Online Disaster Reporting for ImmTrac2 – 2020-09-29

Welcome to Texas Immunization Registry Online Disaster Reporting The first section is on Disaster Reporting Requirements First, let’s define what a disaster is Disasters have A definite beginning and ending date determined by a governmental authority, A specified geographic area such as a county or state, Specific AIMs (antivirals, immunizations, and/or medications) associated with the disaster, and Optionally, may have priority groups Priority groups can protect those at risk, such as those essential to the pandemic response, those who care for the ill, those who maintain national security and community services, children and pregnant women, and workers at greater risk of infection Note that priority groups are not defined for antivirals, which are not preventative like immunizations are According to Section 161.00705 of the Texas Health and Safety Code, Any antiviral, immunization, or medication administered in response to a declared disaster or emergency must be entered into the Texas Immunization Registry (ImmTrac2) According to Section 100.7(b) of the Texas Administrative Code, A health care provider who administers an antiviral, immunization, or medication, an AIM, during a publicly declared disaster shall provide the data elements to the department (DSHS) within 30 days of that medical treatment, in a format and manner prescribed by the department Report Remdesivir administration immediately! This is a requirement by the Texas Department of State Health Services (DSHS) Administration of Remdesivir should be done immediately for clients who are deceased before their client records are closed permanently by Vital Statistics Reporting Requirements Everyone who receives an AIM, (an antiviral, immunization, or medication) during a declared disaster will have their AIM reported to the registry, regardless of whether they consent or not The next section is about disaster immunizations and clients Disaster Immunizations versus Non-Disaster Immunizations Disaster immunizations need to be entered into the registry, regardless of whether they are consented or not Non-disaster immunizations always require a standard ImmTrac2 consent to be entered into the registry Definition of a Disaster Client. Disaster clients have: Received a disaster related AIM, During the disaster period, Are located within the disaster region, and For patients who are not severely ill, can be assigned to a priority group Priority groups are only used for preventative measures There are two types of disaster clients, Disaster Unconsented (DU) clients who did NOT sign a disaster consent and their disaster AIMs will be deleted five years after the end of the disaster Disaster clients are not required to sign a consent Disaster Consented (DC) clients, who signed a disaster consent and their disaster AIMs will remain in the registry longer than 5 years after the end of the disaster Disaster Consents ONLY Pertain to Disaster Immunizations: A disaster consent does NOT allow the storing of non-disaster immunizations in the registry! To enter a non-disaster immunization, you need a standard (non-disaster) consent The next section is on Non-Disaster, Standard ImmTrac2 Consents Texas, an “opt-in” state: Since Texas is an “opt-in” state, you must have an ImmTrac2 consent for non-disaster immunizations to be entered into the registry ImmTrac Child (IC) Consents are: Signed by the parent or guardian of the child, They are in effect until the child turns 18 or the consent is withdrawn, and They apply to non-disaster immunizations ImmTrac Adult (IA) Consents: ImmTrac Adult consents are signed after the child reaches 18 but must be signed before the age of 26 to keep the childhood immunizations in the registry If not signed by age 26, the childhood immunizations are deleted More on ImmTrac Adult Consents With ImmTrac Adult consents, immunizations are kept for life or until the consent is withdrawn, and Adult Consents apply to non-disaster immunizations For a disaster immunization to be stored for life, the client needs to sign a disaster consent The next section provides an example with Andrea’s story At birth, Andrea’s parents signed an ImmTrac Child, an IC, consent for her What does an Immtrac Child consent mean? Immunizations the registry receives for Andrea will be kept until Andrea reaches 18 or the consent is withdrawn At 18, Andrea signed an ImmTrac Adult, an IA, consent: What does an ImmTrac Adult consent mean? Since Andrea signed an ImmTrac Adult consent before 26, her childhood immunizations are kept by the registry, in addition to any adult immunizations she gets The registry will keep Andrea’s immunization records for life unless she sends a signed withdrawal form to the registry At 30, Andrea was in a disaster area,

got an AIM, and signed a Disaster Consent To be a disaster client, you must receive an AIM during the disaster Since Andrea signed a disaster consent, her disaster immunizations will be kept longer than 5 years after the end of the disaster Can Andrea have both a Disaster Consent and a Non-Disaster Consent? Yes! Andrea already had an ImmTrac Adult (an IA) consent so the registry stores her non-disaster immunizations Andrea also received a disaster immunization and signed a Disaster Consent (DC) so the registry can keep her disaster immunizations longer than 5 years beyond the end of the disaster Getting started Who enters the disaster dose? The organization that administered the AIM is responsible for reporting each dose to ImmTrac2 For a browser, we recommend Google Chrome AIMs must be entered by the correct administering provider/facility For subsites, log in using the organization code of your subsite provider/facility, not the org code of the parent site To select or create a client, From the menu panel click “enter new client” which will search to see if the client already exists in the Registry Search to see if the client already exists in the Registry by doing a Smart Search Required fields for a Smart Search include First name, Last name, Birth date, Gender, and Street address The next section describes how to enter consents If the disaster client is found, click on the ImmTrac2 ID on the left side to go to the client’s record and add a consent to the existing record If the client is not found, we can use the buttons on the bottom half of this screen to add a client record and a consent Next we will discuss the four mutually exclusive buttons on the bottom half of the screen You can only choose one of the four buttons If you have a standard ImmTrac2 consent such as an ImmTrac Child (IC) or ImmTrac Adult (IA) consent, click this button labelled “Add a client”. If you also have a signed disaster-related consent from the client, you can add it later when you are confirming consents The button labelled “Request a Consent Form” that is highlighted allows you to request and print a consent form that is prepopulated with the client’s information which you entered in the search screen earlier Use the button labelled “WITH Signed Disaster-Related Consent” if you are adding a disaster-related consent but not a standard consent Use the button labelled “WITHOUT Signed Disaster-Related Consent” if the client did not sign a disaster-related consent and does not have a standard consent either Entering Disaster Consents. The tale of five clients In the first example, Arthur Adams was not found in the ImmTrac2 database, he did not sign a disaster consent, and this requires creating a client record with a Disaster Unconsented (DU) client type To begin, search for the client record by selecting the “enter new client” link Next do a Smart Search for the client, in this case Arthur Adams Fill in at least the minimum fields and click find In this example, no clients were found for the requested search criteria The client was not found in the Registry database and since Arthur Adams did not sign a Disaster Consent, select the option “WITHOUT Signed Disaster-Related Consent”, and click Submit A pop-up message states that a disaster-related client may not be added to ImmTrac2 if the client has not received a disaster-related antiviral, immunization, or medication, an AIM Since Arthur has received an AIM, we will click the OK button to continue The top half of the client’s record is displayed here Because we had the Mother’s maiden last name, we included that The bottom half of the client’s record is displayed here In addition to the required fields, it’s very helpful to include the client’s phone number and e-mail address Click the “Continue Add” button to continue View the Client Summary for Arthur. If it looks incorrect, you can click the “Edit Client Info” button to go back To proceed, click the “Continue” button View the Consent Affirmation for Arthur On this screen you can change the type of consent We are leaving it as a disaster unconsented client Click the “Affirm” button to continue View the Consent Affirmation Confirmation for Arthur At this point Arthur has a client record and a client ID established To add an immunization click the “Go To Client” button On the View Client screen, click the “Edit Client” button Click the “Immunizations” button to view and enter immunizations On the Client Information screen, click “Add New Imms” to enter a new immunization We’ll cover entering immunizations later In the second example, Matt Moriarty was not found in the ImmTrac2 database, he DID sign a disaster consent, and this requires creating a client record with a Disaster Consented (DC) client type To begin, search for the client record by selecting the “enter new client” link Next do a Smart Search for Matt Moriarty and click Find In this example, no clients were found for the requested search criteria The client was not found in the Registry database and since Matt Moriarty DID sign a Disaster Consent, select the option “WITH Signed Disaster-Related Consent”,

and click Submit A pop-up message states that a disaster-related client may not be added to ImmTrac2 if the client has not received a disaster-related antiviral, immunization, or medication, an AIM Matt did, so we will click the OK button to continue The top half of the client’s record is displayed here, including the Mother’s maiden last name since we had it The bottom half of the client’s record is displayed here, including the client’s phone number and e-mail address, which is very helpful Click the “Continue Add” button to continue View the Client Summary for Matt If it looks incorrect, you can click the Edit Client Info button to go back To proceed, click the “Continue” button View the Consent Affirmation for Matt At this point you can change the type of consent We are leaving it as a disaster consented client, and click the “Affirm” button to continue View the Consent Affirmation Confirmation for Matt Now Matt has a client record and a client ID established To add an immunization click the “Go To Client” button On the View Client screen, click the “Edit Client” button Click the “Immunizations” button to view and enter immunizations On the Client Information screen, click “Add New Imms” to enter a new immunization We’ll cover entering immunizations later In the third example, David Disney was not found in the ImmTrac2 database, and he signed both a standard consent AND a disaster consent This requires creating a client record with a standard consent, which would be an ImmTrac Child (IC) or ImmTrac Adult (IA) consent, and also adding a disaster consented (DC) modifier To begin, search for the client record by selecting the “enter new client” link Next do a Smart Search for David Disney and click Find In this example, no clients were found for the requested search criteria The client was not found in the Registry database Since David Disney DID sign a standard ImmTrac Adult consent AND a Disaster Consent, select the first option “Add a client” to create a new client record with an ImmTrac Adult consent Later, we will add the disaster consent modifier to David’s record The top half of the client’s record is displayed here, including the Mother’s maiden last name since we had it The bottom half of the client’s record is displayed here, including the client’s phone number and e-mail address, which is very helpful to include Click the “Continue Add” button to continue View the Client Summary for David If it looks incorrect, you can click the “Edit Client Info” button to go back To proceed, click the “Continue” button View the Consent Affirmation for David This screen is important! Because we had earlier selected the “Add a client” option, on this screen the “ImmTrac2 Adult” button, a standard consent, is already selected On this screen check the third box to add a disaster consent also! Click the “Affirm” button to continue View the Consent Affirmation Confirmation for David At this point David has a client record and a client ID established To add an immunization, click the “Go To Client” button On the View Client screen, click the “Edit Client” button Click the “Immunizations” button to view and enter immunizations On the Client Information screen, click “Add New Imms” to enter a new immunization We’ll cover entering immunizations later In the fourth example, Jessica Jones was found in the ImmTrac2 database with client type IA (ImmTrac Adult), and she had signed a disaster consent Since she already has a client record, this requires merely adding a disaster consent (DC) modifier to her existing client record To begin, search for the client record by selecting the “enter new client” link Next do a Smart Search for Jessica Jones and click find Jessica Jones WAS found in the Registry database so click the ImmTrac2 ID to go to the client record, make sure it’s the right client, and if so, then add a consent to the existing client On the View Client screen, click the “Edit Client” button On the Update Client screen click the “Edit Consent” button Since Jessica already had a client record, client type IA (ImmTrac Adult), all we need to add is her new disaster consent Click “Option 1: Add Consent Forms and attributes for this client”, then click the third box for her new disaster information retention consent, then click the “Update Client” button to continue These are the major client types IA for ImmTrac Adult, IC for ImmTrac Child, DC for Disaster Consented, and DU for Disaster Unconsented On this screen the Client Type is displayed in the upper right corner showing that Jessica has an ImmTrac Adult standard consent This screen displays the DIR attributes “M” is for a disaster consented client who is a minor “Y” is for a disaster consented client who is an adult “N” is for a client who is not disaster consented, whether minor or adult The upper right corner of this display shows that Jessica currently has a Disaster Immunization Retention attribute of N, since we have not finished adding her disaster consent Click the “Affirm” button to add Jessica’s disaster consent Note that Jessica’s DIR attribute is now Y She has a disaster consent and is an adult

Jessica’s client record has been updated. Click the “Edit Client” button to continue On the Update Client screen, click the “Immunizations” button to view or add immunizations On the Client Information screen, click the “Add New Imms” button to view and add immunizations We’ll cover entering immunizations later In the fifth example, Kevin Klein was found in the ImmTrac2 database with client type DU (disaster unconsented), and he had signed a disaster consent AND a standard consent Since he already has a client record, this requires adding a standard ImmTrac Adult (IA) consent and disaster consent (DC) modifier to the existing record To begin, search for the client record by selecting the “enter new client” link Next do a Smart Search for Kevin Klein and click Find A client match for Kevin Klein WAS found in the Registry database so click the ImmTrac2 ID to go to the client record, make sure it’s the right client, and if so then add a disaster consent to the existing client record Note that the Client Type for Kevin is Disaster Unconsented! Don’t assume that being in the database means they signed a consent form! On the View Client screen, note that we have added the Mother’s First Name and the Mother’s Maiden Last Name since we had it Click the “Edit Client” button On the Update Client screen click the “Edit Consent” button Since Kevin already had a client record, type DU (Disaster Unconsented), we need to add his new standard ImmTrac Child consent and his new disaster retention consent Click “Option 1: Add Consent Forms and attributes for this client” Next, click the first box to add his ImmTrac2 Child Consent, and click the third box for his new disaster information retention consent Finally click the “Update Client” button to continue Click the “Affirm” button to add Kevin’s disaster consent Kevin’s Client Type changed from DU (disaster unconsented) to IC (ImmTrac Child) because he added a standard consent Kevin’s Disaster Immunization Retention (DIR) attribute changed from “N” for no disaster consent, to “M” for disaster consent of a minor Click the “Edit Client” button to view and add immunizations On the Update Client screen, click the “Immunizations” button to view or add immunizations On the Client Information screen, click the “Add New Imms” button to view and add immunizations Here’s a summary of the five clients Arthur was not found in ImmTrac2, and did NOT sign any consent, so we created a client record as Disaster Unconsented Matt was not found in ImmTrac2, but DID sign a Disaster Consent, so we created a client record as Disaster Consented David was not found in ImmTrac2, but signed both a Standard Consent and a Disaster Consent, so we created a client record as ImmTrac Adult and Disaster Consented To continue the summary, Jessica was already an ImmTrac Adult in ImmTrac2, AND she added a Disaster Consent, so we added a Disaster Consent modifier to her existing record Kevin was already Disaster Unconsented in ImmTrac2 AND he added both an ImmTrac Child and a Disaster Consent, so we added a standard consent (ImmTrac Child) and a Disaster Consent modifier to the record We’ll cover entering immunizations next Add immunizations! The client and/or consent are added; so it’s time to go to the client record and add the immunization! We will begin the section on adding immunizations from the Client Information screen where you click the “Add New Imms” button When filling out required fields, it’s important to fill out all required fields and at minimum include the priority group if required, the date of administration, trade name, lot number, manufacturer, and dose Dosage for Remdesivir In the initial loading dose, Select 2 for the dose if the vial has the same lot number, assuming two Remdesivir vials of 100 milligrams each If the vial has a different lot number, enter each dose separately as “Full”, then save after each entry For each subsequent dose of Remdesivir, select “Full” for the remaining days of the treatment More on Remdesivir dosage Any dose less than three-quarters of a dose should be reported as half Administration of Remdesivir to children is based on weight ImmTrac2 only allows entries of half or full doses, so when administering less than half a dose to a child, report half a dose since it is the least amount available through the ImmTrac2 user interface If the client’s address in ImmTrac2 does not match the provider’s EMR records, please update ImmTrac2 with the client’s current address Updates to your EMR are encouraged In this example of adding a new immunization for Remdesivir, the fields that are filled in are date administered, immunization, trade name, lot number, manufacturer, and dose A priority group can be added using the drop-down box in the CRA Event Information section Priority groups are only used for preventative immunizations, which Remdesivir is not Click the “Save” button to save the immunization The Client Information screen now displays the immunization entered The next section contains related information for Remdesivir For hospitals entering information on new homeless clients,

If you can’t get an address for the client, enter the hospital address If you can’t get the first and maiden/last name for the client’s mother, enter the client’s first and last names That prevents duplicate names for the client’s mother if there are more than one homeless client at a single hospital Besides the address, try to make the client’s other information that you enter as unique as possible PLEASE do not use “NA” or “UNKNOWN” as placeholders in any fields How do you order Remdesivir? Contact the Vulnerable Populations and Facilities Task Force (VPFTF) at VPFTF@dshs.texas.gov For the most up-to-date information regarding Remdesivir, see our public facing website at www.ImmunizeTexas.org Thank you, from all of us at the Texas Immunization Registry