# Presentation: 472070

## Resource and Patient Management System Immunization TrainingVersion 8.3 Update

- Tania Smallenberg BSN
- Scott Hamstra, MD
- Tucson Area Immunization Coordinator
- National IHS Immunization Team

- Version 8.3 Update

**Notes:**
Resource and Patient Management System Immunization Training

## OVERVIEW

- FOCUS: new features of IMM Version 8.3:
- Summary of Changes
- Manager Menu (MGR)
- Reports Menu (REP)
- Patient Menu (PAT)
- Electronic Health Record (EHR)

- Version 8.3 Update

**Notes:**
Bulleted statement on FOCUS:  new features of IMM Version 8.3.

## SUMMARY OF KEY CHANGES

**MGR    Manager Menu**
- The Vaccine Table and Manufacturers Table have been updated (KINRIX)
- Expanded Influenza forecasting
- Lot Inventory “Low Supply Alert” is now specific and editable for each lot number
- New Lot Table Display Options
**REP    Reports Menu**
- Quarterly Report renamed 3–27 Month Report
- Update of Two Year Old Report with 3 new combinations
- Correction to Adolescent Report
- Hx of Chicken pox
- New Pediatric Influenza Report
**PAT    Patient Menu**
- Add an immunization visit by entering the lot number field first (rather than vaccine)
- New VFC eligibility field in Add Immunization/ Edit visit screens
- New parameters in Lists & Letters
**EHR **
- automatically decrements inventory when immunizations are added through EHR

- Version 8.3 Update

**Notes:**
Summary of Key Changes

## Manager Menu (MGR) New Screen View for LOT and VAC

-  Screen Editor view vs Line Editor
- VAC fields remain the same
- LOT fields have one new addition:
-  Low Supply Alert

- Version 8.3 Update

**Notes:**
Manager Menu ((MGR) New Screen View for LOT and VAC

## Previous Version View

- Immunization v8.2*1
-                          *  EDIT LOT NUMBER FIELDS  *
- Note: To delete a value from any field below, enter "@" (no quotes).
-    This Lot Number, 0417U, is associated with MMR.
- LOT NUMBER: 0417U//
- MANUFACTURER: MERCK & CO.//
- STATUS: ACTIVE//
- EXPIRATION DATE: MAR 2,2009//
- STARTING AMOUNT: 20//
- NUMBER UNUSED: 17//
- VACCINE SOURCE: VFC//
- HEALTH CARE FACILITY:

- Version 8.3 Update

**Notes:**
Previous Version View

## New v 8.3 View

- Imm v8.3           * * *  EDIT A LOT NUMBER  * * *
-       Lot Number:  0434X
- __________________________________________________________________
-        Lot Number: 0434X             Vaccine: VARICELLA
-                                               (VARICELLA)
-            Status: Active
-                                 Manufacturer: MERCK & CO.
-   Expiration Date: MAR 13,2010        Source: VFC
-    Starting Count: 60      Doses Unused: 24    Doses Used: 36
-  **Low Supply Alert: 10**                            (calculated)
-          Facility:
- ____________________________________________________

- Version 8.3 Update

**Notes:**
New v 8.3 View

## MGR - Low Supply Alert Options Vaccine Specific

- In MGR > ESP
- The low supply alert parameter sets the default value for ALL Vaccine lots
- Under MGR > LOT
- have a new field >LOW SUPPLY ALERT
- set and edit a low supply alert quantity for each specific lot number
- Basically = override the default setting with a more helpful parameter

- Version 8.3 Update

**Notes:**
MGR – Low 

## MGRNew LOT Display Options

- Choose to display the LOT list by:
- Unused doses (least first)
- Expiration Date
- Lot Number
- Vaccine Name, then by Used Doses
- Vaccine Name, then by Expiration Date
- Vaccine Name, then by Lot Number
- Inactive lot numbers are defaulted to display after active lots (if you change the display, you are given the option to hide inactive lot numbers)

- Version 8.3 Update

## MGRHelp in LOT Regarding VFC

- When in the LOT add/edit,
- Choose Help to get information about one option to cope with the same lot number that comes from both VFC and non VFC sources (see below)
- Rare – but situation has occurred

- Vaccine Source - VFC or non-VFC.  Note: If there are two issues of the same lot, and one issue is is VFC and the other is not VFC, it may be helpful the create a new lot for the VFC issue and give it the same lot number but append "-vfc" to the end.  This way, the two
- issues can be tracked, inventoried, and reported on separately       (yet easily identified by the common, original lot number).

- Version 8.3 Update

## MGRUpdates to Vaccine Table and Manufacturer Table

- In LOT, the vaccine table and the list of vaccine manufacturers has been updated according to the CDC’s changes to the CVX and MVX Codes
- New Vaccine Code: 130 Kinrix (DTaP-IPV)
- New Manufacturer: ADA Acambis

- Version 8.3 Update

## MGRLowercase ‘e’ Problem Fixed

- 99% of folks would NEVER notice – but LOT # are in CAPITAL LETTERS
- Why? because certain lowercase letters mean something in programming
- If a lot number contains a lowercase ‘e’, followed by one or more numbers, the system thinks it’s in exponential form – creating errors and confusion
- This has been corrected
- BUT please put LOT # in CAPITAL LETTERS

- Version 8.3 Update

## MGRNew VIS Default in VAC

- 1/30/2008 is the >VIS DEFAULT DATE
- reflects the publication date of the CDC “Multiple Vaccine VIS”
- default applies to vaccines (including combinations) that contain any of the following antigens:
- DTaP, Hib, IPV, Hep B, PCV and Rotavirus
- Not the others
- MMR, Varicella, Hep A, Influenza

- Version 8.3 Update

## MGRNOS Updates in VAC Table

- 99% will never notice = FYI
- since these codes are NOT used
- But does show up sometime in historical data
- In VAC, all NOS vaccine codes now have NOS appended to them, for example:
- 17:HIB,NOS
- 31:HEB AP,NOS
- 45:HEB B,NOS
- 85:HEP A,NOS
- 88:FLU,NOS (replaces INFLUENZA)
- 89:POLIO,NOS
- 108:MENING,NOS
- 109:PNEUMO,NOS
- 122:ROTA,NOS

- Version 8.3 Update

## MGRActive Status in VAC Preserved

- In VAC, every vaccine is either
- ACTIVE or INACTIVE
- Versions come “pre-set” with Active and Inactive tags (saved some setup time)
- BUT – MGR > RESTANDARDIZE function would “reset” each time
- Vaccines “disappear” – when made Inactive
- the >ACTIVE field for vaccines in the Vaccine Table are no longer reset by the Restandardize function in MGR
- This change was made in order to preserve local site settings and end one source of confusion

- Version 8.3 Update

## MGRKEY for Lot # Managers

- NEW!!! – LOT # Key separated from MGR Key
- In KEY, added an access key for Lot Number function displayed in the KEY Table:
- BIZMENU
- BIZ EDIT PATIENTS
- BIZ MANAGER
**BIZ LOT ONLY** (previously BI LOT NUMBER NON-MANAGER)
- Those with MGR Key assign the BIZ LOT ONLY
- BIZ LOT ONLY Key is for
- Adding / Editing Lot #
- Managing Inventory

- Version 8.3 Update

## MGRImm v8.3 Appears on All Screens

- The Immunization Package Version number (example: v8.3) now appears in the top left corner of all data entry and menu screens
- This helps Tech Support staff in assisting users when problems arise

- Version 8.3 Update

## REP Name Change: 3-27 Month Report

- The IHS longstanding Quarterly Report now is the QTR 3-27 Month Report
- The report (REP) list:
- ADO		Adolescent Report
- ADL		Adult Report
- FLU		Influenza Report
- QTR		3-27 Month Report
- TWO	Two-Yr-Old Rates Report
- VAC		Vaccine Accountability Report

- Version 8.3 Update

## REPADO Adolescent ReportHx of Chicken Pox

- The ADO Adolescent Report now counts
- the first dose of Varicella vaccine
- or
- a history of chicken pox
- as being up-to-date for Varicella

- Version 8.3 Update

## ADO Adolescent Report

-                      IHS Adolescent Immunization Rates
-                    For patients 11 through 17 Years of Age
-  As of: 12-Nov-2008    Total Patients: 274  Total Females: 140
- ---------------------------------------------------------------
-   Age Group      |       11-12yrs      13yrs       13-17yrs
-   Denominators   |         102           39          172
- ---------------------------------------------------------------------------------------------
-     1-VAR        |          89           26           83
-                  |          87%          67%          48%
-                  |--------------------------------------------
-     2-VAR        |          67           19           54
-                  |          66%          49%          31%
- --------------------------------------------------------------
-  **Hx of Chickenpox|          23           12           83**
**    ****(Immune)     |          23%          31%          48%**
- --------------------------------------------------------------
-  1-TD_B 3-HEPB   |          69           32          **149**
-  2-MMR **1-VAR **    |          68%          82%          **87%**
- -----------------------------------------------------------------------------------------------------
-  1-TD_B 3-HEPB   |          41           17           48
-  2-MMR 1-MEN     |          40%          44%          28%
-  **2-VAR **          |

- Version 8.3 Update

## REPNew FLU Influenza Report

- New Influenza (FLU) Report to assess flu vaccination (new national standard) between Sept 1 and Dec 31 includes
-  younger children in two age groups:
- 6-23 months old
- 24-59 months old
-  shows influenza vaccines
-  at least 1 Flu shot “this season”
-  Fully Immunized (more complex logic)

- Version 8.3 Update

## REP3 New Up-to-Date Measures in Two Year Report

- Three new combination measures as nation looks beyond 43133, 431331, and 4313313:
- 4DTaP-3Pol-1MMR-3Hib-3HepB-1Var-**4Pne**
** ****431331****4 **
- 4DTaP-3Pol-1MMR-3Hib-3HepB-1Var-4Pne-**2HepA-3Rota**
** ****4313314****23 **
- 4DTaP-3Pol-1MMR-3Hib-3HepB-1Var-4Pne-2HepA-3Rota-**2Flu**
** ****431331423****2**

- Version 8.3 Update

## Reports Menu (REP)New Default Beneficiary Type = AI/AN

- For all reports listed in REP, >BENEFICIARY TYPE now defaults to
-  >Indian/Alaska Native rather than >All
- Aids in proper denominator in reports intended for IHS - reporting only the AI/AN population
- Option still exists to edit the default
- All edits apply to the current report only and will default back to Indian/Alaska Native

- Version 8.3 Update

## Patient Menu (PAT)Lot Number Autofills Vaccine Name

- In RPMS IMM (not in EHR)
- when adding a vaccine (ambulatory visit)
-  if skip >VACCINE NAME
-  go to >LOT NUMBER first
- And type in the lot number
- IMM automatically populates >VACCINE NAME
- ONLY works with a new visit
- does not with previous or historical visits

- Version 8.3 Update

**Notes:**
Patient Menu (PAT)  Lot Number Autofills Vaccine Name

## PAT Help with Inactive Lot Numbers 

- In PAT>SGL record,
- when adding a lot number, the user may view a drop down list of all lot numbers
- This is a complete list, both active and inactive lot#
- If an inactive lot number is selected,
- an alert informs the user that the lot number . . .
- Is Inactive
- must first be activated (in MGR>LOT)
- or prompts that a different lot number must be selected
- The user is not able to save an add/edit containing inactive lot numbers

- Version 8.3 Update

**Notes:**
PAT  Help with Inactive Lot Numbers

## PATNew Alert for >OTHER Location

- Most visits are Location: IHS with a specific facility
- Some vaccines are given outside IHS sites
- >LOCATION TYPE = Other
- when chosen, a pop-up now alerts:
- Your Other Location name will be shortened to 50 characters
- Previously if > 50 - the entry failed and went blank
- Applies to SGL screens
- >ADD IMMUNIZATION
- >SKIN TEST
- >EDIT VISIT

- Version 8.3 Update

**Notes:**
PAT New Alert for >OTHER Location

## PATEditing >LOCATION Problem Fixed

- In SGL >EDIT VISIT,
- if the >LOCATION was the user’s default location
- If attempted to change this to another location,
- the edit failed
- Edits of location are now permitted

- Version 8.3 Update

**Notes:**
PAT  Editing>LOCATION Problem Fixed

## PATNew VFC Field

- VFC (Vaccines For Children) eligibility field in SGL record, options are:
- Unknown
- Not Eligible
- Medicaid
- Uninsured
- Am Indian/AK Native  -----  default if Bene Type = AI/AN
- Federally Qualified
- State-specific Elig
- Local-specific Elig
- If the patient’s beneficiary type is AI/AN,
- the VFC field is defaulted to Am Indian/AK Native

- Version 8.3 Update

**Notes:**
PAT New VFC Field

## PAT>SGL Screen Shot of VFC 

- Imm v8.3           * * *  ADD AN IMMUNIZATION VISIT  * * *
-  Patient: DEMO,DAUGHTER         		DOB: 01-Jan-1990 (18 yrs)
-   Chart#: 900001 at SELLS HOSP     	Active     Female
- _____________________________________________________________________
-      Date: NOV 12,2008                       Category: Ambulatory
-   Vaccine:                                       Lot#:
-  Inj Site:                    Vol:     ml
-  Location Type: IHS      Location: SELLS HOSP
-  Provider: HAMSTRA,SCOTT
-  VIS Date:
-  **VFC Elig:**

- Version 8.3 Update

**Notes:**
PAT>SGL Screen Shot of VFC

## Electronic Health Record (EHR)Adding/Deleting Contraindications

- New functionality in IMM to assist EHR
- Not yet functional
- New Public Entry Points (PEPS)
- PEPS may be used by EHR *in the future* to permit adding and deleting contraindications via EHR

- Version 8.3 Update

**Notes:**
Electronic Health Record (EHR) Adding/Deleting Contraindications

## EHRAuto-Decrements in LOT Inventory

- EHR (now same as IMM) automatically decrements the inventory of vaccine lot numbers in LOT when immunizations are added through EHR
-  FYI: applies to immunizations added as
-  >Ambulatory or >Inpatient
- Does not apply if added as >Historical

- Version 8.3 Update

**Notes:**
EHR Auto-Decrements in LOT Inventory

## PATNew Influenza Vaccine Forecast

- Influenza forecasts
-  for patients 6 months through 18 years of age
-  addition of patients 5-18 years of age
- Influenza forecasts each flu season from September 15 to March 15

- Version 8.3 Update

**Notes:**
PAT New Influenza Vaccine Forecast

## PATPPD as Contraindication in SGL

- SGL>CONTRAINDICATIONS
- May now choose TST-PPD if desire to enter a contraindication to TST-PPD
- SGL<ADD IMMUNIZATION
- Cannot select TST-PPD
- SGL>SKIN TEST
- is the proper and only option for adding PPD
- >EDIT VISIT for edits is unchanged

- Version 8.3 Update

**Notes:**
PAT PPD as Contraindication in SGL

## PATHistorical Skin Test Reading (mm)

- In SGL>SKIN TEST,
- the <mm> field is no longer required when entering a _***historical***_ PPD
- Often PPD historical information from other facilities supplied positive or negative status but not the mm reading
- This change eliminates the need to to add an arbitrary number when the actual mm is not available on records from other facilities

- Version 8.3 Update

**Notes:**
PAT Historical Skin Test Reading (mm)

## PATNew Parameters on LLS

- In >PATIENT GROUP parameter you have the additional option:
- Females Only (only female patients included)
- Helpful for HPV Vaccine activities
- New >HEALTH CARE FACILITY parameter defaults to user’s logon site
- Helps users on multi-facility systems hone LLS to patients registered at their own facility

- Version 8.3 Update

**Notes:**
PAT New Parameters on LLS

## PATAge Display Reflects Forecast Date

- In the SGL record and in LLS,
- the patient age will reflect the >FORECAST DATE chosen
-   Previously showed today’s age regardless of                         forecast date
-  If a forecast date (past or future) is selected, the patient age is
-   recalculated
-   and displayed
- to reflect the age on that selected date

- Version 8.3 Update

**Notes:**
PAT Age Display Reflects Forecasts Date

## QUESTIONS?

- 	RPMS Help Desk
- 	Email:  _[support@ihs.gov](mailto:support@ihs.gov)_
- 	Phone: 1-888-830-7280

- Version 8.3 Update

**Notes:**
QUESTIONS?