Immunization Enhancements 14.19.6

Overview

OP sat for certification with the Immunization Integration Program (IIP) from HIMSS adopting the most up-to-date immunization specification standards. Immunization workflow enhancements are one result of this certification work including:

  • A more comprehensive Complete List
  • Streamlined processes to document vaccine deferrals, refusals, and documented immunity
  • Ease of correcting documentation of incorrect administered vaccine details (ie. body site or vaccinator)
  • Streamlined process to correct vaccine inventory errors based on location mistakes
  • Ability to “restart” vaccine forecasting (ie. for patients who had a bone marrow transplant)
  • More comprehensive DAR Vaccine Recall Reports

Delivered Features

  • New fields in Complete List: Dose Size, Dose Units, Doses Given, NDCID, Comments, Source, Administered at Facility (Location) - name and address, Vaccine Status and Status Detail; CVX Code, DNF (Do Not Forecast), *Transmission Status, Entering Facility Name, External information: Provider, Administered Provider, Ordering Provider, Entering Provider
  • Vaccine Statuses: Complete, Partially Administered, Deferred, Refused
  • Enter Immunization button renamed Administer Vaccine
    • Edit/Delete tab removed
  • Current field newly visible in Complete List: Counseling Provider
  • Vaccine records with Adverse Reaction are highlighted yellow
  • New Action buttons for Complete List: 
    • New: enter a single historical vaccine record
    • Edit: edit available fields for selected vaccine record
    • Delete: delete selected vaccine record
    • Refuse/Defer: enter a new vaccine refusal or deferral
    • * Retry Failed: Retries transmissions that are currently marked as warning/errors in the next transmission.
  • New/Edit Vaccine form with access to most of the Complete List fields
  • Indicators displayed on Complete List: Refused; Documented Immunity, has protective titers; Documented Disease
  • Defer/Refuse documentation form
  • Do Not Forecast (DNF) feature
  • Problem List subsection Documented Immunity
  • All Vaccine documentation, edits, deletes are recorded in the Audit Trail
  • Historical Status Indicators tab under Indicators
  • New fields in DAR: 
    • Patient Demographics: Time of Birth, Middle Name included in Patient field
    • Vaccine Status Recall: Birth Time, Vaccine Group, Doses Given, Due Date, Overdue Date
  • Updated VIS sheets - associated with barcodes added to Clinical > Reference Data > More > Immunization Codes > Vaccine Information Sheets
  • Demographics > Basic Information - Middle Name field
  • Patient Chart > History> Perinatal History > Birth Info tab
    • Check the box for part of a Multiple Birth
    • Birth Order with a numeric dropdown up to 9

Note: Transmission Status column and Retry Failed button will only be functional after user’s state Immunization Registry retests to support OP’s robust bi-directional, real-time transmissions.

Workflow

  • More comprehensive Complete List
    • Above mentioned columns are visible
    • NDCID, CVX populates with documentation of vaccine administration and editing a vaccine record
    • Doses Given represents the number of vaccine doses recorded/administered 
    • Print button on Complete List tab will print the displayed Complete List
  • Streamlined processes to document:
    • Administered vaccines default to a status of Complete
    • Alert when choosing a Vaccine with an Expired Lot
    • Alert when ordering a Vaccine with prior Adverse Reaction
    • Alert when ordering a Vaccine with active indicator: Deferred, Documented Immunity, Refused
    • Alert when selecting improper administration route
    • Current standards to exchange information about vaccines now include coded reasons for deferral/refusal of vaccines. User will be guided to select:
      • Reason: Parent, Patient or Medical Decision
      • Details: Other, Philosophical Objection, Religious, Vaccine efficacy concern, Vaccine safety concern, Medical precaution, Out of Stock
    • Vaccine deferrals
      • Document from Order Worksheet or Complete List
      • Defer will be documented and vaccine will continue to be forecasted
      • Assign Defer Until Date
      • Due dates for Tasks and Orders reflect defer until date or chosen date
      • Check box to order consent for refusal/deferral
      • Tasks created: Schedule f/u visit, vaccine, consent
      • Able to convert a vaccine record to Defer/Refuse
      • Status: Deferred
    • Vaccine refusals
      • Document from Order Worksheet or Complete List
      • Refuse will be permanent and vaccine will no longer be forecasted
      • Check box to order consent for refusal/deferral
      • Able to convert a vaccine record to Defer/Refuse
      • Status: Refused
    • Documented immunity
      • Problem List > New > subsection: Documented Immunity; can not enter directly into the Complete List
      • Problem drop down offers only approved CDC SNOMED codes
      • Edits/Deletes to the Problem Documented Immunity will be reflected in the Complete List
    • Quick Entry vaccines have status of Historical information - source unspecified
  • Vaccine Status Indicators will display on Complete List and the Indicators Tab (read only)
    • Only valid indicators that will stop vaccine forecasting are: Refused, Documented Disease, Documented Immunity, serology
  • Ease of correcting/editing documentation of administered vaccine details 
    • Function no longer available in Enter Immunization (Administer Vaccine) button
    • Adjust incorrect details in form such as body site, lot number or vaccinator
    • Change the vaccine's expiration date to be prior to the date given, the Do Not Forecast checkbox is checked and read-only. Vaccine considered invalid and not forecasted. 
    • Change vaccine status to partially administered, the Do Not Forecast checkbox is immediately set to checked and read-only. Vaccine considered invalid and not forecasted. 
    • Able to convert a vaccine record to Defer/Refuse, vaccine will be returned to inventory
    • Status changes available: Complete, Partially Administered, Deferred, Refused
  • Streamlined process to correct vaccine inventory errors based on location mistakes
    • Administration records tied to inventory will only display information associated with that lot number
    • Change lot number on an administered vaccine - inventory will be reconciled (decreased/increased) and location details will be updated
  • Ability to “restart” vaccine forecasting (ie. for patients who had a bone marrow transplant)
    • Manually check Do Not Forecast (DNF) box in the Edit Vaccine Form - this will mark vaccine as no longer valid for forecasting
    • Forecast will reflect updated status with DNF vaccines removed
  • Historical Status Indicators tab under Indicators
    • Reference list of historical vaccine indicators - may no longer stop forecasting based on best practice
    • Able to delete historical vaccine indicators
    • Newly added indicators will be read only
    • No manual entry permitted
    • Current Indicators will be mapped:
      • Documented Disease (DD) - Documented Disease, Other
      • Documented Immunity (DI) - Documented Immunity, Other
      • Refused (R ) - Refused, Parent Decision (permanent, will no longer be forecasted)
      • Adverse Reaction (AR) - Deferred, Medical Precaution
      • Deferred: vaccine not available (DNA) - Deferred, Other, Out of Stock
      • All other statuses (AS, SC, NR, NRL, DMC, DVH) are not valid reasons to adjust vaccine forecasting and will only remain as historical references
  • More comprehensive DAR Vaccine Recall Reports
    • Doses Given represents number of vaccine doses recorded/administered
    • Vaccine Groups represents the Antigen group of the vaccine recorded
    • Due Date: the date the vaccine is due
    • Overdue Date: the date the vaccine is behind and past the recommended dosing range

NoteNew Immunization Registry transmission functionality will be rolled out on a state-by-state basis.