KIDSNET: A tool to help us achieve a 100% CHILDHOOD immunization rate

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. Any changes or expected interruptions to the KIDSNET site will be announced here 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.

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 Click here to select this answer True False 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. FALSE

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

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

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

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

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

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

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

31. Which heading on the side bar when clicked will show the child’s birth weight? Click here to select this answer WIC Newborn Bloodspot Newborn Developmental Risk Assessment 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? Click here to select this answer Lead Poisoning Newborn Bloodspot Newborn Developmental Risk Assessment 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 on Immunization to go to an immunization report; try it now Click here to go back

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

37. 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 The total number of valid doses for each vaccine is shown under each vaccine 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 go back Click here to move on

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? Ask mom to schedule an appointment for 8/1/09 for MMR vaccination Have mom return 12/1/09 for vaccination 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 Click here to go back

41. The correct answer is: Ask mom to schedule an appointment 8/1/09 for vaccination 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 Give dose one of MMR today Remind mom to return 5/1/10 for a physical and MMR While a dose of MMR administered on 12/01/09 would be valid- earlier in the recommended range is better 5/1/10 is beyond the recommended interval; also earlier is better but only if the dose will be valid 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 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. Click here to go back Click here to move on

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 go back Click here to move on

48. A dose of vaccine administered at ______ before the minimum age is considered invalid and must be repeated. Click here to select this answer 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 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