1. RPMS Immunization Program OVERVIEW Amy Groom, MPH November 23 rd, 2010

2. 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

3. IMM software works for all ages across the Entire Life Spectrum

4. Version 8.4 Patch 2 Flu report – limited to Active Clinical Population Include Flu-TIV in long name of vaccine New flu codes –140 – preservative-free TIV –141 – preservative-containing TIV Minor change to 3-27 month report Polio update - 6 month interval required between doses 3 & 4 given as of 1/1/2010.

5. Re-assigning Lot Numbers to new flu codes Alert your providers that the flu code 15 will now be inactive in the immunization package –Code 15 should NOT be used to enter flu vaccines given this season. –Codes 140 (Flu-TIVpf) and 141 (Flu-TIV) should be used for all inactivated flu vaccines that are administered. All vaccines entered with code 15 previously will now display as Flu- TIVhx All lot #s currently assigned to code 15 will need to be re- assigned to codes 140 or 141 as appropriate. –In the Manager’s Menu, select “Lot Number Add/Edit” –Select “Edit Lot #” –For all lot numbers associated with code 15 – Flu-TIVhx Add “HX” in the sub lot field –Change the status for the lot number to “inactive”. –You can now go back to “Add a lot #” option and add the lot# again, associated with the appropriate code (140 or 141).

6. A word about Flu forecasting Current forecasting does NOT take H1N1 vaccine into account Children <9 yrs who received no H1N1 vaccine last season need 2 doses, even if they received 2 doses seasonal flu in a previous season Current forecasting does NOT forecast the 2 nd dose in this situation

7. What to Do For children < 9 years of age - review immunization history for H1N1 vaccine If no H1N1 given – child will need 2 nd dose of seasonal influenza vaccine Print Immunization record for parent and WRITE in #2 shot DUE in one month ADD it to the Problem List for follow up – listing Date at least 28 days later If child received at least 1 dose of H1N1 – follow the RPMS flu forecasting re: 1 or 2 doses

8. Immunization Package Overview

9. What we’ll cover today Manager’s Menu Setting Site Parameters (ESP) Adding lot numbers Form letters Vaccine Table Patient Menu Adding and Editing Data –vaccines you give today –historical vaccines –Patient information Reports Menu –Running Reports –Monitoring vaccine coverage rates in community –Active/inactive in the Immunization Package

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

11. 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 …

12. Site Parameters Immunization v8.4 Apr 15, 2010 13:57:55 Page: 1 of 2 Edit Site Parameters for: DEMO HOSPITAL 1) Default Case Manager.........: TSUI,GLEN M 2) Other Location...............: DEMO HOSPITAL NASHVILLE NON-IHS 3) Standard Imm Due Letter.....: Official Immunization Record 4) Official Imm Record Letter...: Official Immunization Record 5) Facility Report Header.......: CIHA HOSPITAL 6) Host File Server Path........: /m/ 7) Minimum Days Last Letter.....: 30 days 8) Minimum vs Recommended Age...: Recommended Age 9) ImmServe Forecasting Option..: #3, WITH 4-Day Grace, HPV through 18 10) Lot Number Options...........: NOT Required, Default Low Supply Alert=50 11) Pneumo & Flu Parameters......: Pneumo: 65 yrs Flu: All ages (>6 mths) 12) Forecasting (Imms Due).......: Enabled 13) Chart# with dashes...........: No Dashes (123456) 14) User as Default Provider.....: No 15) ImmServe Directory...........: C:\Program Files\Immserve84\ 16) GPRA Communities.............: 1 Communities selected for GPRA 17) Inpatient Visit Check........: Disabled 18) High Risk Factor Check.......: Enabled (Smoking included in Pneumo) 19) Import CPT-coded Visits......: Disabled 20) Visit Selection Menu.........: Disabled (Link Visits automatically)

13. Forecasting All options conform to ACIP recommendations Options 3,4 and 6 forecast Hep A at 12 months; all others forecast Hep A at 15 months All options forecast Tdap, MCV4 and HPV for 11-18 year olds Option to forecast Influenza for All or for <19 years and 50+ For Adults –Pneumo at 65+ (can choose to forecast starting at earlier age –Option to forecast pneumo for high risk, with/without smoking –Hep B only for adults who received a dose < 18 years –HPV for 19 – 26 females IF selected in forecasting options

15. Version 8.4 Forecasting Options with and without the 4 day grace period

16. Adult Pneumococcal Vaccine “Pneumovax” Automatically forecast at age 65 –Can set to younger Forecast another dose if... –dose #1 given before age 65 Forecasts for High Risk patients if enabled) –19-65 year olds with 2 high risk condition visits in past 3 years –Option to forecast for Smokers as part of High Risk

17. Inclusion of Smokers as High Risk MGR– ESP # 18 – High Risk Check Immunization v8.4 * INCLUDE SMOKING AS A PNEUMO RISK FACTOR * You have the option to include smoking in the High Risk factors for Pneumococcal disease. Specifically, the Health Factors looked for will be either "Current Smoker" or "Current Smoker and Smokeless" within the last two years. Do you wish to include a history of SMOKING in the criteria for the High Risk Pneumo group? Enter Yes or No? YES//

18. High Risk ICD-9 Taxonomy for Flu 042.0-043.09, 044.9HIV infection 250.00-250.93Diabetes 393.-398.99Rheumatic Heart D. 402.00-402.91Hypertensive H.D. 404.00-404.93Hypertensive Heart/Renal 410.00-414.9Ischemic H.D 415.0-416.9Pulmonary H.D 424.0-424.9Other endocardial H.D 425.0-425.9Cardiomyopathy 428.0-428.9, 429.2CHF 491.0-491.9Chronic Bronchitis 492.0-492.8Emphysema 493.00-493.91Asthma 494.0-496.Bronchiectasis, CLD, COPD 501-505Pneumoconioses 571.0-571.9Chronic Liver Dis. 581.0-581.9Nephrotic Syndrome 585.6 – 585.9End Stage Renal Disease/Renal Failure 996.80-996.89Transplant V42.0-V42.89Kidney Transplant V58.1Chemotherapy V67.2Chemotherapy f/u

19. Setting Up Form Letters 2 templates: Standard Due & Official Form Letter: Standard Due Letter ------------------------------------------------------------------- top: Anchorage Primary Care Center 4320 Diplomacy Dr. Anchorage, AK 99508 |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

20. 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: 11759 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

21. Adding a Lot # Imm v8.4 * * * ADD A LOT NUMBER * * * Lot Number: _______________________________________________________________________________ Lot Number: Vaccine: Sub-lot: Status: Manufacturer: Expiration Date: Source: Starting Count: Doses Unused: Doses Used: Low Supply Alert: (calculated) Facility: _______________________________________________________________________________ Enter/edit the Lot Number. Press H for help Insert

22. # Vaccine HL7 Active Default Lot# VIS Default Forecast 6 DTaP........ (20)....Active......................30-Jul-2001..... YES 7 HBIG........ (30)....Active...................... YES 8 HEP A....... (85)....Active......................25-Aug-1998..... YES 9 HEP B.NOS (45)....Inactive......................11-Jul-2001..... YES 10 HEP B ADLT..(43)..Active......................11-Jul-2001..... 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

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

24. 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

25. Patient: DEMO,PATIENT DOB: 27-Jul-2002 (6 months) Chart#: 999998 at ANCH MED CTR Inactive Female M HBsAg: U # Immunization History Immunizations DUE on 01/22/2003 1 09/30/2002 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

27. EHR

28. CONTRAIND (IMM v8.0) Mar 26, 2003 12:21:12 Page: 1 of 1 Patient: DEMO, PATIENT DOB: 14-Feb-1986 (17 years) Chart#: 104079 at ANCH MED CTR Active Male # Vaccine Reason Date Noted --------------------------------------------------------------------- 1 VARICELLA: Hx of Chicken Pox 23-Aug-1999 --------------------------------------------------------------------- Enter ?? for more actions. A Add Contraindication D Delete Contraindication ADDING CONTRAINDICATIONS

29. 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

30. RPMS Immunization Package Lists and Letters

31. Immunization v8.4 Apr 09, 2010 16:06:56 Page: 1 of 1 IMMUNIZATION LISTS & LETTERS 1 - Date of Forecast/Clinic..: 09-Apr-2010 2 - Age Range................: 1-72 Months 3 - Patient Group............: Active 4 - Community................: ALL 5 - Case Manager.............: ALL 6 - Designated Provider......: ALL 7 - Immunizations Received...: ALL 8 - Immunizations Due........: ALL 9 - Health Care Facility.....: DEMO HOSPITAL 10 - Lot Number...............: ALL 11 - Additional Information...: None 12 - Order of Listing.........: by Patient Age 13 - Include Deceased.........: No Select a left column number to change an item. List of Patients Print Due Letters Help Select Action: Quit//

32. Reports

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

34. Active/Inactive in the Immunization Package – What does it mean? Active/Inactive in the Immunization Package is independent of ‘Active” status in RPMS –Can be inactive in the immunization package, but still have an active chart Active/Inactive effects who is included in your childhood reports –3-27 month, Two year old –All children <36 months who reside in one of your GPRA communities are automatically activated into the immunization package –Can Inactivate children who meet the Moved or Going Elsewhere (MOGE) criteria Active/Inactive status DOES NOT effect inclusion in Adolescent or Adult reports Active/Inactive DOES NOT effect forecasting – software forecasts for all patients, regardless of status

35. Reports IMMUNIZATION v8.4 * REPORTS MENU * Site: DEMO HOSPITAL ================== User: GROOM,AMY ADO Adolescent Report ADL Adult Report FLU Influenza Report H1 H1N1 Accountability Report QTR 3-27 Month Report TWO Two-Yr-Old Rates Report VAC Vaccine Accountability Report Select Reports Menu Option:

36. Adolescent Report

37. Adolescent Report cont.

38. Flu Report (Limited to Active Clinical Users)

39. Adult Report

40. 3-27 month old report *

41. Two-Yr-Old Immunization Report

42. Two-Yr-Old Immunization Report Cont

43. What’s Coming – Version 8.5 Update forecasting –Option for Zostavax, Male HPV, Tdap for all, Mening booster? Additional Patient Groups for Lists and Letters, Reports –Active clinical, User pop, All Update reports –2 year old report –Adolescent to include Male HPV Ability to download reports into Excel