RPMS Immunization Package Training – PATIENT MENU

Version 8.5*5Amy Groom, MPH

IHS Immunization Program ManagerAmy.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*5CVX 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 LimitedFluLaval® , multi dose vial ID Biomedical Corp. Fluvirin® , multi dose vial NovartisFluzone®, multi dose vial Sanofi Pasteur

140 Influenza, seasonal, injectable, preservative free , trivalent FLU-IIV3pf

Afluria®, single dose syringe CSL LimitedFluarix® single dose syringe GSKFluvirin® , single dose syringe NovartisFluzone®, single dose syringe, single dose vial Sanofi Pasteur

144 Seasonal influenza, intradermal, preservative free, trivalent FLU-DERMAL Fluzone® Intradermal Sanofi Pasteur135 Influenza, high dose seasonal, preservative-free FLU-HIGH Fluzone® High Dose Sanofi Pasteur

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® Novartis

Quadrivalent Inactivated Vaccines (IIV4)

150 Influenza, injectable, quadrivalent, preservative free FLU-IIV4pfFluarix® Quadrivalent, single dose syringe GSKFluzone® Quadrivalent,single dose syringe and single dose vial Sanofi Pasteur

158 Influenza, injectable, quadrivalent FLU-IIV4 FluLaval® Quadrivalent, multi dose vial GSKQuadrivalent Live Attenuated Virus Vaccines (LAIV4)

149 Influenza, live, intranasal, quadrivalent (LAIV4) FLU-LAIV4 FluMist® MedImmuneCodes that should ONLY be used to record vaccines given elsewhere, if formulation is unknown

88 Influenza virus vaccine, unspecified formulation FLU-NOS None NoneCodes 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 None None

16 influenza virus vaccine, whole virus FLU-WHOLE None None

111 Influenza virus vaccine, live, attenuated, for intranasal use, trivalent (LAIV3) FLU-LAIV3 FluMist® MedImmune

151 Influenza nasal, unspecified formulation FLU-NasNOS FluMist® MedImmune

123 Influenza virus vaccine, H5N1, A/Vietnam/1203/2004 (national stockpile) FLU-H5N1 None None

Red denotes new RPMS Short Name

Flu VaccinesRPMS 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 FixIssue: 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 5Patient: 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 due2 08/31/11 DTaP Demo | DTaP past due

| HIB,NOS past due3 11/01/11 DTaP Demo | VARICELLA past due | HEP A PED past due4 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 ContraindicationsE 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 11/21/20121 07/15/11 DTaP (KINRIX) Demo | HEP B PED past due2 08/31/11 DTaP Demo | DTaP past due | HIB,NOS past due3 11/01/11 DTaP Demo | VARICELLA past due | HEP A PED past due4 07/15/11 IPV (KINRIX) Demo | PCV-13 past due5 08/31/11 IPV Demo |6 11/01/11 IPV Demo | Last Letter: None708/31/11 PEDVAXHIB Demo 88 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 EditS Skin Test Add I ImmServe Profile C ContraindicationsE Edit Visit H Health Summary L Letter PrintSelect 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

* * * 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

Editing Patient Case Data

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”

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: _________________________________________________________________

Adding an Immunization

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 obtainAKA-01 ALASKA-01 adultuninsuredASA-05 AMERICAN SAMOA-05 uninsured adults

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 DosePATIENT 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 03/06/20131 07/15/11 DTaP (KINRIX) Demo | HEP B PED past due2 08/31/11 DTaP Demo | DTaP past due

| HIB,NOS past due3 11/01/11 DTaP Demo | VARICELLA past due | HEP A PED past due4 07/15/11 IPV (KINRIX) Demo | PCV-13 past due5 08/31/11 IPV Demo | FLU-TIV past due6 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 EditS Skin Test Add I ImmServe Profile C ContraindicationsE Edit Visit H Health Summary L Letter PrintSelect 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//

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 STORAGE2 INVALID-DEFECTIVE3 INVALID-EXPIRED4 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 ContraindicationCONTRAIND (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 ContraindicationE Edit Contraindication H HelpSelect 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 TestPATIENT 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 03/06/20131 08/24/10 FLU-TIVhx Demo | HEP B PED past due2 10/07/10 FLU-TIVhx Demo | DTaP past due | HIB,NOS past due3 09/25/09 H1N1-pfree Demo | IPV past due | MMR past due4 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 EditS Skin Test Add I ImmServe Profile C ContraindicationsE Edit Visit H Health Summary L Letter PrintSelect Action: Quit// S

Imm v8.5*4 ADD/EDIT SKIN TEST VISIT

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:______________________________________________________________

Add Skin Test ResultImm 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 ImmunizationsWhat 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 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 HelpSelect Action: Quit//

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=d

ocuments

• IHS vaccine preventable disease page– www.ihs.gov/epi

• CDC vaccine resources– www.cdc.gov/vaccines

• Immunization Action Coalition– www.immunize.org