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    This page is created to hold a listing of all the new data elements expected as part of VistA Evolution - Immunizations.

    We will need the following data to be collected with future immunization entries. Any existing VistA fields are assumed to remain present and applicable to immunization data storage or messaging. Those existing fields shall be evaluated to determine readiness for support of the corresponding HL7 messaging element. Also, any existing RPMS fields are requested to be created in the VistA evolution product even if not intended for immediate functional use.

    As of 11/5/13, this page has been redesigned to be public-facing for use with a Performance Work Statement.

    IMMUNIZATION FILE #9999999.14 [CHANGES TO ACHIEVE FUTURE STATE]

    Current Field Number from VistA or Indian Health System RPMS Field Name Current Data Dictionary Attributes (for existing fields), Suggested Data Dictionary Attributes (for proposed new fields) Exists in Current VistA?
    .01 NAME 45 characters yes, length will need to be expanded to account for CDC full vaccine name and short description. (See fields .1 and 1.14 below).
    .02 SHORT NAME 10 characters yes; lengthen to CDC/CVX example so that it can be a PRINT NAME. Changes here will affect existing Health Summary report formatting.
    .03 CVX 3 digit numeric no; use same DD placement as RPMS
    .1 CDC SHORT DESCRIPTION no; use data location of RPMS 'ALTERNATE SHORT NAME' and edit field definition to make it long enough to meet the necessary length of standard entries
    1.14 CDC FULL VACCINE NAME no; use data location of RPMS 'FULL NAME'; consider a word-processing field so that it can match format from CDC table.
    Component Vaccine yes/no no = single ingredient vaccine (or at least defined by a single VIS)
    yes = multi-component vaccine (includes anything that requires multiple VIS to be given)
    (multiple) Components could be a self-referential file pointer back to IMMUNIZATION (vaccine table) list of the components of a vaccine (e.g., Hep A and Hep B)
    TBD (multiple) Available Lot Numbers a multiple that is locally managed, to list which lot numbers are available for selection by the users no; each entry will have a lot number, manufacturer (as MVX pointer) and expiration date
    TBD (multiple) Vaccine Information Statements a multiple that is nationally managed, to hold the current available VIS choices for a given immunization no; need to define VIS name (e.g., INFLUENZA INACTIVATED INJECTABLE), VISN language (e.g., differentiate between English [default] and Spanish) and publication date.
    TBD VUID no; used for file standardization, file lockdown, and data update pushes
    TBD CLASS set of codes... (L)ocal, (V)ISN, (N)ational no; it remains to be determined whether VA file standardization will be VUID-based or CLASS-based. Recommend creation of both fields at this time in order to maintain options for consistency with overall PCE standardization. A pattern for this field exists within Clinical Reminders (PXRM namespace).

    For reference, pre-existing VA data dictionary:

    ^AUTTIMM(D0,0)= (#.01) NAME [1F] ^ (#.02) SHORT NAME [2F] ^  ^  ^ (#.05) MAX 
    ==># IN SERIES [5S] ^ ^ (#.07) INACTIVE FLAG [7S] ^
    ^AUTTIMM(D0,88)= (#8801) MNEMONIC [1F] ^

    V IMMUNIZATION FILE #9000010.11 [CHANGES TO ACHIEVE FUTURE STATE]

    Field Number Field Name Attributes Exists?
    Name of which VIS was offered/given to patient by pointer reference, this should identify the name, version/language and the date

    may need to be a multiple, with commonly just one entry, but to accommodate multiple VIS's given for multi-component vaccines.
    no
    Date on which VIS was offered/given to patient no
    #1201 EVENT DATE AND TIME Date/Time of administration okay for user interface to default VA administrations to "NOW", but has to be editable and precise to time for VA administrations. Historical documentation needs to capable of storing to the DATE, but can accept MONTH/YEAR imprecision (e.g., flu shot or a series immunization), or just YEAR imprecision (e.g., tetanus, zoster, pneumovax), depending on which immunization it is.

    JIC-0290 - The system SHALL provide the ability for the vaccinator to capture the date and time an immunization was actually administered.
    corrected to yes, 4-11-2014
    Recorded Date/Time to differentiate between the time that the data was entered to the system and the date/time of the administration event; usually will be timestamped as NOW. no
    Lot number administered determine whether to store one field and point to MVX and Expiration Date, or to store all three explicitly no
    Injection Site the anatomic location (e.g. left deltoid) where the vaccine was administered Maps to HL7 Table 0163. no
    Injection Route e.g., IM, SQ. Maps to HL7 Table 0162 no
    Administered amount ('volume') number of units administered, e.g., 0.5 mL, includes both numeric amount (0.5) and the units of measurement (mL) no
    Injection Location; better named as 'Clinic of Administration' (required by other stakeholders) the geographic location (i.e., facility) where the vaccine was administered no
    #1202 Ordering Provider yes
    #1204
    ENCOUNTER PROVIDER
    Administering Provider the process does not guarantee that "ordering" provider, "administering" provider and "documenting" provider are one and the same. yes
    Documenting Provider no
    Vaccination Event Information Source per HL7 2.5.1, this is to capture "administered" vs. "historical" data no
    81101 Comments per HL7 2.5.1, Table 5-11. No coding change necessary; listing here for cross-walk when HL7 message construction is evaluated yes
    81203 Data Source There is an existing field DATA SOURCE. Used to track the difference between VA-administered data and external source persisted data. Will require new entries in the PCE DATA SOURCE file #839.7, used by the API that stores external data into VistA. yes
    Contraindications/Precautions Source: NVAC Core Data Elements. no
    Contraindications/Precautions Observation Date (see above) no
    Exemption(s) or Parent Refusals, Date of exemption/refusals, Documented Reason - 3 fields Needs more research to determine if VA will record these in the V IMMUNIZATION file for exemptions or refusals documented at/by VA. no
    #.04 SERIES field definition will need to be updated to account for inbound /refusal/ records, even if VA does not record our own refusals in this element. Maps to HL7 Table 0322 yes
    #.06 REACTION File definition is currently is a set of codes. Suggestion has been made to change to a pointer to VistA file 120.83. Implies a mapping between file 120.83 and SNOMED-CT to be created. Alternatively, map to HL7 Table 0396. yes
    #.07 CONTRAINDICATION to create the OBX-14 segment yes

    For reference: pre-existing VA data dictionary:

    ^AUPNVIMM(D0,0)= (#.01) IMMUNIZATION [1P:9999999.14] ^ (#.02) PATIENT NAME 
    ==>[2P:9000001] ^ (#.03) VISIT [3P:9000010] ^ (#.04) SERIES
    ==>[4S] ^ ^ (#.06) REACTION [6S] ^ (#.07) CONTRAINDICATED [7S]
    ==>^ (#.08) DIAGNOSIS [8P:80] ^ (#.09) DIAGNOSIS 2 [9P:80] ^
    ==>(#.1) DIAGNOSIS 3 [10P:80] ^ (#.11) DIAGNOSIS 4 [11P:80] ^
    ==>(#.12) DIAGNOSIS 5 [12P:80] ^ (#.13) DIAGNOSIS 6 [13P:80] ^
    ==>(#.14) DIAGNOSIS 7 [14P:80] ^ (#.15) DIAGNOSIS 8 [15P:80] ^
    ^AUPNVIMM(D0,11,0)=^9000010.1111^^ (#1101) REMARKS
    ^AUPNVIMM(D0,11,D1,0)= (#.01) REMARKS [1W] ^
    ^AUPNVIMM(D0,12)= (#1201) EVENT DATE AND TIME [1D] ^ (#1202) ORDERING
    ==>PROVIDER [2P:200] ^ ^ (#1204) ENCOUNTER PROVIDER [4P:200]
    ==>^
    ^AUPNVIMM(D0,801)= (#80101) EDITED FLAG [1S] ^ (#80102) AUDIT TRAIL [2F] ^
    ^AUPNVIMM(D0,811)= (#81101) COMMENTS [1F] ^
    ^AUPNVIMM(D0,812)= (#81201) VERIFIED [1S] ^ (#81202) PACKAGE [2P:9.4] ^
    ==>(#81203) DATA SOURCE [3P:839.7] ^

    DATA ELEMENTS NOT PART OF AN IMMUNIZATION FILE, BUT REQUIRED FOR DATA TRANSMISSION

    Data Description Source of the Requirement
    Facility Street Address HL7 2.5.1, version 1.4 dated August 1 2012, Table 4-19, page 66

    Also: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-full-d.pdf, page D-14, from http://www.cdc.gov/vaccines/pubs/pinkbook/table-of-contents.html

    in order to track "4) name and title of the person who administered the vaccine and the address of the clinic or
    facility where the permanent record will reside"
    Patient Address Details HL7 2.5.1, version 1.4, Table 4-19, and Appendix B. Street Address, City, State, Zip, Country and County will all be required.
    Patient Identifier Projects performing IIS data exchange must determine whether the patient ID is an SSN or a VHIC card number, or something else. That decision will inform requirements about patient ID assigning authority.
    Next of Kin HL7 2.5.1, version 1.4, Table 5-10. Patient Demographics services must support this need.
    Patient Name Type Master Veteran Index to account for HL7 Table 0200, Name Type Code? http://phinvads.cdc.gov/vads/ViewValueSet.action?id=4ED34BBC-617F-DD11-B38D-00188B398520. Source: HL7 2.5.1, Table 4-25.
    History of Vaccine Preventable Diseases Not for V IMMUNIZATION file ... could be in V POV or patient problem list (historical), etc.
    Is required to construct an HL7 message. Include the date of event.
    Refusals Current VA practice is that refusals documented at the VA are not stored in the V IMMUNIZATION file, and instead are typically in V HEALTH FACTORS.

    File attachment: Differences between RPMS and VISTA (made using the Fileman 22.2 compare UCIs feature)
    Download file "ComparisonRPMSandFOIA.docx"

    Authoritative sources for the above list of "What needs to be documented with an immunization administration record?":

    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/d/vacc_admin.pdf

    http://www.law.cornell.edu/uscode/text/42/300aa-25

    http://www.immunize.org/guide/aov07_documents.pdf

    Link to the HL7 2.5.1 IG for Immunization Messaging:

    http://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html

    Link to the Transmission to immunization registries test procedure: http://www.healthit.gov/sites/default/files/170.314f2transmissiontoimmunizationregistries_2014_tp_approved_v1.3.pdf

    Link to the Guidelines for Pre-loading Test Data:

    http://www.healthit.gov/sites/default/files/guidelines-for-pre-loading-test-data-for-immunization-registries_032013.pdf

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