RPMS Immunization Package Training – PATIENT MENU Version 8.5*5 Amy Groom, MPH IHS Immunization Program Manager Amy.Groom@ihs.gov

Some basic tips To go back to a previous screen, enter “^” (shift 6) To save changes and exit, hit the F1 key and “E” in quick succession To quit and go back to the previous screen WITHOUT saving changes, hit the F1 key and “Q” in quick succession

Patch 5 – Key Changes Additional functionally required for Meaningful Use Updated Smoking Health Factors used for determining High Risk Pneumo forecasting Correction to HPV coverage calculation for Males Addition of new vaccine codes, including all new influenza vaccine codes, to the Vaccine Table Addition of new manufacturer code to the Manufacturer code table– Protein Sciences Change in RPMS short names for influenza vaccines to reflect new CDC nomenclature Change in Influenza report to capture vaccines given starting July 1st Update to NDC code table to include new flu vaccine NDC codes Updated influenza vaccine forecasting to include new influenza vaccine codes

Influenza Vaccines in RPMS Version 8.5*5 CVX Code Full vaccine name (CDC abbreviation) RPMS Short Name Brand Manufacturer Trivalent Inactivated Vaccines (IIV3) 141 Influenza, seasonal, injectable, trivalent FLU-IIV3 Afluria®, multi-dose vial CSL Limited FluLaval® , multi dose vial ID Biomedical Corp. Fluvirin® , multi dose vial Novartis Fluzone®, multi dose vial Sanofi Pasteur 140 Influenza, seasonal, injectable, preservative free , trivalent FLU-IIV3pf Afluria®, single dose syringe Fluarix® single dose syringe GSK Fluvirin® , single dose syringe Fluzone®, single dose syringe, single dose vial 144 Seasonal influenza, intradermal, preservative free, trivalent FLU-DERMAL Fluzone® Intradermal 135 Influenza, high dose seasonal, preservative-free FLU-HIGH Fluzone® High Dose 155 Seasonal, trivalent, recombinant, injectable influenza vaccine, preservative free (RIV) FLU-RIV3 FluBlok® Protein Sciences 153 Influenza, injectable, Madin Darby Canine Kidney, preservative free (cell culture) (ccIIV3) FLU-ccIIV3 Flucelvax® Quadrivalent Inactivated Vaccines (IIV4) 150 Influenza, injectable, quadrivalent, preservative free FLU-IIV4pf Fluarix® Quadrivalent, single dose syringe Fluzone® Quadrivalent,single dose syringe and single dose vial 158 Influenza, injectable, quadrivalent FLU-IIV4 FluLaval® Quadrivalent, multi dose vial Quadrivalent Live Attenuated Virus Vaccines (LAIV4) 149 Influenza, live, intranasal, quadrivalent (LAIV4) FLU-LAIV4 FluMist® MedImmune Codes that should ONLY be used to record vaccines given elsewhere, if formulation is unknown 88 Influenza virus vaccine, unspecified formulation FLU-NOS None Codes that should not be used this influenza season - Inactivate them in your vaccine table 15 Influenza virus vaccine, split virus (incl. purified surface antigen)-retired CODE FLU-TIVhx 16 influenza virus vaccine, whole virus FLU-WHOLE 111 Influenza virus vaccine, live, attenuated, for intranasal use, trivalent (LAIV3) FLU-LAIV3 151 Influenza nasal, unspecified formulation FLU-NasNOS 123 Influenza virus vaccine, H5N1, A/Vietnam/1203/2004 (national stockpile) FLU-H5N1 Red denotes new RPMS Short Name

Flu Vaccines RPMS Immunization Package New codes will be inactive in the Vaccine Table Sites must activate them to use them CVX code 111 – Flu-LAIV3 will be inactive This is the trivalent LAIV (FluMist®) vaccine - will not be available this year Forecasting Same as last year – begins August 1st, ends March 31st 2 dose algorithm for children < 9 years included

Bug in Patch 5 – Temporary Fix Issue: Disappearing vaccine histories for some adults in the EHR. Solution: Because patch 5 contains critical information for patient care related to influenza, sites should install this patch. To address the problem identified above, sites should either : DISABLE the High Risk Factor Check in the Imm Managers' menu/ESP, parameter #18, or Keep High Risk Factor Check ENABLED but remove SMOKERS.  

Agenda PATIENT Menu SGL Patient Record Adding and Editing Data Patient case data vaccines you give today historical vaccines Forcing doses to be valid/invalid ImmServe Profile Lists and Letters Generating Patient Lists

RPMS Immunization Package MENU SYSTEM PAT Patient Menu … REP Report Menu … MGR Manager Menu …

RPMS – Patient Menu PAT Patient Menu SGL Single Patient Immunization Record LET Print Individual Patient Letter LLS Due 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 VIEW (IMM v8.5*4) Nov 21, 2012 10:54:14 Page: 1 of 5 Patient: PATIENT, DEMO1 DOB: 15-Apr-2011 (19 mths) Chart#: 34000 at DEMO HOSPITAL Active Female M HBsAg: UNK # Immunization History | Immunizations DUE on 11/21/2012 1 07/15/11 DTaP (KINRIX) Demo | HEP B PED past due 2 08/31/11 DTaP Demo | DTaP past due | HIB,NOS past due 3 11/01/11 DTaP Demo | VARICELLA past due | HEP A PED past due 4 07/15/11 IPV (KINRIX) Demo | PCV-13 past due 5 08/31/11 IPV Demo | 6 11/01/11 IPV Demo | Last Letter: None 08/31/11 PEDVAXHIB Demo 8 11/01/11 PEDVAXHIB Demo | * CONTRAINDICATIONS/REFUSALS * + 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 Select Action: Quit// PATIENT VIEW (IMM v8.5*4) Nov 21, 2012 10:54:14 Page: 1 of 5 Patient: PATIENT, DEMO1 DOB: 15-Apr-2011 (19 mths) Chart#: 34000 at DEMO HOSPITAL Active Female M HBsAg: UNK # Immunization History | Immunizations DUE on 11/21/2012 1 07/15/11 DTaP (KINRIX) Demo | HEP B PED past due 2 08/31/11 DTaP Demo | DTaP past due | HIB,NOS past due 3 11/01/11 DTaP Demo | VARICELLA past due | HEP A PED past due 4 07/15/11 IPV (KINRIX) Demo | PCV-13 past due 5 08/31/11 IPV Demo | 6 11/01/11 IPV Demo | Last Letter: None 08/31/11 PEDVAXHIB Demo 8 11/01/11 PEDVAXHIB Demo | * CONTRAINDICATIONS/REFUSALS * + 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 Select Action: Quit//

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 ONLY impacts 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 determine inclusion in Adolescent , Adult, or Influenza reports Active/Inactive DOES NOT impact forecasting – software forecasts for all patients, regardless of status

Editing Patient Case Data * * * EDIT PATIENT CASE DATA * * * Patient Name: PATIENT, DEMO1 (19 mths) Chart#: 34000 Street: 1234 MAIN ST. Patient Phone: 505-777-8888 Cty/St/Zip: ALBUQUERQUE, NM 00087 _______________________________________________________________(The above data may be edited through Patient Registration.) Case Manager: NURSE,DEMO1 Parent/Guardian: Other Info: SHEEP CAMP IN SUMMER Inactive Date: Inactive Reason: Moved to/Tx Elsewhere: Ft. Defiance Forecast Influ/Pneumo: Normal Mother's HBsAG Status: Unknown State Registry Consent: YES

State Registry Consent Field Use depends on rules around participation in state immunization registries If an Opt -Out state (most states) All patients are automatically entered into the registry unless they specifically say they don’t want to (Opt out) Use consent field to record those who “Opt Out” Leave registry consent field BLANK unless patient opts out of the registry – then enter “No” Opt-In (MT) Requires that patients specifically consent to have their data shared with the state registry (Opt in) Use consent field to record those who “Opt in” Leave BLANK unless patient Opts in – then enter “Yes”

Adding an Immunization Imm v8.5* 4 * * * ADD AN IMMUNIZATION VISIT * * * Patient: PATIENT,DEMO2 DOB: 11-Nov-1985 (27 yrs) Chart#: 136175 at DEMO HOSPITAL Inactive Female _________________________________________________________________ Date: NOV 21,2012 Category: Ambulatory Vaccine: Tdap Lot#: (Tdap) NDC Code: Inj Site: Vol: .5 ml Location Type: IHS Location: DEMO HOSPITAL Provider: USER,ASTUDENT VIS Date: JAN 24,2012 Vac Elig: _________________________________________________________________

NDC Codes NDC Codes are National Drug Classification codes A unique code that identifies the Manufacturer, the vaccine type, and the presentation (e.g. syringe, vial) NDC codes change frequently! Currently can only enter NDC codes included in the drop down menu Missing codes

Using Vaccine Eligibility Codes Before using non – VFC vaccine eligibility codes, check with your state immunization program! Add vaccine for a patient In “Vaccine Eligibility” field “??” to see all active codes Type in code can type in local label (uninsured adult) OR standard code (e.g. CHA-01)

Imm v8.5*4 ADD AN IMMUNIZATIOIN VISIT Imm v8.5*4 * * * ADD AN IMMUNIZATION VISIT * * * Patient: PATIENT, DEMO1 DOB: 11-Nov-1985 (27 yrs) Chart#: 136175 at DEMO HOSPITAL Inactive Female ________________________________________________________________ Date: NOV 21,2012 Category: Ambulatory Vaccine: Tdap Lot#: (Tdap) NDC Code: Inj Site: Vol: .5 ml Location Type: IHS Location: DEMO HOSPITAL Provider: USER,ASTUDENT VIS Date: JAN 24,2012 Vac Elig: ?? _________________________________________________________________ Choose from: 999 Unknown Unable to obtain AKA-01 ALASKA-01 adultuninsured ASA-05 AMERICAN SAMOA-05 uninsured adults Imm v8.5*4 ADD AN IMMUNIZATIOIN VISIT

Invalid Doses The forecasting software (ImmServe) will flag doses as invalid if: Minimum age is not met Minimum interval between doses is not met Interval between 2 live virus vaccines is too short Invalid doses are flagged with “*”, and the message “INVALID – SEE IMMSERVE”

Invalid Dose PATIENT VIEW (IMM v8.5*4) Mar 06, 2013 15:59:23 Patient: PATIENT, DEMO1 DOB: 15-Apr-2011 (22 mths) Chart#: 34000 at DEMO HOSPITAL Active Female M HBsAg: UNK Immunization History | Immunizations DUE on 03/06/2013 1 07/15/11 DTaP (KINRIX) Demo | HEP B PED past due 2 08/31/11 DTaP Demo | DTaP past due | HIB,NOS past due 3 11/01/11 DTaP Demo | VARICELLA past due | HEP A PED past due 4 07/15/11 IPV (KINRIX) Demo | PCV-13 past due 5 08/31/11 IPV Demo | FLU-TIV past due 6 11/01/11 IPV Demo | 7 02/12/13 *IPV Demo | Last Letter: None -INVALID--SEE IMMSERVE- | |----------------------------- 8 08/31/11 PEDVAXHIB Demo | * CONTRAINDICATIONS/REFUSALS + 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 Select Action: Quit//

ImmServe Profile ImmServe is the software that creates provider reminders/forecasts ImmServe Profile gives you specific information re: what vaccines are due, will be due, and why doses are flagged as Invalid To check the ImmServe Profile select “I” for ImmServe Profile.

Patient Immunization Profile Mar 06, 2013 PATIENT IMMUNIZATION PROFILE Mar 06, 2013 16:21:23 Page: 3 of 6 Patient: PATIENT, DEMO1 DOB: 15-Apr-2011 (22 mths) Chart#: 34000 at DEMO HOSPITAL Active Female *** The Influenza dose on 11/7/2011 was given too soon after 11/4/2011. Dose 2 of Influenza must be given at least 24 day(s) after dose 1 of Influenza. This dose will therefore not count as part of the Influenza series. *** The IPV dose on 2/12/2013 was given at too young an age. Dose 4 of IPV must be given at or after 1457 day(s) of age. This dose will therefore not count as part of the OPV/IPV series. + Enter ?? for more actions Select Action: Quit// Patient Immunization Profile Mar 06, 2013

Force a Dose to be Invalid Select “E” to Edit the Immunization Visit Select the visit with the vaccine that you want to make invalid Enter “Invalid” in Dose Override Field; select reason for invalid Imm v8.5*4 * * * EDIT AN IMMUNIZATION VISIT * * * Patient: PATIENT,DEMO2 DOB: 28-Oct-1981 (31 yrs) Chart#: 555555 at DEMO HOSPITAL Inactive Male _________________________________________________________________ Date: APR 28,1995 Category: Ambulatory Vaccine: TD (ADULT) Lot#: (Td-ADULT) NDC Code: Inj Site: Vol: ml Location Type: IHS Location: IHS HOSPITAL Provider: VIS Date: Reaction: Vac Elig: V04 - Am Indian/AK Native Dose Override: INVALID _________________________________________________________________ 1 INVALID-BAD STORAGE 2 INVALID-DEFECTIVE 3 INVALID-EXPIRED 4 INVALID-ADMIN ERROR

Force a dose to be Valid Select “E” to Edit the Immunization Visit Select the visit with the vaccine that you want to force to be valid Enter “Force Valid” IN Dose Override Field Imm v8.5*4 * * * EDIT AN IMMUNIZATION VISIT * * * Patient: PATIENT, DEMO2 DOB: 15-Apr-2011 (22 mths) Chart#: 34000 at DEMO HOSPITAL Active Female __________________________________________________________________ Date: FEB 12,2013 Category: Historical Event Vaccine: IPV Lot#: (IPV) NDC Code: Inj Site: Vol: ml Location Type: IHS Location: DEMO HOSPITAL Provider: GROOM,AMY VIS Date: Reaction: Vac Elig: V04 - Am Indian/AK Native Dose Override: FORCE VALID __________________________________________________________________ Exit Save Refresh

Add a Contraindication CONTRAIND (IMM v8.5*4) Mar 06, 2013 15:39:23 Page: 1 of 1 Patient: PATINET, DEMO1 DOB: 01-Feb-2009 (49 mths) Chart#: 6666 at DEMO HOSPITAL Active Male # Vaccine Reason Date Noted Enter ?? for more actions. A Add Contraindication D Delete Contraindication E Edit Contraindication H Help Select Action: Quit//A

Add a Contraindication In Patient Record, select “C” for Contraindications Select ‘Add” to add new contraindication Imm v8.5*4 * * * ADD A CONTRAINDICATION * * * Patient: PATIENT,DEMO1 DOB: 01-Feb-2009 (49 mths) Chart#: 6666 at DEMO HOSPITAL Active Male _______________________________________________________________ Vaccine: PERTUSSIS (PERTUSSIS) Reason: Anaphylaxis Date Noted: MAR 6,2013 _________________________________________________________________ Enter the date on which this Contraindication was noted.

Skin Test PATIENT VIEW (IMM v8.5*4) Mar 06, 2013 15:41:19 Patient: PATIENT, DEMO1 DOB: 01-Feb-2009 (49 mths) Chart#: 6666 at DEMO HOSPITAL Active Male M HBsAg: UNK Immunization History | Immunizations DUE on 03/06/2013 1 08/24/10 FLU-TIVhx Demo | HEP B PED past due 2 10/07/10 FLU-TIVhx Demo | DTaP past due | HIB,NOS past due 3 09/25/09 H1N1-pfree Demo | IPV past due | MMR past due 4 02/01/10 PPD Demo | VARICELLA past due (Negative 0mm) | HEP A PED past due | PCV-13 past due | FLU-TIV due | | Last Letter: None + 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 Select Action: Quit// S

Imm v8.5*4 ADD/EDIT SKIN TEST VISIT Patient: PATIENT, DEMO1 DOB: 01-Feb-2009 (49 mths) Chart#: 6666 at DEMO HOSPITAL Active Male _________________________________________________________________ Date: MAR 6,2013 Category: Ambulatory Skin Test: PPD Site: LEFT FOREARM Volume: .1 ml Result: Reading: mm Date of Reading: Location Type: IHS Location: DEMO HOSPITAL Skin Test Provider: PROVIDER, DEMO Skin Test Reader: ______________________________________________________________ Imm v8.5*4 ADD/EDIT SKIN TEST VISIT

Add Skin Test Result Imm v8.5*4 * * * ADD/EDIT SKIN TEST VISIT * * * Patient: PATIENT, DEMO DOB: 01-Feb-2009 (49 mths) Chart#: 6666 at DEMO HOSPITAL Active Male ________________________________________________________________ Date: MAR 6,2013 Category: Ambulatory Skin Test: PPD Site: LEFT FOREARM Volume: .1 ml Result: POSITIVE Reading: 20 mm Date of Reading: MAR 6,2013 Location Type: IHS Location: DEMO HOSPITAL Skin Test Provider: PROVIDER, DEMO1 Skin Test Reader: NURSE, DEMO1 ______________________________________________________________________

Hands on Exercises SGL Patient Menu – Use Demo Patients! Change patient status to Inactive in Immunization Registry Add a MMR vaccine for today’s date Add FluMist for yesterday’s date Check the ImmServe profile to see why the MMR is invalid Force the MMR vaccine to be Valid Make the FluMist vaccine invalid because of poor storage Add a contraindication for Varicella vaccine, Hx of Chickenpox

Immunizations in EHR

Electronic Health Record (EHR) The EHR sits on top of RPMS Data entered into the RPMS roll and scroll will display in EHR Data entered intoo the EHR will display in roll and scroll

EHR Immunizations What you can do Most SGL Patient Menu options Enter/edit immunizations for a patient Enter/edit contraindications Enter/edit skin tests Enter/edit VFC vaccine eligibility codes Change active/inactive status Change Case manager What you can’t do Access the Manager’s Menu Change Forecasting options, VIS dates Enter /Edit Lot numbers Use Lists and Letters Run Reports Force dose to be valid/invalid Add non-VFC vaccine eligibility codes

Immunization Tab in EHR

Add Immunization

Add Vaccine Eligibility Codes Currently can only select VFC eligibility codes EHR Patch 11 will have new state eligibility codes

Add Skin Test

Add Contraindication Select Vaccine for, then add a contraindication

PatIEnt Lists and Letters

Patient Lists and Letters Available in the PAT Menu Roll and scroll only Complement the canned immunization coverage reports Allows you to run lists of patients based on different criteria List of patients who received a certain lot# Lists of patients who are due for certain vaccines List of patients who received vaccines in a certain time period Generate reminder letters for a listof patients

Immunization v8.5*4 Patient Menu IMMUNIZATION v8.5*4 * PATIENT MENU * Site: DEMO HOSPITAL ================== User: GROOM,AMY SGL Single Patient Record LET Print Individual Patient Letter LLS Patient Lists and Letters You've got PRIORITY mail! Select Patient Menu Option: Immunization v8.5*4 Patient Menu

Immunization Lists & Letters Immunization v8.5*4 Mar 06, 2013 16:24:28 Page: 1 of 1 IMMUNIZATION LISTS & LETTERS 1 - Date of Forecast/Clinic..: 06-Mar-2013 2 - Age Range................: 1-72 Months 3 - Patient Group (01).......: 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// Immunization Lists & Letters

Lists and Letters To change a parameter, type in the number of the parameter To change Age Range from Months to years Type in Parameter # (2) Type in “Y” to change to Years: “M” to change to Months Patient Group Can choose more then one, separated by a comma (e.g. 3,4 = Active, Inactive) For lists that include adolescents or adults, ALWAYS include both “Active” and “Inactive” patient groups.

Hands on Exercises – Lists and Letters Generate the following lists and include the total number: Children 0 – 35 months who are Inactive ___________ Children 0 – 35 months inactivated between Jan 1, 2010-March 31st 2010 ______ Children 0 – 35 months automatically activated between Jan 1st 2011 – Dec. 31st 2011_____ Active and Inactive Adolescents 11-18 yrs _____________ All Patients 11-12 yrs who are Due for a Tdap ________ Patients due for a 2nd or 3rd dose of HPV _____ All children <5 who received a Varicella vaccine between Dec. 1st, 2010 – Dec. 31st 2010, ________ List of all AI/AN (e.g. beneficiary) patients < 5 years of age who refused a vaccine _________ List of all patients all ages who received seasonal flu vaccine Oct 31st, 2011. List of children < 6 yrs who are due for a PCV, with parent/guardian name

Immunization Resources RPMS Immunization Package User Manual RPMS Application Documents http://www.ihs.gov/RPMS/index.cfm?module=home&option=documents IHS vaccine preventable disease page www.ihs.gov/epi CDC vaccine resources www.cdc.gov/vaccines Immunization Action Coalition www.immunize.org