Immunizations for Public Health TRG-CS November 2, 2012

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MEDITECH Interoperability

Immunizations for Public Health

Training/Reference Guide: Client Server

Table of Contents

Table of Contents .............................................................................................................................1

Overview ..........................................................................................................................................1

Site Setup .........................................................................................................................................1

Query/Assessment-Based Model vs. Centralized Management Tool Model ..................................3

Set up for Centralized Management Tool Model ..........................................................................17

Set up for Query/Assessment -Based Model .................................................................................18

Testing Steps ..................................................................................................................................20

Overview

The MEDITECH Unsolicited Vaccination Record Update outbound interface will consist of

messages from the Pharmacy system. This interface will send a patient’s immunization

information to a state immunization registry. The specs for this interface are the R1765 and

can be provided upon request by your Interoperability Specialist.

There is some additional information as well as dictionary setup needed in order for the

interface to function properly.

Site Setup

Information

MEDITECH will need to know what is required by the other vendor in the following fields:

Sending application; Sending facility; Receiving application and Receiving facility.

MSH|3 – Sending Application

MSH|5 – Receiving Application

MSH|6 – Receiving Facility

If the above questions are answered as follows, the MSH segment would format as:

MSH|3 – Sending Application (PHA)

MSH|5 – Receiving Application (OV)

MSH|6 – Receiving Facility (OV)

MSH|^&|PHA|.|OV|OV|201101111351||VXU^V04^VXU_V04|IMMUN.1.104|P|2.5.1|||AL|NE

Once this information is obtained it should be provided to your Interoperability specialist so

the appropriate parameters can be setup to enable the MSH segment to format properly.

Query/Assessment-Based Model vs. Centralized Management Tool

Model

The immunization historical and administration process follows one of two workflow

methods, which include a Query/Assessment-Based Model or the Centralized Immunization

Management Tool.

One feature of the Centralized Management Tool is that it provides standard historical

immunization queries. With the query based model, users will have to manually build the

queries as outlined in the Immunization Queries section below.

For more information please see the link below.

http://www.meditech.com/bestpractices/otherfiles/bp1csimmunizations.pdf

CVX Codes

Note that only immunizations that have a CVX codes will generate an event for the HL7

Immunization Interface. To enter the CVX codes in the MIS CVX Code dictionary, a user

would start from the MIS main menu and use the following routines:

- Clinical Dictionaries (A-E)

- CVX codes

- Enter/Edit

The site would be responsible for entering, editing, and updating the dictionary as needed.

A list of current CVX codes can be found at the following link:

http://www2a.cdc.gov/nip/IIS/IISStandards/vaccines.asp?rpt=cvx

A sample of how the CVX Code dictionary would look like for CVX code 111:

CVX codes are used to link the standard nomenclature for each Pharmacy vaccine entry,

and to send the immunization outbound via the HL7 interface. A Query or Group Response

can be mapped to a CVX code in this dictionary so that historical immunization data

recorded using queries or group responses can reference a code.

Note: Please follow up with your Pharmacy specialist if you have any questions in relation to

this dictionary.

From the edit screen within the CVX Code Dictionary, select the desired CVX code in

the “CVX Code” field using an F9 look-up. This field is a look-up into the MIS Query

dictionary. You can use this field to map a vaccine query to the selected CVX Code.

“Vaccine Group Response” and “Group Response Element” Fields: These fields look-

up into the MIS Group Response Dictionary. You can use these fields to map a group response and group response element to the selected CVX Code.

*Note: You can only link either a Query or a Group Response, but not both.

MIS Mapping

The Next of Kin Relationship, Patient Race, Marital Status, Religion, Route of Administration

and Manufacturer will require mapping the MEDITECH values to the HL7 defined standards.

The MIS Maps routine will be used to accomplish this requirement. MEDITECH recommends

the following naming conventions for these query mnemonics:

Map MEDITECH Preferred MIS Map Mnemonic MEDITECH Preferred Name

NOK Map IMMUN.NOK Immunizations Next of Kin

Race Map IMMUN.RACE Immunizations Race

Marital Status Map IMMUN.MS Immunizations Marital Status

Religion Map IMMUN.REL Immunizations Religion

Route of Administration Map IMMUN.ROA Immunizations Route of Admin

Manufacturer Map IMMUN.MVX Immunizations Manufacturer Name

A user will input these maps within the MIS Maps Dictionary. This dictionary can be

accessed starting from the MIS main menu using the following routines:

- Communications

- Maps

- Enter/Edit

The MIS Maps will need to be set up for each facility database. Please ensure the

"Database" field is populated next to the "Map From Value in Dictionary" field.

Once all of the above MIS mappings have been completed, please provide these

MIS map mnemonics to your NMI specialist so they may update the

Immunizations parameters in the NMI toolbox.

NOK Map

The Next of Kin mapping needs to be setup as follows:

HL7 Table is 0063 – Relationship

Value Description

ASC Associate

BRO Brother

CGV Care giver

CHD Child

DEP Handicapped dependent

DOM Life partner

EMC Emergency contact

EME Employee

EMR Employer

EXF Extended family

FCH Foster child

FND Friend

FTH Father

GCH Grandchild

GRD Guardian

GRP Grandparent

MGR Manager

MTH Mother

NCH Natural child

NON None

OAD Other adult

OTH Other

OWN Owner

PAR Parent

SCH Stepchild

SEL Self

SIB Sibling

SIS Sister

SPO Spouse

TRA Trainer

UNK Unknown

WRD Ward of court (Appendix A, Version 2.5.1 © 2007. All rights reserved.)

Below is an example of how the NOK mapping should be setup. In the below example the site

currently has “B” defined in their MIS relationship dictionary as brother. According to the table

above “B” should be mapped to the value “BRO”:

]

Race Map

The race mapping needs to be setup as follows:

HL7 Table is 0005 – Race

Value Description

1002-5 American Indian or Alaska Native

2028-9 Asian

2054-5 Black or African American

2076-8 Native Hawaiian or Other Pacific Islander

2106-3 White

2131-1 Other Race (Appendix A, Version 2.5.1 © 2007. All rights reserved.)

Below is an example of how the Race mapping should be setup. In the below example the site

currently has “AA” defined in their MIS Race dictionary as African American. According to the

table above “AA” should be mapped to the value “2054-5”:

Marital Status Mapping

The marital status mapping needs to be setup as follows:

HL7 Table is 0002 - User Marital Status

Value Description

A Separated

B Unmarried

C Common law

D Divorced

E Legally Separated

G Living together

I Interlocutory

M Married

N Annulled

O Other

P Domestic partner

R Registered domestic partner

S Single

T Unreported

U Unknown

W Widowed (Page A-22 Health Level Seven, Version 2.5.1 © 2007. All rights reserved.)

Below is an example of how the Marital Status mapping should be setup. In the below example

the site currently has “X” defined in their MIS Marital Status dictionary as Separated. According

to the table above “X” should be mapped to the value “E”:

Religion Mapping

The religion mapping needs to be setup as follows:

HL7 Table is 0006 – Religion

Value Description

ABC Christian: American Baptist Church

AGN Agnostic

AME Christian: African Methodist Episcopal Zion

AMT Christian: African Methodist Episcopal

ANG Christian: Anglican

AOG Christian: Assembly of God

ATH Atheist

BAH Baha'i

BAP Christian: Baptist

BMA Buddhist: Mahayana

BOT Buddhist: Other

BTA Buddhist: Tantrayana

BTH Buddhist: Theravada

BUD Buddhist

CAT Christian: Roman Catholic

CFR Chinese Folk Religionist

CHR Christian

CHS Christian: Christian Science

CMA Christian: Christian Missionary Alliance

CNF Confucian

COC Christian: Church of Christ

COG Christian: Church of God

COI Christian: Church of God in Christ

COL Christian: Congregational

COM Christian: Community

COP Christian: Other Pentecostal

COT Christian: Other

CRR Christian: Christian Reformed

EOT Christian: Eastern Orthodox

EPI Christian: Episcopalian

ERL Ethnic Religionist

EVC Christian: Evangelical Church

FRQ Christian: Friends

FWB Christian: Free Will Baptist

GRE Christian: Greek Orthodox

HIN Hindu

HOT Hindu: Other

HSH Hindu: Shaivites

HVA Hindu: Vaishnavites

JAI Jain

JCO Jewish: Conservative

JEW Jewish

JOR Jewish: Orthodox

JOT Jewish: Other

JRC Jewish: Reconstructionist

JRF Jewish: Reform

JRN Jewish: Renewal

JWN Christian: Jehovah's Witness

LMS Christian: Lutheran Missouri Synod

LUT Christian: Lutheran

MEN Christian: Mennonite

MET Christian: Methodist

MOM Christian: Latter-day Saints

MOS Muslim

MOT Muslim: Other

MSH Muslim: Shiite

MSU Muslim: Sunni

NAM Native American

NAZ Christian: Church of the Nazarene

NOE Nonreligious

NRL New Religionist

ORT Christian: Orthodox

OTH Other

PEN Christian: Pentecostal

PRC Christian: Other Protestant

PRE Christian: Presbyterian

PRO Christian: Protestant

QUA Christian: Friends

REC Christian: Reformed Church

REO Christian: Reorganized Church of Jesus Christ-LDS

SAA Christian: Salvation Army

SEV Christian: Seventh Day Adventist

SHN Shintoist

SIK Sikh

SOU Christian: Southern Baptist

SPI Spiritist

UCC Christian: United Church of Christ

UMD Christian: United Methodist

UNI Christian: Unitarian

UNU Christian: Unitarian Universalist

VAR Unknown

WES Christian: Wesleyan

WMC Christian: Wesleyan Methodist

(Appendix A, Version 2.5.1 © 2007. All rights reserved.)

Below is an example of how the Religion mapping should be setup. In the below example the

site currently has “A” defined in their MIS Religion dictionary as Agnostic. According to the

table above “A” should be mapped to the value “AGN”:

Route of Administration Mapping

The route of administration mapping needs to be setup as follows:

HL7 Table is 0162 - Route of Administration

Value Description

AP Apply Externally

B Buccal

DT Dental

EP Epidural

ET Endotrachial Tube*

GTT Gastrostomy Tube

GU GU Irrigant

IA Intra-arterial

IB Intrabursal

IC Intracardiac

ICV Intracervical (uterus)

ID Intradermal

IH Inhalation

IHA Intrahepatic Artery

IM Intramuscular

IMR Immerse (Soak) Body Part

IN Intranasal

IO Intraocular

IP Intraperitoneal

IS Intrasynovial

IT Intrathecal

IU Intrauterine

IV Intravenous

MM Mucous Membrane

MTH Mouth/Throat

NG Nasogastric

NP Nasal Prongs*

NS Nasal

NT Nasotrachial Tube

OP Ophthalmic

OT Otic

OTH Other/Miscellaneous

PF Perfusion

PO Oral

PR Rectal

RM Rebreather Mask*

SC Subcutaneous

SD Soaked Dressing

SL Sublingual

TD Transdermal

TL Translingual

TP Topical

TRA Tracheostomy*

UR Urethral

VG Vaginal

VM Ventimask

WND Wound

(Appendix A, Version 2.5.1 © 2007. All rights reserved.)

Below is an example of how the Route of Administration mapping should be setup. In the below

example the site currently has “AE” defined in their Pharmacy Route of administration

Dictionary as Apply Externally. According to the table above “AE” should be mapped to the

value “AP”:

Manufacturer Mapping

The manufacturer mapping needs to be setup as follows:

HL7 Table is 0227 - Manufacturer Manufacturers of Vaccines (code=MVX)

Value Description

AB Abbott Laboratories

AD Adams Laboratories, Inc.

ALP Alpha Therapeutic Corporation

AR Armour

AVB Aventis Behring L.L.C.

AVI Aviron

BA Baxter Healthcare Corporation

BAH Baxter Health Corporation

BAY Bayer Corporation

BP Berna Products

BPC Berna Products Corporation

CEN Centeon L.L.C.

CHI Chiron Corporation

CMP Celltech Medeva Pharmaceuticals

CNJ Cangene Corporation

CON Connaught

DVC DynPort Vaccine Company, LLC

EVN Evans Medical Limited

GEO GeoVax Labs, Inc.

GRE Greer Laboratories, Inc.

IAG Immuno International AG

IM Merieux

IUS Immuno-U.S., Inc.

JPN The Research Foundation for Microbial Diseases of Osaka University

KGC Korea Green Cross Corporation

LED Lederle

MA Massachusetts Public Health Biologic Laboratories

MBL Massachusetts Biologic Laboratories

MED MedImmune, Inc.

MIL Miles

MIP Bioport Corporation

MSD Merck & Co., Inc.

NAB NABI

NAV North American Vaccine, Inc.

NOV Novartis Pharmaceutical Corporation

NVX Novavax, Inc.

NYB New York Blood Center

ORT Ortho-Clinical Diagnostics.

OTC Organon Teknika Corporation

OTH Other manufacturer

PD Parkedale Pharmaceuticals

PMC Aventis Pasteur Inc.

PRX Praxis Biologics

PWJ PowerJect Pharmaceuticals

SCL Sclavo, Inc.

SI Swiss Serum and Vaccine Inst.

SKB GlaxoSmithKline

SOL Solvay Pharmaceuticals

TAL Talecris Biotherapeutics

UNK Unknown manufacturer

USA United States Army Medical Research and Material Command

VXG VaxGen

WA Wyeth-Ayerst

WAL Wyeth-Ayerst

ZLB ZLB Behring

(Appendix A, Version 2.5.1 © 2007. All rights reserved.)

Below is an example of how the Manufacturer mapping should be setup. In the below example

the site currently has “ABBOT” defined in their MIS Manufacturer Dictionary as Abbot

Laboratories. According to the table above “ABBOT” should be mapped to the value “AB”:

The MIS Maps will need to be set up for each facility database. Once all of the

above MIS mappings have been completed, please provide these MIS map

mnemonics to your NMI specialist so they may update the Immunizations

parameters in the NMI toolbox.

Set up for Centralized Management Tool Model MIS Vaccine Dictionary

In the MIS Vaccine Dictionary, a CVX code field has been added to define the nomenclature

for each vaccination entry. In the Pharmacy Drug Dictionary, a field has been added to

define the Vaccine Dictionary entry to associate to the medication.

Vaccines are built within the Vaccine Dictionary. In order for CVX codes to be transmitted in

the outbound message across the Immunization Interface, they need to be mapped to the

vaccines that have been built in the MIS Vaccine Dictionary.

Note: Please follow up with your Pharmacy specialist if you have any questions in relation to

this dictionary.

From the main edit screen within the Vaccine Dictionary, select the desired vaccine in the

“Mnemonic” field using an F9 look-up. This field is a look-up into the MIS CVX Code

Dictionary. Use this field to map the corresponding CVX Code for each vaccine.

- MIS main menu

- Clinical Dictionaries (F-O)

- Immunizations

- MIS Vaccine

- Enter/Edit

Next the Vaccine can be associated to the Pharmacy drug dictionary.

PHA Drug Dictionary

- Pharmacy main menu

- Dictionaries

- Drug

- Enter/Edit

Set up for Query/Assessment -Based Model

Immunization Queries

Immunizations are collected using queries and group responses. MEDITECH will allow a

query or group response to be mapped to a CVX code in the CVX Code dictionary, in order

to capture these immunizations queries. MEDITECH recommends the following naming

conventions for these query mnemonics:

A user will input these queries within the MIS Query Dictionary. This dictionary can be

accessed starting from the MIS main menu using the following routines:

- Custom Defined Routines

- Queries

- Enter/Edit

-

Once entered, it may look similar to the following:

Once entered please provide these MIS query mnemonics to your PHA specialist.

PHA Drug Dictionary

Immunization Query Meditech’s Preferred Query Mnemonic

Series IMM.SERIES

Manufacturer IMM.MANUF

Lot Number IMM.LOT

Expiration Date IMM.EXP

Once all the CVX codes have been entered in the MIS CVX code dictionary, a user will then

have to associate the CVX codes to the appropriate drug in the PHA Drug dictionary. The PHA

Drug dictionary can be found using the following routine starting from the PHA main menu:

- Dictionaries

- Drug

- Enter/Edit

Once a drug mnemonic is entered/selected the appropriate CVX code is then entered on page 1:

Testing Steps

Note

-Only immunizations that have CVX codes will generate an event for the HL7

Immunization Interface.

-A message will not generate when the immunization medication is first ordered in the

Meditech Pharmacy application.

-A message will only generate when the immunization medication is administered in the

Meditech eMar/PCS application, for inpatient order types.

1. Pharmacist desktop.

- Use Patient Profile to find your patient.

2. Once your patient has been found. Click "Enter Orders".

3. The “Type of Order” must be “Inpatient”. Then Click "ENTER"

4. Choose the Medication and choose the Order Type. The Order Type must be “Immunize”.

The “Vaccine” tab can be selected to show only vaccines.

After the order type is chosen, a Drug info screen will display. Close out the Drug info

screen. The system will then check for EMR/MRI Discrepancies.

5. Click Save after filing out required Immunization Event fields.

6. Click "Save" on bottom right.

7. After Save is clicked, the following "File order session" prompt will display. Answer yes to

this prompt.

For sites that have the internal Pharmacy toolbox parameter “Immunization screen” set to

“Record event”, a message will be sent after the file order session screen query is answered

“YES”.

The Immunization screen parameter “Record Event”, allows users in PHA or POM to enter

the vaccination data and document the administration on the same screen. As soon as this

is saved, a message is generated.

The Immunization screen parameter “Ordering Screen”, allows users in PHA or POM to enter

the vaccination order and then allows the nurse to administer and document the order on

the eMAR. A message is not generated until the order has been administered.

For sites using the Ordering screen, a message will not generate until the vaccine is

administered. Please continue follow these steps outlined below.

8. Fill out the required fields on the Ordering Screen. Click Save.

9. At the Pharmacist desktop, check off the drug and select eMAR.

10. Click Ack if necessary and administer.

11. On the Immunization Documentation screen, fill out the required fields and click Save.

Check the immunization interface in the MIS Interface Manager to confirm if a message has

formatted.