Overview of Scenario
The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.
Example of Scenario
Juana Maria G. Morales is not covered by the Vaccine for Children’s program. When Dr. Smith tries to order Varicella vaccine from VFC stock, her EHR informs her that Juana is not eligible for a vaccine from the VFC stock.
Programming vaccine dose ineligibility (or eligibility) requires clearer documentation and specification of the requirement. All vendors evaluated provide the ability for providers to specify VFC eligibility at each visit and most when documenting administration of each vaccine. All also support including VFC eligibility in the vaccine administration report.
Vendors support providers to document VFC eligibility in two ways: (1) Expect the provider’s practice to evaluate each patient’s VFC eligibility at each visit and update the status in the patient’s demographics. Therefore, the system does not require a check box with each vaccine administered. (2) Expect the provider to select the VFC eligibility reason when documenting each vaccine administered.
- To automate VFC eligibility evaluation additional information must be readily available. Potential mechanisms for developing automated eligibility checks include:
- Use of the InfoButton Standard to access VFC eligibility rules specific to the state in which the patient lives.
- Dependency: Electronically accessible eligibility criteria in each state, or a compendium of all state criteria in a central source.
- Direct the InfoButton to the eligibility rules to enable processing within the EHR.
- Use EHR eligibility/authorization capabilities to electronically determine each patient’s eligibility at each visit.
- Dependency: Each state can set up an electronic access point to criteria or an electronic hub can provide a central source for real-time eligibility/ authorization checks directly from an EHR. Such capability may also be managed by Surescripts which manages similar capabilities for e-prescribing across the US.
- Most EHRs currently perform eligibility and benefit checks as an administrative function at the beginning of each visit using American National Standards Institute Accredited Standards Committee (ANSI ASC X12) messaging. ANSI ASC X12 is used for electronic data interchange (EDI). EHRs currently use the EDI Eligibility, Coverage and Benefit Inquiry (EDI 270) to determine eligibility and benefits. The process currently accesses the patient’s insurance plan to evaluation eligibility.
- The ANSI ASC X12 EDI 270 standard would need to be updated to include the VFC eligibility related vocabularies.
Providers have additional vaccine handling and storage responsibilities in the VFC program that EHRs do not currently support. Providers may want to review the 2012 Department of Health and Human Services (HHS) Office of the Inspector General report addressing these vaccine handling and storage responsibilities and review their state requirements in this area.[iii],[iv],[v]
- Vendor Perspective. Currently, the software must be able to capture and store VFC eligibility and include the information in each vaccine administration report sent to the public health immunization registry.
- Provider and Implementer Perspective. Providers participating in VFC programs should be familiar with VFC eligibility requirements to document dose level eligibility appropriately in the EHR. Providers may also want to address VFC requirements for vaccine handling and storage issues discussed in the Guidance section. EHRs do not assist with management or documentation of such vaccine handling and storage issues.
Click here for test script scenarios that include the capability, Notify of Vaccine Dose Eligibility. The scripts also indicate successful performance for each of the test sections.
The data elements include the condition specific to the clinical scenario in the test script.
[i] AIRA Modeling of Immunization Registry Operations Work Group (eds). Immunization Information System Collaboration with Vaccines For Children Program and Grantee Immunization Programs. Atlanta, GA: American Immunization Registry Association. April 14, 2011. Available at: http://www.immregistries.org/. Accessed 22 September 2015.
[ii] AIRA. Recording Dose Level Eligibility in Immunization Information Systems: Perceptions about Benefits, Barriers and Mitigation Strategies. December 30, 2012. Available at: http://www.immregistries.org/. Accessed 22 September 2015.
[iii] Department of Health and Human Services Office of Inspector General. Report OEI-04-10-00430: Vaccines for Children Program: Vulnerabilities in Vaccine Management. June 5, 2012. Available at: http://oig.hhs.gov/oei/reports/oei-04-10-00430.asp. Accessed 22 September 2015.
[iv] Association of Immunization Managers. Department of Health and Human Services (DHHS), Office of Inspector General (OIG) Vaccines for Children Program: Vulnerabilities in Vaccine Management Response Talking Points. 2012. Available at: http://c.ymcdn.com/sites/www.immunizationmanagers.org/resource/collection/673B9536-81FD-4389-8D45-862AE45811AF/OIG_Response_Talking_Points_.pdf. Accessed 22 September 2015.
[v] Centers for Disease Control and Prevention. Statement regarding Office of the Inspector General Vaccines for Children Program. June 7, 2012. Available at: http://www.cdc.gov/media/releases/2012/s0607_children_vaccine.html. Accessed 22 September 2015.