and there are no future Hepatitis B vaccines needed Click here to go back Click here to move on

39. Here you see that the child has received 5 valid doses of DTaP and no further DTaP is needed however, KIDSNET directs you to look below and you now see that…… A dose of Tdap (or Td if Tdap is contraindicated) is due in the future and can be given as early as 11/17/2011 (remember earlier, but within the recommended time is better). Look at due future dates for every vaccine- it maybe that the vaccine is due and can be given tomorrow, next week or next month- this is how we can really make a difference in immunization rates Click here to go back Click here to move on

40. Today is 6/22/09 and you are looking at the below. This child is in for an ear infection today. The last physical exam for this child was 5/1/09. What is the best course of action? Click here to select this answer Click here to select this answer Give dose one of MMR today Remind mom to return 5/1/10 for a physical and MMR Click here to select this answer Click here to select this answer Ask mom to schedule an appointment for 8/1/09 for MMR vaccination Have mom return 12/1/09 for vaccination Click here to go back

41. The correct answer is: Ask mom to schedule an appointment 8/1/09 for vaccination Give dose one of MMR today Remind mom to return 5/1/10 for a physical and MMR Ask mom to schedule an appointment for 8/1/09 for MMR vaccination Have mom return 12/1/09 for vaccination MMR IS NOT YET DUE- IT IS TOO EARLY 5/1/10 is beyond the recommended interval; also earlier is better but only if the dose will be valid While a dose of MMR administered on 12/01/09 would be valid- earlier in the recommended range is better Click here to go back Click here to move on

42. It is critical to pay attention to footnotes (these are marked with [ ] and a number) At the bottom of the page there is an explanation of the footnote If more information is needed, click the recommended explanation, try it now Click here to go back Click here to move on

43. Click here to go back Click here to move on

44. Footnote explained……  We will see this footnote with Pediarix vaccine. Infants receiving a birth dose of hepatitis B vaccine and the series of Pediarix injections end up having an extra dose of the vaccine (usually due to the 4 month Pediarix). Pediarix is acceptable to use for the 2, 4 and 6 month old series of vaccines however, the Hepatitis B component at the 4 month schedule does not count toward the Hepatitis B series.  Do not count the dose of Hepatitis B contained in Pediarix as valid. Disregard the invalid dose and administer Hepatitis B with 8 weeks between doses 2 and 3, and at least 16 weeks after dose 1, according to the immunization schedule. Click here to go back Click here to move on

45. KIDSNET Footnotes  [While in the previous example the footnote was just pointing out a fact and required no action, other footnotes may require action. ] Click here to go back Click here to move on

46. KIDSNET Foot note: Minimum age not observed Click here to go back Click here to move on Many vaccines are not counted as valid if given before a certain age. Vaccines may be given up to 4 days of the recommended age; doses at greater than 5 days before minimum age are considered invalid. If a vaccine is given prior to the minimum age by five (5) or more days, that dose is considered invalid and the dose does not count. In this case, the dose should be repeated if indicated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval observing the age rules.

47. This little guy received 5 doses in total of DTaP yet, only 3 of those doses Were valid. Look at the footnote and you will see why……… If we had taken advantage of KIDSNET in the first place, we would have seen that the last 2 doses were too early to be administered- He is due for dose #4 now, so let’s get him immunized Click here to move on Click here to go back

48. A dose of vaccine administered at ______ before the minimum age is considered invalid and must be repeated. 2 or more days 3 or more days 4 or more days 5 or more days Click here to select this answer Click here to select this answer Click here to select this answer Click here to select this answer Click here to go back

49. The correct answer is…. 5 or more days…..  Vaccines may be given up to 4 days of the recommended age; doses at greater than 5 days before minimum age are considered invalid.  If a vaccine is given prior to the minimum age by five (5) or more days, that dose is considered invalid and the dose does not count. Click here to go back Click here to move on

50. KIDSNET Footnotes: Live virus vaccine separation not satisfied  What is means: Live viruses (mainly MMR and Varicella mainly) must either be given at the same time or separated by at least 28 days.  When live virus vaccines are given on different dates but less than 28 days of each other, the first vaccine is counted as valid but the subsequent vaccine is not counted as valid and must be repeated at the appropriate time interval. The ACIP now recommends that if two live parenteral vaccines are given less than 28 days apart, the vaccine given second should not be counted as valid and should be repeated at least 4 weeks after the "invalid" dose.  What to do: Re-administer the determined invalid vaccine at least 28 days from the administration of the invalid dose.  How to prevent in the future: Do not separate live virus vaccines (MMR and Varicella). Administer on the same day. Note that inactivated vaccines do not interfere with the immune response to other inactivated vaccines or to live vaccines. An inactivated vaccine can be administered either simultaneously or at any time before or after a different inactivated vaccine or live vaccine Click here to go back Click here to move on

51. TRUE OR FALSE: Varicella and DTaP must be administered on the same day or separated by at least 28 days. True False Click here to select this answer Click here to select this answer Click here to go back

52. The correct answer is……… There is no minimum separation required when a inactivated vaccine is given apart from a live virus vaccine. The rule on separation applies only to live virus vaccines (MMR and Varicella) which must be administered on the same day or separated by a minimum of 28 days. Click here to go back Click here to move on

53. TRUE OR FALSE: To avoid the possibility of invalid doses, MMR and Varicella should generally be administered on the same day. True False Click here to select this answer Click here to select this answer Click here to go back

54. The correct answer is……… Administering live virus vaccines on the same day avoids problems with spacing the vaccines to ensure immunogenicity. Click here to go back Click here to move on

55. If an MMR is given on the 15 th of the month and a Varicella is given on the 20 th of that same month, which dose is considered invalid and must be repeated? Varicella MMR Neither Click here to select this answer Click here to select this answer Click here to select this answer Click here to go back

56. The correct answer is……. Varicella  When live virus vaccines are given on different dates but less than 28 days of each other, the first vaccine is counted as valid but the subsequent vaccine is not counted as valid and must be repeated at the appropriate time interval. The ACIP now recommends that if two live parenteral vaccines are given less than 28 days apart, the vaccine given second should not be counted as valid and should be repeated at the minimum interval after the "invalid" dose. Click here to go back Click here to move on

57. KIDSNET Footnote: Minimum interval not satisfied  The "minimum" interval is the shortest time between two doses of a vaccine series in which an adequate response to the second dose can be expected. (example: Hep A doses must be separated by 6 months; there must be at least 4 or more weeks between MMR #1 and MMR #2, etc. )  If a vaccine is given prior to the minimum interval by five (5) or more days, that dose is considered invalid and the dose does not count.  The dose should be repeated if still indicated.  The repeat dose should be spaced after the invalid dose by the recommended minimum interval. Click here to go back Click here to move on

58. TRUE OR FALSE: The "minimum" interval is the shortest time between two doses of a vaccine series in which an adequate response to the second dose can be expected. True False Click here to select this answer Click here to select this answer Click here to go back

59. The correct answer is……… Click here to go back Click here to move on Click here for a printable page on minimum intervals

60. TRUE OR FALSE: You are reviewing a KIDSNET generated immunization record for a 14 month old child and the foot note reads: “minimum interval not observed” for Rotavirus #2 and the end cap states “end of series reached. At this point you should repeat the Rotavirus dose #2. True False Click here to select this answer Click here to select this answer Click here to go back

61. The correct answer is……… Although the second dose of Rotavirus was administered too soon after the first, Rotavirus should not be administered after 8 months of age. The practitioner should not repeat the immunization. The end cap reads “end of series reached”, indicating no further action is required. Click here to go back Click here to move on

62. When reviewing the KIDSNET child immunization record…….  Compare the record to our patient record for accuracy  Look closely at footnotes and upcoming due dates Click here to go back Click here to move on

63. Click here to go back Click here to move on A great feature of KIDSNET is that it allows us to run the following reports:

64. Click here to go back Click here to move on The past due or missing immunization report is customizable based on the data that you want This report must be run at least monthly with follow up and outreach for those who are missing immunizations; submit the information to KIDSNET

65. Click here to go back Click here to move on The Lead Screening Report This report must be run at least monthly with follow up and outreach for those who are past due for lead screening and submit the information to KIDSNET

66. Special Reports We can also request special reports that the KIDSNET staff will customize for our practice Click here to see the KIDSNET custom report request form Click here to go back Click here to move on

67. Be sure to submit all vaccines given to KIDSNET promptly after the visit Run the past due immunization report and lead screening report monthly and identify children in need of follow up Submit to KIDSNET when we are no longer the PCP for a child so that the child will no longer show in our past due immunization report and lead screening report Run a KIDSNET immunization report for every child visit, regardless of the reason for visit; also run lead screening report for all children 6 and under Examine the report for missing or invalid doses and take action Identify any upcoming due dates for vaccination and schedule an appointment as appropriate Ensure that all children visiting us as their PCP are enrolled in KIDSNET with our site as their PCP even if immunizations were not given at our facility (Do this at the child’s first visit- even if this was a sick visit) Complete a KIDSNET data form with request for labels for all new children enrolled at our site Include past immunization data if available with the KIDSNET data form if this information is not already in KIDSNET Steps to Achiev ing 100% Immu nizatio n Rates Click here to go back Click here to move on

68. Using “add child” on KIDSNET Children who are not in KIDSNET may be added to the system if all of the following circumstances have been met: A complete, unsuccessful search for the child has been completed; and The child has not turned 19 years old. The child was not born in RI on or after 1/1/1997; (All children born in RI after 1/1/97 should be in the database)  The child does not have a blocked record. You will know that a record is blocked when the message “Access Denied” is returned after a search is performed; and  The child is not in Foster Care.  DO NOT ADD the child if they are in foster care. If you are unable to find a child who is in foster care or was born in RI after 1/1/1997, please call the Help Desk at 1-800-942-7434. To add a child to the system, click on Add Child at the bottom of the Search page. Use the tab key to move from field to field to enter data. All asterisked fields are required. Click here to go back Click here to move on

69. KIDSNET Update is a publication issued by KIDSNET as often as needed in order to keep all users, affiliated programs submitting data, other state agencies, health plans, and other interested parties informed about what KIDSNET is working on, including: New policies affecting KIDSNET; Recent efforts and upgrades to the data system; New features that become available; Important child health developments; and other items of interest. Click here to go back Click here to move on

70. Our Goal is 100% KIDSNET is a valuable tool that can assist us to achieve a 100% immunization rate if we take advantage of all of the features. In addition, with so many vaccines to be administered, KIDSNET provides a double check for us to avoid vaccine administration errors. Click here to go back Click here to move on

71. Other Useful Tools: THE CDC CHILDHOOD IMMUNIZATION SCHEDULER AVAILABLE FREE ONLINE Click here to go back Click here to move on

72. This tool provides parents with a printable schedule of when their child is due for vaccines Click here to go back Click here to move on

73. A clinicians version is also made available Click here to go back Click here to move on

74. To begin using this tool, click on the icon below Click here to go back Click here to move on

75. Click here to go back Click here to move on CLICK ON THE CIRCLE FOR MORE INFORMATION What is ARORA?

76. You have reached the end of this program….. Once you are confident that you are comfortable with all the materials presented, proceed to the KIDSNET post test at http://www.classmarker.com/professional/ Your username is the first initial of your first name followed by your full last name. Your password is= nwhealth Click here to go back and review previous slide Start OverExit