Immunization Forecasting

When you review a patient’s immunization record, either in a chart note or in the Immunization History section of the chart, PCC EHR can display a list of the patient’s upcoming or missing immunizations.

Immunization Forecasting is an optional feature that relies on your practice’s specific immunization configuration.

Contents

1 Forecasting Results
2 Forecasting Warnings
3 Where Do Forecasting Recommendations Come From?
4 New Immunizations, Rules and Periodic Updates to Immunization Recommendations
5 Forecasting and Patient or Diagnosis Contraindications
6 Understanding an Invalid Vaccine Warning
7 Configure Immunization Forecasting

Forecasting Results

When Immunization Forecasting is turned on for your practice, you will see details about the patient’s next recommended immunizations wherever the immunization history appears.

For each vaccine family, from left to right, you can see:

the next expected dose in the series (1st dose, 2nd, 3rd, etc),
the recommended date (when it is ideal to receive this immunization) along with the patient’s age on that date,
the minimum date the immunization could be given early,
a past due date,
and a maximum date after which the shot or series would be invalid. (Rotavirus is the only common immunization with a normal Maximum Date.)

In the example above, the Forecasting Results recommend that this patient receive their first HPV, sixth DTaP, and first Meningococcal vaccines during their 11 year visit, around 1/30/2016. The patient missed their second dose of Hepatitis A vaccine, and they also did not receive an annual flu shot for 2014. HPV appears first because the Minimum Date is past; today the patient is within the minimum recommend range for receiving their first HPV shot.

Your practice can review the forecasting information and make a decision about which shots to administer today.

Here are some notes to keep in mind as you review the Forecasting Results:

What Order Are Vaccines In?: Vaccines in the Forecasting Results window are in the order of the earliest date reached. That means that a vaccine that has met the Minimum Date may be in front of one that has reached the Recommended Date.
Bolded, Color-Coded Date Recommendations: If a Minimum Date has been reached, you’ll see that date in bold. That means the immunization can technically be given. If a Recommended Date has been reached, you’ll see it in bold green. Green means that today is a good time to give the shot, as the recommended date has arrived or just passed. If a shot or series is overdue, you’ll see the date in bold red.
Refresh the Record: PCC EHR updates forecasting results when you open a chart or whenever a user edits a patient’s immunizations or immunization orders. You can see the most recent updated date and time next to the section title. You can also click Refresh to update the immunization forecasting.
What is a Vaccine Family?: Common combination vaccines, such as MMR, are always listed as a vaccine family. This is because the single-antigen version of these vaccines (such as a Measles vaccine) are not used in the United States. If a patient does have a single-antigen version of a vaccine on their record, Immunization Forecasting will attempt to evaluate the dose accordingly.

Forecasting Warnings

A patient’s immunization record may also include a Forecasting Warnings section.

Each line in the Forecasting Warnings section will show a vaccine name, a date for an immunization from the patient’s record, and a message.

There are two types of warning messages:

Informational Warnings: A Warning message is informational. The vaccine is still acceptable towards the series and does not need to be repeated, but it may have been administered early or in a time frame that does not match the manufacturer’s recommendation. Warnings can be safely ignored but may be useful as you are reviewing a patient’s immunization record. For example, in the above image, a patient received an extra Hepatitis B vaccine.
Invalid Vaccines: An Invalid Vaccine warning is about a vaccine that may not meet the requirements for the vaccine series. Your practice should review all invalid vaccines.

In the above example, a patient received their fourth DTaP shot too early.

Show or Hide Informational Warnings: Warnings can be distracting. You can deselect the “Show Informational Warnings” checkbox to hide them. Invalid Vaccine warnings can not be hidden, and they will appear even if the “Show Informational Warnings” checkbox is deselected.

Where Do Forecasting Recommendations Come From?

PCC displays forecasting results and warnings from the Immunization Calculation Engine by HLN Consulting. The Immunization Calculation Engine uses a rule set built on the ACIP immunization schedule guidelines from the CDC.

Forecasting results and warnings do not represent medical authority in deciding which immunizations a patient should receive. Your practice may adhere to a custom immunization schedule and make different decisions. The Immunization Forecasting section bases its recommendations on the ACIP guidelines.

For example, if a patient’s record indicates a dose that does not meet ACIP criteria, you may see a recommendation for that dose to be given. You may also see a Forecasting Warning about the invalid dose.

New Immunizations, Rules and Periodic Updates to Immunization Recommendations

ACIP guidelines and immunization schedules can change over time. PCC has a team that reviews and considers each update to the Immunization Calculation Engine.

Once the team approves a new update or change to forecasting rules, it is reflected in the Immunizations component for all PCC practices.

PCC announces these updates in our release documentation, and depending on the size and impact of the update will also communicate the changes on PCC Community and through the PCC Newsfeed.

Forecasting and Patient or Diagnosis Contraindications

The immunization forecasting features of PCC EHR will ignore contraindications in the patient history for “Current” reasons, i.e. illness or pregnancy.

If a patient has a persistent contraindication reason charted for an immunization, such as intussusception history (a contraindication for the rotavirus vaccine) or immunodeficiency (a contraindication for live vaccines), then the corresponding vaccine family will no longer appear in Forecasting Results or Forecasting Warnings.

As always, clinicians should remember that immunization forecasting in PCC EHR is a just calculation based on ACIP immunization logic, and not a medical decision. While the forecasting and immunization warnings will understand and accommodate diagnosis contraindications or exceptions to rules that it knows about, the dates shown are advisory and are not a substitute for a physician’s decision.

Understanding an Invalid Vaccine Warning

There are many reasons a vaccine dose may be considered invalid.

A dose in the patient’s history may not meet the ACIP schedule.
The patient may not have had the required 28-day interval between live vaccines.
The recommended Polio vaccine schedule changed significantly in 2009 (dose 4 should now occur after 4 years of age with a 6 month interval from dose 3).
Other vaccine guidelines may have changed.

If your practice believes an Invalid Vaccine warning is in error, please contact PCC Support at 802-846-8177 or 800-722-7708 or support@pcc.com.

Immunization forecasting in PCC EHR is a calculation based on ACIP immunization logic. The dates shown are advisory and are not a substitute for a physician’s decision.

Configure Immunization Forecasting

Immunization Forecasting is an optional feature. Contact PCC Support to turn it on or off.

Accurate forecasting requires that your practice indicate (by CVX code) which versions of each immunization your practice gives.

You can also configure which immunizations appear in PCC EHR and how they are tracked and displayed.

Read Add and Configure Immunizations to learn more.

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