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RPMS Immunization Program OVERVIEW. Scott Hamstra, MD Pediatrician, 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
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RPMS Immunization ProgramOVERVIEW Scott Hamstra, MD Pediatrician, Sells Indian Hospital, Tucson Area ImmunizationCoordinator
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? ACTIVE MOGE
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 …
Manager’s 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
Site Parameters – 19! • Edit Site Parameters for: SELLS HOSP 1) Default Case Manager.........: 2) Other Location...............: TUCSON, AZ 3) Standard Imm Due Letter .....: DUE 4) Official Imm Record Letter...: Official Immunization Letter 5) Facility Report Header.........: SELLS HOSP 6) Host File Server Path.........: c:\export\requests\ 7) Minimum Days Last Letter.....: 30 days 8) Minimum vs Recommended Age...: Recommended Age 9) ImmServe Forecasting Option.: #3, WITH 4-Day Grace, HPV thru 18 10) Lot Number Options..........: Required, Low Supply Alert=5 11) Age Appropriate for Pneumo..: 65 years old, one time only. 12) Forecasting (Imms Due)......: Enabled 13) Chart# with dashes.......: No Dashes (123456) 14) User as Default Provider....: Yes 15) ImmServe Directory..........: C:\Program Files\Immserve821\ 16) GPRA Communities........: 60 Communities selected for GPRA 17) Inpatient Visit Check.......: Enabled 18) High Risk Factor Check......: Enabled 19) Import CPT-coded Visits....: Disabled
Version8.3 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.
Version8.3ForecastingOptionswith and without the 4 day grace period • Option 6 Mths 12 Mths 15 Mths • ------ ------ ----------------------------- --------- • ...... 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 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
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
Edit Vaccine Table # Vaccine HL7ActiveDefault Lot# VIS DefaultForecast 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 • This is a standard list with standard HL7 codes • Inactivate vaccines that you do not use • makes it easier to see choices of available vaccines. • Set default VIS dates • Set default lot numbers
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: • Accurate data • Accurate forecasting • Appropriate administration • Timely data entry • Ends duplicate data entry • Decreases charting • Print out Official Record • Increased data access
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: 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 | • 12/01/2002 IPV AnchContraindications: 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
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 __________________________________________________________________________________________________ IF DATE = TODAY – then Default Category is “Ambulatory” Recommend that ALL require lot #s for Ambulatory vaccines. Press F1-e to save and exit.
ADDING CONTRAINDICATIONS 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 ContraindicationD Delete Contraindication
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..............: ALL 5 Case Managers............: ALL 6 Immunizations Received...: ALL 7 Immunizations Due........: MMR 8 Health Care Facilities...: ALL 9 Lot Numbers..............: ALL 10 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 Report Adolescent 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 Report Adult 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 Report 20-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% • ------------------------------------------------------------------------------- Total Patients included who had Influenza Refusals on record 3