RPMS Immunization ProgramRPMS Immunization ProgramOVERVIEWOVERVIEW

Scott Hamstra, MDPediatrician, 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– PAT Patient Menu …– REP Report Menu …– MGR Manager Menu …

• ERR Edit Patient Errors• CMG Add/Edit Case Manager• CMT Transfer a Case Manager’s patients• SCN Scan For Patients --------------------------• ESP Site Parameters Edit• PKG Package Setup Information• LET Form Letters Add/Edit• LOT Lot Number Add/Edit• VAC Vaccine Table Edit• RES Restandardize vaccine table • EXP Export Immunizations• KEY Allocate/Deallocate Imm Menu Keys

Manager’s Menu …

Site Parameters – 19! • Edit Site Parameters for: SELLS HOSP

1) Default Case Manager.........:

2) Other Location...............: TUCSON, AZ3) Standard Imm Due Letter .....: DUE4) Official Imm Record Letter...: Official Immunization Letter5) Facility Report Header.........: SELLS HOSP6) Host File Server Path.........: c:\export\requests\

7) Minimum Days Last Letter.....: 30 days8) Minimum vs Recommended Age...: Recommended Age9) ImmServe Forecasting Option.: #3, WITH 4-Day Grace, HPV thru 1810) Lot Number Options..........: Required, Low Supply Alert=511) Age Appropriate for Pneumo..: 65 years old, one time only.

12) Forecasting (Imms Due)......: Enabled13) Chart# with dashes.......: No Dashes (123456)

14) User as Default Provider....: Yes15) ImmServe Directory..........: C:\Program Files\Immserve821\16) GPRA Communities........: 60 Communities selected for GPRA17) Inpatient Visit Check.......: Enabled18) High Risk Factor Check......: Enabled19) 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 2-4-6 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 Optionswith and without the 4 day grace period

Option 6 Mths 12 Mths 15 Mths------ ------ ----------------------------- ---------1) ...... IPV Hib, MMR, Pn, Var ..... DTaP

2) ...... .... Hib, IPV, MMR, Pn, Var ...... DTaP

3) ...... IPV DTaP, Hib, MMR, Pn, Var .....

4) ...... .... 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

• 042.0-043.09, 044.9 HIV infection• 250.00-250.93 Diabetes• 393.-398.99 Rheumatic Heart D.• 402.00-402.91 Hypertensive H.D.• 404.00-404.93 Hypertensive Heart/Renal• 410.00-414.9 Ischemic H.D• 415.0-416.9 Pulmonary H.D• 424.0-424.9 Other endocardial H.D• 425.0-425.9 Cardiomyopathy• 428.0-428.9, 429.2 CHF• 491.0-491.9 Chronic Bronchitis• 492.0-492.8 Emphysema• 493.00-493.91 Asthma• 494.0-496. Bronchiectasis, CLD, COPD• 501-505 Pneumoconioses• 571.0-571.9 Chronic Liver Dis.• 581.0-581.9 Nephrotic Syndrome• 585. Renal Failure• 996.80-996.89 Transplant• V42.0-V42.89 Kidney Transplant• V58.1 Chemotherapy• V67.2 Chemotherapy f/u

Setting Up Form Letters2 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 actionT Top F Forecast C ClosingH History B Bottom P Print Sample LetterM Middle D Date/Loc X Delete Form LetterSelect Action: Quit//

*** Use Screen Editor

– go to TBOX and change from Line Editor

Adding Lot NumbersEDIT 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

# 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 codes2. Inactivate vaccines that you do not use

makes it easier to see choices of available vaccines. 3. Set default VIS dates4. 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 data2. Accurate forecasting 3. Appropriate administration4. Timely data entry5. Ends duplicate data entry6. Decreases charting7. Print out Official Record8. Increased data access

RPMS Immunization Package

• MENU SYSTEM

– PAT Patient Menu …– REP Report Menu …– MGR Manager Menu …

RPMS – Patient Menu

• PATPatient 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: 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 DTaP Anch | HIB past due

2 12/01/2002 DTaP Anch | IPV

3 09/30/2002 HEP B PED Anch | PNEUM-CONJ past due

4 12/01/2002 HEP B PED Anch | DTaP past due

5 09/30/2002 IPV Anch |

6 12/01/2002 IPV Anch 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#: 107560 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, 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

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

• PAT Patient Menu…

– SGL Single Patient Record

– LET Print Individual Patient Letter• rarely use in this IMM menu• but used in EHR daily

– LLS Due Lists and Letters

Patient MenuLists and Letters Feature

1 Date of Forecast/Clinic.: TODAY (or date in future)2 Age Range...............: 12-72 Months(Can change to Years)3 Patient Group...........: Active (Inactive, other choics)4 Communities..............: ALL5 Case Managers............: ALL6 Immunizations Received...: ALL7 Immunizations Due........: MMR8 Health Care Facilities...: ALL9 Lot Numbers..............: ALL10 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 = 19-35 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 43133 standard in 2008 • Moving to include

– Varicella = 431331– Pneumococcal conjugate 4313313

• This report’s 43133 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 19-35 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 ReportAdolescent 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: 381• -------------------------------------------------------------------------------• Age Group | 11-12yrs 13yrs 13-17yrs• Denominators | 239 99 485• ===============================================================================• 1-HEPB | 233 98 473 • | 97% 99% 98%• |--------------------------------------------------------------• 2-HEPB | 231 98 472• | 97% 99% 97% • |--------------------------------------------------------------• 3-HEPB | 230 98 471• | 96% 99% 97%• -------------------------------------------------------------------------------• 1-MMR | 233 99 474• | 97% 100% 98%• |--------------------------------------------------------------• 2-MMR | 233 97 470• | 97% 98% 97%• -------------------------------------------------------------------------------• 1-VAR | 203 74 230• | 85% 75% 47%• |--------------------------------------------------------------• 2-VAR | 151 50 148• | 63% 51% 31%• -------------------------------------------------------------------------------• Hx of Chickenpox| 54 38 252• (Immune) | 23% 38% 52%

Adolescent Report cont’• 1-Tdap | 142 88 248• | 59% 89% 51%• |-----------------------------------------------------• 1-Tdap/Td | 154 91 467• | 64% 92% 96%• ------------------------------------------------------------------------• 1-HEPA | 233 99 473• | 97% 100% 98%

• |------------------------------------------------------

• 2-HEPA | 230 98 468• | 96% 99% 96%• -----------------------------------------------------------------------• 1-MEN | 147 87 429• | 62% 88% 88%• ------------------------------------------------------------------------• 1-FLU | 30 12 34• | 13% 12% 7%• ------------------------------------------------------------------------

• 1-TD_B 3-HEPB | 150 87 420• 2-MMR 1-VAR | 63% 88% 87%• ------------------------------------------------------------------------• 1-TD_B 3-HEPB | 97 45 138• 2-MMR 1-MEN | 41% 45% 28%• 2-VAR |

Adolescent – Female portion Female | 11-12yrs 13yrs 13-17yrs• Denominators | 128 56 253• ---------------------------------------------------------------• 1-HPV | 77 49 220• | 60% 88% 87%• |--------------------------------------------------------------• 2-HPV | 44 37 158• | 34% 66% 62%• |--------------------------------------------------------------• 3-HPV | 22 24 89• | 17% 43% 35%• -------------------------------------------------------------------------------• 1-TD_B 3-HEPB | 17 13 33• 2-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: 7

• -------------------------------------------------------------------------------• *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 ReportAdult 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 (09/01/08 - 12/31/08)

2 - Community..................: ALL

3 - Health Care Facility.......: ALL

4 - Case Manager...............: ALL

5 - Beneficiary Type...: INDIAN/ALASKA NATIVE

Influenza Immunization Report20-Jan-2009

• -------------------------------------------------------------------------• Beneficiary Type: INDIAN/ALASKA NATIVE• -------------------------------------------------------------------------• | Age in Months on 12/31/2008 |• |--------------------------------------------------| Totals• | 10-23 24-59 |

• Denominator | 189 502 | 691• -------------------------------------------------------------------------

• 1-Influenza | 95 159 | 254• 2008 Season | 50% 32% | 37%

• Fully | 49 110 | 159• Immunized | 26% 22% | 23%• -----------------------------------------------------------------------------

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Total Patients included who had Influenza Refusals on record 3