1. RPMS Immunization Training Scott Hamstra, MD, FAAP National Immunization Trainer

2. Immunization v8.2*1 Training Welcome to Immunization v8.2*1 training. Training for this application has been broken down into a series of self-paced modules for the user to complete at their own speed. This module teaches the user how to generate and understand IMM reports – specifically focused on the TWO YEAR OLD REPORT which matches the CDC National 19-35 month old vaccine report measures.

3. OVERVIEW  A means to track and recall patients for immunizations.  Feedback to providers and administrators about immunization rates in their patient population.  A way to share immunization information with authorized agencies. The RPMS Immunization Module provides the following:

4. Immunization v8.2*1 Training MODULE 3 REPORTS focus on Two Year Old Report (19-35 month Olds) Learning Objective Understand and use IMM REPORTS to assess community rates of immunizations, note patterns and opportunities to improve care and data quality.

5. IMM REPORTS Reports are “snap-shots” of vaccine coverage for a group of patients, showing –Numerator (how many got the shot) –Denominator (how many in the group) –Calculated percentage rate and –Lists of patients Current or Not Current with the required vaccines

6. IMM REPORTS – 4 19-35 MONTH OLD REPORT standard CDC report – used for comparison to non-IHS sites 3-27 MONTH OLD REPORT long standing, still used and useful IHS quarterly report ADULT REPORT Active Clinical User population of >50 & >65 year olds VACCINE ACCOUNTABILITY REPORT shows all vaccines given in a timeframe broken down by age groups The following slides will guide you step-by-step in viewing and understanding Reports in the RPMS Immunization module.

7. Immunization Main Menu From the Immunization Main Menu, select the Report Menu. Type REP at the “Select Immunization Menu Option:” prompt. Only users with the Manager Menu security key will see the MGR option... ---.... ---.. * ~ *. \ /.* ~ * * * \ / * * * * * * ( NEW * (|) * Version ) * IMMUNIZATION * *** * 8.2*1 * *. * *.* * * * * > * * < * * * * * * * * * * * @ * * * * @ * ( * * * * ) *. * *** *.* / /-- ~ ~ ~ --\ \ MAIN MENU at SORRY U R SICK MEDICAL CENTER PAT Patient Menu... REP Reports Menu... MGR Manager Menu... Select Immunization Menu Option: REP

8. Patient Menu IMMUNIZATION v8.2*1 * PATIENT MENU * Site: SORRY U R SICK MEDIC ================= User: WHITE,DAVID ADL Adult Immunization Report QTR Quarterly Immunization Report TWO Two-Yr-Old Immunization Rates VAC Vaccine Accountability Report Select Patient Menu Option: TWO From the Patient Menu, select the Two-Yr-Old (19-35 Month Olds) Report option by typing TWO at the “Select Patient Menu Option:” prompt.

9. Selection Screen TWO-YR-OLD IMMUNIZATION RATES REPORT 1 - Quarter Ending Date........: 2 - Age Range..................: 19-35 months 3 - Community..................: ALL 4 - Health Care Facility.......: ALL 5 - Case Manager...............: ALL 6 - Beneficiary Type...........: INDIAN/ALASKA NATIVE Select a left column number to change an item. View Rates Report Print Rates Report Explanation Select Action: Quit// Type the number (1 – 6) to choose the specifics in each category that you desire.

10. Select A Report Date Enter the date for which you want to view the patient’s immunization data at the “Select Forecast Date:” prompt. Note: You CAN look ahead to the next quarterly report date or behind to get an “updated” previous quarterly report. Immunization v8.2*1 * SELECT QUARTER ENDING DATE * The "Quarter Ending Date" should be the last day of the quarter being reported on. Typically, this date is either March 31, June 30,September 30, or December 31. However, you may enter any date you choose and the report will generate immunization statistics based on the date entered. NOTE: The patient ages (3 months, 5 months, etc.) will be calculated as of the date you enter here. For convenience's sake, if you enter only month/year, such as 9/98, the program will automatically assign the report to the last day of that month, such as 9/30/1998. Please enter a Quarter Ending Date:

11. Selection Screen TWO-YR-OLD IMMUNIZATION RATES REPORT 1 - Quarter Ending Date........: 06/06/06 2 - Age Range..................: 19-35 months 3 - Community..................: ALL 4 - Health Care Facility.......: ALL 5 - Case Manager...............: ALL 6 - Beneficiary Type...........: INDIAN/ALASKA NATIVE Select a left column number to change an item. View Rates Report Print Rates Report Explanation Select Action: Quit// The Report Date is now visible – note that numbers 2 – 6 have defaults but you are free to choose and change the specifics in each category that you desire.

12. Immunization v8.2*1 * TWO-YR-OLD AGE RANGE * This parameter allows you to select the Age Range of Patients for the Two-Yr-Old Report. Selecting "19-35 months" will include in the report all children who were between those ages on the date entered in the "Quarter Ending Date“ parameter. Selecting "24-35 months" will only include children who were between those ages on the date entered in the "Quarter Ending Date" parameter. Select one of the following: 1 19-35 months 2 24-35 months Choose either 1 or 2: 19-35// Select Age Range The Age Range can be limited to just 2 year olds = 24-35 month old children – but the default and customary report is for the 19-35 month old range.

13. Selection Screen TWO-YR-OLD IMMUNIZATION RATES REPORT 1 - Quarter Ending Date........: 06/06/06 2 - Age Range..................: 19-35 months 3 - Community..................: ALL 4 - Health Care Facility.......: ALL 5 - Case Manager...............: ALL 6 - Beneficiary Type...........: INDIAN/ALASKA NATIVE Select a left column number to change an item. View Rates Report Print Rates Report Explanation Select Action: Quit// 3 Again note that numbers 2 – 6 have defaults that you will likely use EXCEPT for #3 COMMUNITY – since you WILL want to choose one or more communities rather than ALL – Type 3.

14. Immunization v8.2*1 * SELECTION OF COMMUNITIES * You have the opportunity here to use the GPRA set of Communities. * Enter "G" to automatically use the GPRA set and proceed. * Enter "L" to LOAD the GPRA set and then edit your list before proceeding. * Enter "P" to load the PREVIOUS set of Communities you used. Select G, L, or P: Load// Select Age Range This is a great new community selection screen prompt ! It allows you to choose the GPRA communities with a single button, timesaving for sites with lots of communities! You may choose P – for a subset of communities that you like to view – IMM remembers for you from last time

15. Selection Screen TWO-YR-OLD IMMUNIZATION RATES REPORT 1 - Quarter Ending Date........: 06/06/06 2 - Age Range..................: 19-35 months 3 - Community..................: 60 communities selected (=GPRA) 4 - Health Care Facility.......: ALL 5 - Case Manager...............: ALL 6 - Beneficiary Type...........: INDIAN/ALASKA NATIVE Select a left column number to change an item. View Rates Report Print Rates Report Explanation Select Action: Quit// Back at the Selection Screen showing your selections. Now type V or P – to “View” or “Print” the Report.

16. Two Year Old Report SELLS HOSP IHS Two-Yr-Old Immunization Rates For Children between 19 and 35 Months of Age As of: 30-Jun-2006 Total Patients: 216 --------------------------------------------------------------------------- Communities: AJO; ARTESA; BIG FIELDS; BOXSTAND; CHARCO 27; CHILDS RANCH; CHOULIC; CHUKUT KUK; COBABI; COLD FIELDS; COMOBABI; COWLIC; CROWHANG; DARBY WELL; DIRT BURN; FRESNAL CANYON; FRESNAL VILLAGE; GU VO; GUNSIGHT; HICKIWAN; IRON STAND; ITAK KOM VO; KOSON VAYA; KUAKATCH; LINCON; LITTLE TUCSON; LUKEVILLE;MENEGERS DAM; NESTOR; NEW FIELDS; NOLIA; ONION STAND This shows the Report Header, date, total # of children and the communities. Below this (next PowerPoint slide) – you’ll see the vaccine rates for each dose of vaccine and for the combination of vaccines – specifically 4:3:1:3:3

17. Two Year Old Report looking more closely at DTaP Received by | 3 mo 5 mo 7 mo 16 mo 19 mo 06/30/06 | # % # % # % # % # % # % ============================================================================= 1-DTaP | 89 99 100 103 103 103 | 85% 94% 95% 98% 98% 98% |--------------------------------------------------------------- 2-DTaP | 72 88 102 103 103 | 69% 84% 97% 98% 98% |----------------------------------------------------------------- 3-DTaP | 57 98 100 103 | 54% 93% 95% 98% |----------------------------------------------------------------- 4-DTaP | 50 72 87 | 48% 69% 83% ------------------------------------------------------------------------------ 4 doses of DTaP are recommended for all children in the 19-35 month old age range. The report shows both the number of children and the % rate who have gotten all 4 doses. The Healthy People 2010 Goal = 90%. Note this report also gives insight into how many of the 105 children actually had 1 st DTaP by 3 mo = 85% and 94% by 5 mo --- and still 2 children as of today have NEVER had their 1 st DTaP – hmmmmm – I’d check on those 2!

18. Two Year Old Report Received by | 3 mo 5 mo 7 mo 16 mo 19 mo 06/30/06 | # % # % # % # % # % # % ==================================================================== 1-POLIO | 89 99 100 103 103 103 | 85% 94% 95% 98% 98% 98% |-------------------------------------------------------- 2-POLIO | 72 88 102 103 103 | 69% 84% 97% 98% 98% |------------------------------------------------------- 3-POLIO | 55 97 99 102 | 52% 92% 94% 97% -------------------------------------------------------------------- 1-HIB | 88 99 100 103 103 103 | 84% 94% 95% 98% 98% 98% |-------------------------------------------------------- 2-HIB | 1 69 87 102 103 103 | 1% 66% 83% 97% 98% 98% |------------------------------------------------------- 3-HIB | 1 2 63 80 92 | 1% 2% 60% 76% 88% The report shows the same data for each vaccine -- Polio and Hib shown here and again keep in mind The Healthy People 2010 Goal = 90% for each vaccine.

19. Two Year Old Report Received by | 3 mo 5 mo 7 mo 16 mo 19 mo 06/30/06 | # % # % # % # % # % # % ==================================================================== 4-DTaP 3-POL| 91 143 183 1-MMR 3-HIB | 41% 65% 83% 3-HEPB | After each individual vaccine - the report shows the same data for the important 43133 combination of vaccines The Healthy People 2010 Goal = 80% for the complete group of vaccines – in this case – above the 80% goal.

20. Immunization Main Menu.. ---.... ---.. * ~ *. \ /.* ~ * * * \ / * * * * * * ( NEW * (|) * Version ) * IMMUNIZATION * *** * 8.2*1 * *. * *.* * * * * > * * < * * * * * * * * * * * @ * * * * @ * ( * * * * ) *. * *** *.* / /-- ~ ~ ~ --\ \ MAIN MENU at SORRY U R SICK MEDICAL CENTER PAT Patient Menu... REP Reports Menu... MGR Manager Menu... Select Immunization Menu Option: You are now back at the Immunization Main Menu.

21. Test Questions #1You may only view Quarterly Reports on the last day of each fiscal quarter – the standard reporting date. TRUE or FALSE

22. Test Questions #2The Two Year Old Report (19-35 months) is the critical standard report that provides data like the CDC’s National Immunization Survey TRUE orFALSE

23. Test Questions #3 Reports provide a list of Current and Not Current Patients TRUE orFALSE

24. Test Questions #4Patients with “No Immunizations Due” may still be listed as Not Current in a report TRUE orFALSE

25. Test Questions #5The 3-27 month old report is the one used for the CRS/GPRA reports. TRUE or FALSE

26. Test Answers 1. False - Reports can be generated on any day for any date, past or future. 2. True – IHS designed the 19-35 month old report to match the CDC standard national immunization report. 3. True – It is very helpful to have a Not Current Patient List and be able to go directly to that patient record to review clinical details. 4. True - Since vaccines have a minimal interval, time between shots, children who fall behind get catch up vaccines, they will often be Not Current and yet still Not Due for days to weeks. It’s tricky. 5. False – The 19-35 month old report is the one that all agencies use. The 3-27 month old report is an IHS report that can be used as a “worksheet” to help meet the 19-35 month old vaccine rate goals.

27. OPTIONS THAT WILL BE ADDRESSED IN FUTURE MODULES S – Basically same process as immunization entry E – If you make an error –select visit/vaccine – correct the error and save. D – If the entire visit was incorrect – you can delete the visit – BE CAREFUL! I – If the forecast is confusing to you – ImmServe Profile provides the detailed logic behind why a vaccine may or may not be due today. H – View a Health Summary (perhaps hard chart not available). P – Patient Edit allows you to change to “Inactive” status ** BE CAREFUL! ---- You must follow the MOGE guidelines! C – You may select from legitimate contraindications for a specific vaccine. L – After administering vaccines and updating IMM – you have the option to print an official immunization record/history to give to the patient or parent/guardian. 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 ADDITIONAL PATIENT ENTRY OPTIONS

28. Questions? Questions? OIT Help Desk (888)830-7280 support@ihs.gov

29. Congratulations!!! End of Module 3