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Immunizations for Public Health Stage 2 TRG-CS August 26, 2013

MEDITECH Interoperability

Immunizations for Public Health Stage 2

Training/Reference Guide: Client Server

Table of Contents

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

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

Site Setup ................................................................................................................. 2

CVX Codes ................................................................................................................ 3

Interface Value Set Mapping ........................................................................................ 5

MIS Maps .................................................................................................................. 9

MIS EHR Parameters ................................................................................................ 14

Query/Assessment-Based Model vs. Centralized Management Tool Model ........................ 17

Set up for Centralized Management Tool Model ............................................................ 18

Set up for Query/Assessment -Based Model ................................................................. 20

Testing Steps ........................................................................................................... 22

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 specifications for this interface are R1765 and have been approved based on the specifications provided by the government. Many States have their own requirements and it is important to let your Interoperability specialist know what state agency your Hospital will be reporting to so that the appropriate interface code can be delivered. The federal specifications can be found at the following link: https://www.meditech.com/Specifications/CS/MIS_251_SPEC_HTM_Interface_Specification_CS_HL7_VXU_Unsolicited_Immunizations_R1765.htm

There is some additional information as well as dictionary setup needed in order for the interface to function properly.

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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|4.1 – Sending Facility

MSH|4.2 – Sending Facility OID MSH|5 – Receiving Application MSH|6 – Receiving Facility 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.

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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/vaccines/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.

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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.

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Interface Value Set Mapping

With Stage 2 changes, the Immunizations Reporting interface will now utilize Interface

Value Set Mappings. This will allow organizations to map MEDITECH defined values to

values that are required by the Stage Agency to adhere to their standards. All Interface

Value Set Mapping dictionaries and routines can be accessed by:

- MIS Main Menu - Communications

- Interface Value Set Mapping

PHVS Code Set For Immunizations Reporting purposes, the PHVS Code Set will be utilized to identify the

values that should be mapped to the interface. Verify that the PHVS Code Set is defined

in your system:

- Code System - View

If the PHVS Code Set is not defined, then you will have to initialize your Interface

Mapping Dictionaries. Refer to the Interface Value Set Mapping TRG for more information.

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Message Generator Hook Points

Message Generator Hook Points will be used to determine which Value Set Mappings will

be utilized for the Immunizations Reporting interface.

Note: This is a screenshot of the MISTB Message Type dictionary that is not accessible to

customers.

The Hook Points you have available will be pulled from the associated Message Type for the interface which will use the IMM VXU V04 Message Type and this will standardly come

with a set of pre-defined Hook Points that you will be able to use as shown above in the

Message Type dictionary. Each Hook Point will have a pre-defined Value Set that it is

associated to which can be changed if needed. The following Hook Points can standardly

be utilized by the Immunizations Reporting interface:

Hook Point Value Set Type AdminSite AdminSite Query

AdminSiteD AdminSite Dictionary

Ethnicity Ethnicity Query

Facility Facility Dictionary

FinStatus FinancialClass Query

Manufacture ManufactureOfVaccine Dictionary

PubCode PublicityCode Query

Race Race Dictionary

RefusalReason RefusalReason Query

Relationship Relationship Dictionary

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Route RouteOfAdmin Dictionary

UnitsOfMeasure UnitsOfMeasure Dictionary

The Value Sets can be changed for each Hook Point if needed, and the above Hook Point

to Value Set relationship is what will initially be setup when the interface is first delivered.

For more information on how to override the default Hook Point settings, refer to the

Interface Value Set Mapping TRG.

Value Sets

To access the Value Sets that you will want to utilize:

- Value Set - Enter/Edit

You will be able to create your Value Sets in this dictionary. For the Immunizations

Reporting interface, select the PHVS Code System. You can then select which Value Set that you want to edit.

You will be able to enter in specific Codes with their associated Descriptions into your

Value Sets. These are free text fields, so it is up to the customer what to define for each Value Set. The Codes defined in each Value Set will be available to be mapped to MEDITECH values in the Interface Mapping dictionaries and the Codes will be used to

send in the messages for their corresponding mapped values.

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Interface Mapping

To access your Interface Mapping dictionaries:

- Mapping - Enter/Edit Dictionary Map

- Enter/Edit Query Map

From these dictionaries, you will be able to associate MEDITECH Dictionaries or Queries

to a Value Set that you have built. The Mnemonic field will be a look up to the available

Dictionaries or Queries that will be available to be mapped.

The Immunizations Reporting interface will use Value Sets associated to the PHVS Code

System. Please note that it is possible to associate Maps or Queries to multiple Code

Systems. In the Code System column, enter in PHVS. This will bring you down to the Value Set column and you can do a look up to the possible Value Sets defined under the

PHVS Code System. Choose the Value Set that you will want to associate to the

Dictionary or Query that you are working on (i.e. Choose the Race Value Set for the RACE

MIS Dictionary).

The Entry column will be a look up to values defined in your Dictionary or Query. These

will be the MEDITECH defined entries that will be mapped to the associated Value Set entry. The Code column will be a look up to the Value Set Codes that you have defined

for that Value Set. As an example with the screenshots above; the Meditech RACE

Dictionary mnemonic of HA is mapped to the 2076-8 code. This will allow 2076-8 to be

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sent in the HL7 messages.

The Default Code parameter can be defined to use if none of the associated MEDITECH values are mapped. This parameter is a look up to the Codes defined for that Value Set.

You will have to setup all Value Sets and Interface Mappings that you wish to use for this

interface. For more information, refer to the Interface Value Set Mapping TRG.

MIS Maps

Marital Status and Religion will require mapping the MEDITECH values to the HL7 defined standards using MIS maps. Note that DDP 17442 is being evaluated which will retire the use of these MIS Maps as the Value Set mapping will used instead.

Map MEDITECH Preferred Mnemonic MEDITECH Preferred Name

Marital Status Map IMMUN.MS Immunizations Marital Status

Religion Map IMMUN.REL Immunizations Religion

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:

- MIS Main Menu - Communications - Maps - Enter/Edit

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

these MIS map mnemonics to your Interoperability specialist so they may

update the Immunizations parameters in the MISTB Generator parameters.

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

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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”:

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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

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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

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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”:

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MIS EHR Parameters

Stage 2 changes will introduce additional parameters that can be accessed in the EHR

Parameters dictionary:

- MIS Main Menu - Communications

- EHR Routines

- Parameters

- Enter/Edit

From the General main tab, click on Page 2 to access the Immunization Settings.

Full Immunizations in Use: This is a Y/N field that should be set to Y if you are utilizing

the Immunizations Reporting interface.

Imm Opt Out Query: MIS Query used to ask patients if they wish to opt out of reporting

their Immunizations. Answering the query as Y will prevent Immunizations for that

patient from sending across the interface. If the query is answered as N, or if there is no

query defined on the patient, the Immunizations will be sent. This is based on Demo Recall.

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Do Not Share Query: Y/N MIS Query used to ask patients if they wish to share their

Immunizations information with other Providers. The response to this query will be sent

in PD1|12.

Publicity Code Query: MIS Query used to capture the Publicity Code. This will be a

Group Response that is on a Nursing Admission Assessment and the response is sent in

PD1|11. The Group Response should be setup with values defined in NIP-defined table

0215:

Value Description

01 No reminder/recall

02 Reminder/recall - any method

03 Reminder/recall - no calls

04 Reminder only - any method

05 Reminder only - no calls

06 Recall only - any method

07 Recall only - no calls

08 Reminder/recall - to provider

09 Reminder to provider

10 Only reminder to provider, no recall

11 Recall to provider

12 Only recall to provider, no reminder

Send Historical Immunizations: This is a Y/N field. Selecting Y will allow Historical

Immunizations entered on the historical vaccinations assessment to be sent out in the

same message as administered vaccinations. Administered Immunizations will only be

sent if this is selected as N. RXA|9 will be used to dictate a Historical or Administered

Vaccine:

00 Administered vaccine

01 Historical vaccination from client record

Immunizations are collected using queries and group responses. In order to capture these immunization queries, a query or group response will need to me mapped to a CVX code in the CVX Code dictionary. The following queries defined under the MIS Parameter

Immunization View Only section are queries that are defined in your MISTB parameters by your PHA Specialist to capture information for Historical Immunizations:

Funding Status Query: Vaccine For Children (VFC) eligibility status.

Funding Status Date Query: The date the VFC status was determined.

VIS Given Date Query: Y/N query for the date the Vaccine Information Statements

(VIS) was given to the patient.

Administration Site Query: The administration/injection site (i.e. Left Deltoid).

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Imm Series Query: Immunization series number.

Imm Manufacturer Query: The drug manufacturer.

Imm Lot Query: The lot number of the immunization.

Imm Expiration Query: The immunization expiration date.

Note: Patient Demographic and Historical Immunization queries must be set up as Demo Recall queries. You can only view the queries defined here. Contact your PHA specialist

for assistance in setting up or changing these queries in your MISTB parameters.

IMMUN Historical Immunization Queries

These can be used to map historical queries to CVX codes which can be pulled into the

interface messages.

CCD Historical Immunization Queries

These are queries that can be used to send historical immunizations out of the CCD

interface. These queries do not affect the Immunizations Reporting interface.

Patient Demographic Queries:

The Ethnicity and Mother’s Maiden Family Name queries will be defined on the Page 3

under the General tab.

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Patient Ethnicity Query: Enter query used to capture the patient’s ethnicity. This will be

populated in PID|22. A value set will be used to map the values to HL7 Table 0189.

This query will be mapped to the Value Set defined to the Ethnicity Hook Point.

Mother’s Maiden Family Name Query: Enter query used to capture the mother’s maiden

name. This will be populated in PID|6.

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 for Best Practices: https://www.meditech.com/bestpractices/otherfiles/bp11csimmunizations.pdf Best Practices for LSS: https://customer.meditech.com/en/d/bestpractices/otherfiles/bp14epcsimmunizationregistries.pdf Immunizations for 5.66: https://customer.meditech.com/en/d/clientservicesenhresources/otherfiles/phacbbpimmunizations.pdf PHA Centralized Immunizations Adobe Captivate: https://www.meditech.com/prpha/pages/phabccpcentralizedimmunizationenhancement.htm

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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

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PHA Drug Dictionary

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

- Pharmacy main menu - Dictionaries

- Drug - Enter/Edit

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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:

Immunization Query Meditech’s Preferred Query Mnemonic Series IMM.SERIES Manufacturer IMM.MANUF Lot Number IMM.LOT Expiration Date IMM.EXP

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.

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PHA Drug Dictionary 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:

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Testing Steps

Note: -Only immunizations that have CVX codes will generate an event for the HL7 Immunization Interface. - A message will only generate when the immunization medication is administered in the Meditech eMar/PCS application, for inpatient order types, and NOT when it is first ordered.

1. Pharmacist desktop.

- Use Patient Profile to find your patient.

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2. Once your patient has been found. Click "Enter Orders". 3. The “Type of Order” must be “Inpatient”. Then Click "ENTER"

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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.

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

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6. Click "Save" on bottom right.

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

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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 continued on the next page.

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

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

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10. Click Ack if necessary and administer.

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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.