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Immunizations in MacPractice 11

In the new 2015 Certified build of MacPractice, we've made some extensive changes to our Immunizations widget in the Clinical Ability. This article will give an overview of these changes and go over the workflow for adding and managing Immunizations for your patients in MacPractice. If you are new to MacPractice, this article will cover the basic workflow of the Immunization widget and the functionality within. If you're unfamiliar with the changes made to the Clinical Ability in MacPractice 11, please refer to the Clinical Ability article here.

It is important to stress that without connecting to an Immunization registry, that this information will strictly stay in your MacPractice database. If you wish to connect your MacPractice server to an Immunization registry for the purposes of downloading and uploading Immunizations record, you'll need to contact Support with all the necessary details so we can assist in configuring that connection.

Overview
The Immunizations Widget is located in the Clinical Ability. From here, you can review immunization records for the currently selected patient. By default, the widget displays all immunization records by chronological order. You can use the drop down menu at the top to filter out historical records or records downloaded from an Immunization registry. There's also the Info Button, which uses the Info Button standard to pull contextual information regarding the immunizations in question.

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Columns in the Immunization widget can be clicked to sort the displayed results in ascending or descending. Let's break down each column:

  • Immunization: The name of the immunization in question. In prior builds of MacPractice, this would also display the dosage and units; this has been removed from the name.
  • # in Series: If this immunization is one in a series of immunizations conducted, you can use this field to denote which number in the series the immunization record is for. 
  • Date: The date of the immunization record in question.
  • Source: This column identifies where the Immunization record originates from. If this is "MacPractice", then the immunization record was entered in by the office. If this is "Registry", this was a record downloaded from an Immunization record.
  • Administered By: This column lists the provider that administered the immunization record.
  • Office: This column lists the office reference where the immunization was conducted.
  • Information Source: This column distinguishes whether the immunization record is new, or a historical record.

Immunization References
In the Clinical Sidebar, you'll note that there is a reference category for Immunizations. These contain all of the Immunizations that can be applied to a patient's record. On a brand new database, this category is empty, so the office will need to add all the immunizations they intend on conducting before being able to add them to patient records.

To add a new Immunization Reference, simply click on the Immunization node in the Clinical Sidebar, then click the Green Plus. By default, new Immunization records will search for a codified Immunization to utilize. 

It is important to clarify that you can add multiple references for the same immunization. The purpose behind multiple references is to pre-configure certain immunization configurations, such as setting up references for each number in a series, or utilizing a different lot number, or different dosages. This saves on manual data entry. However, when adding these immunizations to a patient's case, you can always adjust the fields as necessary.

Codifying Immunizations
If you are a previous MacPractice user and you've updated from 7.3 and earlier to this build, you'll likely have several Immunizations already entered into the database. However, these immunizations records may not be codified. A Codified Immunization is one that is standardized and recognized as an official immunization, and they can be uploaded to Immunization registries. Codifying your immunizations is necessary to utilize the Immunization registry upload/download functionality.

To codify an older immunization reference, first select the immunization reference in the sidebar.

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In the upper right corner, you'll see the Status field, which will list either "Inactive" or "Active". Inactive indicates that the immunization in question is not currently in use or is not codified. The presence of the Codify button (highlighted in the above screenshot) also indicates that this immunization has not been codified.

To codify, simply click the Codify button in the upper right corner.

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You'll be taken to a search window where you can search for an appropriate immunization to codify your immunization reference. You can see the Status (Active, Inactive), the immunization's CVX number, and brief names and descriptions of the immunization in question.

Typically you'll always want to use an immunization with an Active status, as that is currently in use and available. When you've decided on the appropriate immunization, click on the immunization and then click the "Okay" button to codify it.

Let's cover the remaining fields and their usage. If a field is marked (codified), it will be greyed out and unable to be edited if the immunization reference has been codified. We strongly recommend you detail out an immunization reference as completely as you can.

  • Immunization Name (codified): The full name of the immunization in question.
  • Short Description (codified): A short description of the Immunization in question.
  • Status (codified): Whether the immunization in question is in active use or whether it's inactive.
  • Dose: The dosage of the immunization in question. This is usually paired with the Units field to determine the exact amount of the immunization to be applied.
  • Units: Paired with the dose field, Units describes how the dosage is measured, typically in millileters (mL).
  • Route: This drop down allows you to select the appropriate route for the immunization in question. You can read more about routes here.
  • Site: This drop down allows you to select the site where the immunization should be applied, such as left arm, right arm, etc.
  • Lot Number: The lot number of the immunization. This is used to track where the vaccine originated from, and is one of the key pieces of data that is required by law to record when applying immunizations.
  • Expiration Date: The expiration date of the immunization in question.
  • Number in Series: Some vaccines must be applied in stages of a series of vaccines. These fields allow you to indicate whether this vaccine is a stand alone vaccine (indicated by 1 out of 1), or whether there are several in the series (2 out of 3 for example).
  • Recommended Age: The recommended age for a vaccination to be applied. 
  • CPT Code: This field allows you to link a CPT code to an immunization reference. By clicking the magnifying glass icon, you can search for and apply a CPT code to the immunization reference. 
  • National Drug Code: This field allows you to link a NDC number to the immunization reference. By clicking  the magnifying glass, you can select any applicable NDC numbers.
  • CVX Code (codified): The CVX identifier of the vaccine in question.  
  • Manufacturer: This field allows you to select the manufacturer of the vaccine in question. Manufacturers in red are inactive, as in they are not currently distributing the vaccine.
  • Route Code: The shorthand route code for the route that the vaccine should be applied.
  • RxNorm Code: This field allows you to link an RxNorm code to the vaccine in question.
  • VIS Published Date: The Published Date listed on the Vaccine Information Sheet for the vaccine in question. 
  • Vaccine Grouping by CVX Code: This field allows you to indicate whether the vaccine belongs to a group of vaccines intended to immunize against a particular disease. You can read more about vaccine grouping here.
  • Notes: A notes field to be used only by the office. This is a great place to insert notes for the intended usage of this immunization record.

Adding a new Immunization Record
After the complicated set up for immunizations, adding an immunization record to a patient is a relief, as it's much simpler. On the Immunization widget in the Clinical Ability, simply click on the Green Plus in the upper right corner of the widget. This will bring up a search window displaying your Immunization References. Simply select the immunization reference in question you'd like to add. 

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The next window allows you to adjust the details of the immunization. You can set the Incident which this Immunization record belongs. The Date and Time fields are automatically filled with the current date and time for your convenience, but you can adjust these as necessary.

The Dosage, Units, and Lot Number are required fields, as is the VFC Eligibility status (follow the link to be taken to the CDC site article that reviews VFC Eligibility). The other fields may be optional, but we strongly recommend that you review each field and complete them to the best of your ability. Once the required fields are entered, you can click the "Done" button to add the Immunization record to the patient's file.

Adding a Historical Immunization Record
A Historical Immunization Record is used when the office has not conducted the immunization in question but you are aware of prior immunizations in the patient's past. These records can be added, or they can be retrieved from an Immunization Registry as indicated by the Source column of the Immunization Widget.

To add a Historical Immunization, click the Historical button in the upper right hand corner of the Immunization widget. Like a normal immunization record, you'll be taken to a search window where you can find the immunization reference you'd like to add.

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The data entry window for Historical Immunizations is much simpler than a normal Immunization record, as it is intended to simply document that the office is aware of a previous immunization. Simply detail the record to the best of your ability, and when you are satisfied, click the "Done" button.

The More Button
The More Button contains functionality that relates to immunization registries, and other miscellaneous data.

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Let's cover each piece of functionality one by one from top to bottom:

  • Patient Registry ID/Set Up Registry: This field and button are used to tie a patient to an Immunization Registry. The Patient Registry ID is un-editable by default, as it is intended to be used to store a Registry ID that is retrieved from an Immunization Registry.
    The Set Up Registry button is used to fetch information from an Immunization Registry that has been previously added in MacPractice Preferences under the HL7/Immunizations category. This will likely be done and assisted by MacPractice Support, so if you need to connect an Immunization Registry, please contact Support first so we can assist you with this step.
  • Export Method for Registry Upload: This allows you to define which method should be utilized to upload information to an Immunization Registry. These methods are defined in MacPractice Preferences > HL7/Immunizations. You can either opt to use any Active methods (methods that are checked in HL7/Immunization Preferences), or you can opt to create a new HL7 Preference.
  • VFC Eligibility Status: This field allows you to define the patient's VFC Eligibility Status.
  • Registry Reminder for Immunizations/Reminder Effective Date: 
  • Member of Special Risk Group checkbox: This checkbox allows you to indicate whether the patient belongs to a Special Risk Group.
  • Rabies Exposure Date(s) table: This table allows you to manage rabies exposure dates for the patient in question. Clicking the Green Plus will simply add today's date to the table.
  • View Previous Downloads button: This button will display all instances of downloaded information from an Immunization Registry for the patient in question.
  • Request History from Registry button: This button will request any data associated with the Patient Registry ID for this patient, if it has been entered. This requires that an Immunization Registry is connected.
  • Export Immunizations button: This button will export any immunization records to a connected Immunization Registry. A Patient Registry ID must be connected to this patient and that you have an Immunization Registry configured in MacPractice Preferences. 
  • Print Immunizations button: This button allows you to print off any immunization records. It will take the information in the Immunizations widget and print off that summary for your records.

 

 

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  • Avatar
    Andrea Ringsmuth

    for this one "Export Method for Registry Upload: This allows you to define which method should be utilized to upload information to an Immunization Registry. These methods are defined in MacPractice Preferences > HL7/Immunizations. You can either opt to use any Active methods (methods that are checked in HL7/Immunization Preferences), or you can opt to create a new HL7 Preference."

    They're not creating a new HL7 preference here, it just lets you select from existing HL7 prefence profiles. The part that's confusing is that the default name of the preference is "New HL7 Preference", but that can be overridden in the preference window. It would be more accurate to say "...Or you can select an existing HL7 preference."

  • Avatar
    Andrea Ringsmuth

    I feel like we should explain in here somewhere when immunizations get sent to the registry. A lot of people in the past have been confused by the Export button and think they have to click that each time. That is only used during initial setup to send the patient's current history. Once you are connected to a registry, an immunization is sent automatically each time you create a new record or edit an existing record. Both new and historical immunizations are sent. I mostly just don't want people thinking they have to click Export each time to send data to the registry, that would add a lot of work for them and that's not the point of the SOAP connection.

  • Avatar
    Andrea Ringsmuth

    We might want to describe what's going on in the VIS table in the new immunization record. They're required by law to provide current vaccine information statements for several immunizations (https://www.cdc.gov/vaccines/hcp/vis/about/required-use-instructions.html). If they're using a codified immunization, we'll pre-populate that table with the current VIS and published date, and they have to input the date they gave the VIS to the patient or guardian. If they don't supply this information (given and published date) it could cause the registry upload to fail. If they don't see the correct VIS in the table they can click the plus to search for one, and they can freely remove an VIS from the table too if they want. If they had something entered in the vaccine group codes list in the reference, this will also pre-populate the VIS table with the group code (because the VIS are given based on the group code not the individual vaccines), however, the new way we're doing it will supply the published date for them automatically so there really isn't a benefit to filling out the group codes in the reference any more. Anyway, given how this is required by law for them to fill this out I just felt we should have some guidance on it. If they let the automatic mapping happen they should only have to fill in the given date.

  • Avatar
    Andrea Ringsmuth

    "Registry Reminder for Immunizations/Reminder Effective Date: " Looks like this is missing its explanation. The definition from the HL7 spec says this: "This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for the patient. In the context of immunization messages, this refers to how a person wishes to be contacted in a reminder or recall situation." Probably want to rewrite that a little more user friendly, or maybe just use the last sentence.

  • Avatar
    Andrea Ringsmuth

    "Rabies Exposure Date(s) table: This table allows you to manage rabies exposure dates for the patient in question. Clicking the Green Plus will simply add today's date to the table." Slightly confusing on this one. It defaults to today's date but you can single click to edit the date. I'd write it as Click the green plus to enter a new date. The date will default to today's date but you can single-click the date to edit it.

  • Avatar
    Andrea Ringsmuth

    Couple new fields are being added to the More tab btw. There will be a Protection Status Indicator and effective date. This indicates whether the patient data is able to be shared or not. For example if it set to not share data, that means the data is protected and the registry might store/contain the data but won't allow it to be downloaded or looked up by other providers or data systems.

    The default value in the status pop up menu should be “Unknown - No determination has been made regarding patient’s (or guardian’s) wishes regarding information sharing.” The other two options should be “Do Not Share Data - Protect the data. Patient (or guardian) has indicated that the information shall be protected.” and “Sharing OK - It is not necessary to protect data from other clinicians. Patient (or guardian) has indicated that the information does not need to be protected.”