016 Seasonal Influenza searches

016 Seasonal Influenza searches

The latest version is 016 Seasonal Influenza 2023-24 (v4.1)
This collection of searches has been designed to support Practices running a call/recall programme for their seasonal influenza campaign. Built in line with the Enhanced Service criteria, searches are grouped by eligibility cohorts to assist in prioritising groups of patients to invite, and then to monitor uptake across each of the cohorts. A data quality folder offers searches to highlight missed or incorrect coding to ensure that all activity will be funded following the monthly CQRS extracts.

This year there are 7 folders of searches available to use.
Within the top level folder is an aggregate report Flu planning - previous uptake which will show how many patients had a flu jab in previous years. Bear in mind that not all of these jabs would have been done by the surgery, but it should offer an indication of roughly how many patients typically might want a flu jab in each of the 3 age groups (over 65 / 18-64 / under 18).
Seasonal Flu Report is an aggregate report which may be of use to Practices who want a summary of the figures the Cohort (A), Uptake (C), and Declined (X) folders. The data can be extracted to Excel if desired for greater manipulation.

A) Cohorts


The cohorts folder underpins the recall, uptake, and activity folders. The cohorts have been written to reflect the groups specified in the national guidance document.
  1. All patients at risk - every patient found in one of the at risk cohorts.
  2. Over 65 - all patients born before 01/04/1959. Some patients will be aged 64 when they receive the vaccine, but they will have turned 65 by 31st March 2024.
  3. AT RISK 18-64 - patients born on or after 01/04/1959 and aged over 18. These patients have a clinical at risk condition making them eligible to receive a vaccine (or they are currently pregnant). Inclusion in this cohort is dependent on coding defined by the Seasonal Influenza Enhanced Service. This means anybody invited and/or vaccinated using searches based on this search will be counted (assuming correct vaccination coding) in the monthly CQRS claims. The IIF business rules for VI-02 are slightly different, so an additional supporting search exists in the Data Quality folder to pick up extra patients. Some patients won't be immediately eligible for a flu vaccination (although they are likely to have received one before), and eligibility can be confirmed for Enhanced Service payment by adding certain groups of code:
                         Health care workers
                         Long term indication for seasonal influenza vaccination
                         Needs influenza vaccination
                         Lives with immunocompromised person
  4. Under 18 - this search encapsulates all patients from the 5 cohorts below.
  5. AT RISK under 18 - patients under 18 (but older than 6 months) who have a clinical at risk condition and do not appear in any of the other cohorts below.
  6. Children 2-3 - all children born between 01/09/2018 and 31/08/2020. These children fall under the scope of the Childhood seasonal influenza seasonal influenza vaccination programme enhanced service. They are eligible for a nasal flu spray administered by the surgery.
  7. AT RISK primary school age - all children in Reception to Year 6 inclusive (ie: those children born between 01/09/2011 and 31/08/2018) who have a clinical at risk condition. These patients are not a priority for primary care to vaccinate - this is the responsibility of the schools teams - but if they miss vaccination at school it is possible for the surgery to vaccinate. Staff may choose to refer to this cohort to confirm whether an individual child is eligible. 
  8. AT RISK secondary school age - children in Y7-Y11 who have a clinical at risk condition. We have kept this cohort separate like last year, although the lack of coverage from the schools programme this season means they will be the responsibility of the surgery. We recommend inviting them at the same time as patients in the AT RISK under 18 cohort. 
  9. HEALTHY school age - children in Reception to Y6 inclusive who do not have a clinical at risk condition. This cohort is shown for reference in case patients attempt to obtain a flu vaccination at the surgery. Primary Care has no remit to vaccinate any patient in this cohort.
  10. Patients NOT at risk - any adult patient between the ages of 18 and 49 who do not have a clinical at risk condition.
The cohort searches should NOT be used for any exercise in inviting patients for vaccination.
The cohort for healthy patients aged 50-64 has been removed for 23/24 as the annual NHS letter does not reference this group.

B) RECALL

The searches in this folder follow a similar structure to those in the cohorts folder. The recall searches do not include any patient who has a declined/contraindicated code since 1st September, or a vaccination; it is therefore essential to ensure that all events are coded accurately and as soon as possible. 

Never base invitations on SIV-B00 or SIV-B40.
Practices may wish to re-run the searches during their main vaccination drive and review patients appearing in SIV-B43 and SIV-B44. These school age cohorts are the responsibility of the schools teams, but Practices can still vaccinate and claim for patients at risk who for whatever reason have not been able to have a dose under the schools programme.


In addition to the searches based directly on the cohorts, SIV-B11 is a subset of over 65 patients who also have a clinical at risk condition. If Practices wish to target a second invitation later in the flu season to 'mop up' missed patients, this search in particular may help to prioritise those patients with higher clinical risk including those patients who would have previously appeared in QOF flu indicators (CHD / COPD / Diabetes / Stroke).

Some Practices may wish to customise searches in this folder to avoid inviting patients who are already booked in for a vaccination. See below for guidance.

C) UPTAKE

These searches display every patient who has received a flu vaccination anywhere. In addition to your own vaccination activity it includes vaccinations done by pharmacies, hospitals, midwives, schools. This folder only works if all reports of vaccinations are filed or coded accurately in a timely fashion. This folder more than ACTIVITY (the next folder) influences what patients are shown in the RECALL folder.

Accurately coding vaccinations done elsewhere is important to ensure the enhanced service extraction doesn't unintentionally pick up activity for payment which your Practice did not do.


D) ACTIVITY

The ACTIVITY folder displays the vaccinations which have been done by your organisation. There are only 4 valid codes for use (Administration of first inactivated seasonal influenza vaccination; Administration of second inactivated seasonal influenza vaccination; Administration of first intranasal seasonal influenza vaccination; Administration of second intranasal seasonal influenza vaccination). These are the only codes recognised by the two enhanced services for payment of activity.

The report SIV-D00 can be used to review all vaccinations given. For such a review it would be best to export the results and view in Excel. The report contains columns for the vaccinating staff member, as well as batch number and expiry date. Filtering by staff member may help to identify codes added by (admin) staff who would not normally be found to add vaccinations with their login. In the event of a product recall, the batch number will quickly help to identify affected patients.

All cohorts are shown, and consider that SIV-D45 (healthy school age) and SIV-D99 (adults not at risk) should be close to zero. For SIV-D99 in particular keep a regular eye on the search to monitor new patients added to the search, possibly weekly at the height of the vaccination campaign; it may be appropriate to add the code 'Needs influenza vaccination' to some patients after a clinical review, while the remaining patients may serve as a learning exercise for staff to understand how to avoid ineligible patients being vaccinated. 


Q) DATA QUALITY


Staff running the Practice's vaccination programme should pay regular attention to this folder. Some of the searches found in the Data Quality folder will highlight activity which may need to be reviewed or corrected before the beginning of the month, to support the CQRS extracts.
SIV-A21: This search drives all of the at risk inclusion or exclusion used in the cohort folder. It is based entirely on the CQRS business rules for seasonal influenza, and should not be edited. It is possible to use the Check Patient feature against patients found in Population Included to understand why they might be eligible. See also SIV-A22.
SIV-A22: The criteria defined in SIV-A21 may not be as broad as many Practices are used to allowing, so there may be patients from this cohort who present and say they have received a flu vaccination in previous years. The Check Patient feature may help to understand why the patient may be eligible to receive a vaccination. Clinical staff can add a code of "Needs influenza vaccination" on an annual basis, either using PCIT's flu protocol or retrospectively by looking at patients in SIV-D99.
Many patients are likely to be included in other clusters, or more narrowly defined clusters in SIV-A21. The list of conditions in SIV-A22 are:
Epilepsy; COPD; rare genetic/metabolic/autoimmune conditions defined for COVID-19 risk; CHD; dementia; respiratory conditions defined for COVID-19 risk; MS; MND; AF; PAD; RA; asplenia; Addisons disease; cerebral palsy; history of venous thromboembolism; systemic lupus; thalassaemia/sickle cell anaemia/spherocytosis; polio; adrenal insufficiency. 
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SIV-Q00: Three searches identify patients who have been vaccinated by the surgery using one of the 4 primary vaccination codes. This search has been improved for 23/24 by ignoring patients who had a vaccination at a previous surgery before registering with the current surgery. The search and its children, which subdivide activity into injection and nasal spray, may be used as a rough guide as to how many vaccinations of each type have been administered.
If vaccine manufacturer information has been correctly recorded against the codes (possible when using a protocol), data the report SIV-D00 can be manipulated in Excel to establish a breakdown of each type of vaccine.
Patients who have deregistered during the flu vaccination season are NOT included in these searches.

SIV-Q01: Counts the patients who were not originally eligible, but has been flagged following clinical review as being eligible to receive a vaccination. This code is essential on non-eligible patients (by the definition of the business rules) to ensure payment. Consider clinical review and coding "Long term indication for seasonal influenza vaccination" to save having to add a code every year.
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SIV-Q04: Identifies patients who have had an invalid flu vaccination code added this season, and the activity would not be counted in CQRS. Patients who also have a valid vaccination code are not included. Ideally this search should return 0 patients, but in the event of a number look at the report to check the code used as well as which staff member added it. If staff administering the vaccines adhere to using a protocol for coding, this search should remain empty!
SIV-Q05: Coding vaccinations as problems clogs up the problem page with unnecessary information. If the Practice is also using a protocol to code vaccinations it would highlight where it is not being used. Any patients listed can be a learning exercise for staff to know how to manage coding.
SIV-Q06: Another data quality search to root out coding issues. This can be used in two ways; one to pick up where staff double code during the same encounter, and when using the report it is also possible to pick out codes added on separate dates, perhaps as a result of other healthcare providers sending data twice.
SIV-Q07: Patients who have a medication issue for a flu jab but the episode is not coded are still counted for a CQRS claim, but nothing will appear on the patient's vaccination summary. If a patient were to request a vaccination history, a complete summary would need to show every jab which means the event must be coded.
---------------
SIV-Q10: Immunocompromised patients and the rest of their household can be easily identified for review. If a household member is not already eligible by some other means, the code 'Lives with immunocompromised person' may be added to their record.
SIV-Q11: In conjunction with working through SIV-Q10, this is able to list the patients who have had the code added in the past few years, but these patients will need the code re-adding on an annual basis in order to maintain eligibility to receive a flu vaccination. 
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SIV-Q12 and SIV-Q13: These two searches highlight patients who were coded as healthcare workers or needing influenza vaccination in the previous 3 years (but not this year). Patients would require repeat coding in order to maintain eligibility to receive a flu vaccination. Patients appearing in these searches may also appear in SIV-D99 as the relevant code has not been added this year.
SIV-Q13 provides a report containing all 'Needs influenza vaccination' from the past 3.5 years along with associated text to identify in advance which patients could definitely need a flu jab. Following clinical review it may be appropriate to code 'Long term indication for seasonal influenza vaccination' to save annual coding.

SIV-Q14: Introduced to v4.1, this search identifies patients who have been declined or contraindicated this year, but the code will not remove the patient from the IIF flu vaccination denominator. The valid codes are those which contain the term "seasonal", whilst historically there have been other codes. For example, Influenza vaccination declined (the old 9OX5 Read code) works for some PRIMIS searches, but is not recognised for IIF, whereas Seasonal influenza vaccination declined (previously 9OX51) is recognised. Generally these codes are only valid if added after 1st September each year. Use the report to review the invalid codes and then remedy the coding.

U) Utility Contact Tools

This folder contains 3 separate elements which are linked, and may be used as the final step in converting a list of patients for recall into a mass communication.

Care home residents

So far the searches have not covered care home residents in much detail. This search helps to separate out care home residents for whom there might be special local arrangements to run a planned vaccination session for the entire home.
The PCN DES now provides a defined national solution to documenting care home residents. With this in mind the care home residents search only incorporates patients with the relevant 'Lives in a care home' type coding. Since it is in a Practice's interest to maintain an accurate care home resident cohort for EHCH-01, we have assumed that Practices will be doing this.
It is recognised that some care homes - often non-CQC registered - are not covered under the PCN DES so the coding might be absent. Practices may wish to add any such patients to the search by adding a rule to look for patients living at a particular address and postcode.

Housebound patients

Like care home residents above, your Practice may have special arrangements to vaccinate this group, either using district nursing teams or your own staff going out on visits.

Placeholder and communication reports

The placeholder itself is simply a search to help join the rest of the searches and reports. The structure of the searches helps to separate out patients with mobile numbers from those who do not have a mobile number on record. It is envisaged that the placeholder will be linked as a child search to a patient group from the RECALL folder. This could be done either by cutting and pasting the searches (including descendants) to the RECALL folder, or copying.

To link the placeholder to a parent search, right click on the Placeholder, select Properties, press the Results from radio button, then use the spyglass to locate the targeted cohort.

Having covered care home residents and housebound patients above, these two groups have been excluded from the communications searches to save inviting patients who are already likely to receive their vaccination during a home visit.

The mobile searches go further than simply separating those patients with an 07 number on their record. Of course it should be stated that only 07 numbers appearing in the mobile number field will be picked up, so any mobile numbers saved in the home telephone number field will not be listed. The searches are also designed to exclude those patients who have declined permission for their mobile number to be used in specific situations and place them in the 'no mobile number' group.

For those patients with a mobile number, the most effective and cheapest method of communication is to send a text message inviting for a flu jab We have provided a number of different pre-configured reports depending on the platform used. Practices are welcome to delete the mobile reports which are not relevant. For everybody else a mail shot will probably be the preferred method used for invitation.  

X) Declined or Contraindicated

In addition to an overall search to count the number of patients who declined (with no subsequent flu vaccination), the declined codes are broken down into the various eligibility cohorts. This feature request may be of interest to Practices who want to understand how different groups of patients respond to invitations.

A single search SIV-X100 shows the number of patients who have a permanent contraindication for a flu vaccine. This search does not feature as an exclusion from the main recall searches as it picks up any adverse reaction or allergy to a specific flu vaccination. Newer types of vaccination may mean the patient could received a flu jab. In the event that a patient is called in, coding Seasonal influenza vaccination declined or contraindicated will remove the patient for the remainder of the flu season.

SIV-X101 was introduced in v4.1 to separate out expiring contraindications. These are where the Practice has coded Seasonal influenza vaccination contraindicated or ...not indicated since 1st April of this contract year. Patients appearing in this search will be removed from the searches in the recall folder, as well as being removed from the denominator for IIF flu vaccination.

Coding

Flu vaccinations
Administration of first inactivated seasonal influenza vaccination      [985151000000100]
Administration of first intranasal seasonal influenza vaccination      [884861000000100]
Seasonal influenza vaccination given by other healthcare provider      [955651000000100]
Seasonal influenza vaccination given by midwife      [1066171000000108]
Seasonal influenza vaccination given by pharmacist      [955691000000108]
Seasonal influenza vaccination given while hospital inpatient      [955701000000108]
Seasonal influenza vaccination given in school      [1239861000000100]
First inactivated seasonal influenza vaccination given by pharmacist      [1037351000000105]
First inactivated seasonal influenza vaccination given by midwife      [1066181000000105]
First intranasal seasonal influenza vaccination given by other healthcare provider      [955661000000102]
First intranasal seasonal influenza vaccination given by pharmacist      [1037311000000106]

Declined
Seasonal influenza vaccination declined      [822931000000100]
First intranasal seasonal influenza vaccination declined      [885971000000103]
Second intranasal seasonal influenza vaccination declined      [886011000000103]
No consent for seasonal influenza vaccination      [868491000000103]

Contraindicated
Seasonal influenza vaccination contraindicated      [822971000000103]
Seasonal influenza vaccination not indicated      [822951000000107]

Adapting the searches for use within your own surgery

The searches provided are influenced entirely by codes and medication issues. We know that to make the RECALL searches the most effective, another exclusion rule needs to be added. Unfortunately as a third party we are unable to provide this because the rule is based on your organisation's appointment book. If the Practice's Appointment Book uses specific slot types for flu clinics, it is possible to factor any future booked appointments into the search to save inadvertently inviting patients who are already scheduled to receive a vaccination.

Due to the way the searches have been written for 2023/24, it is only necessary to apply the appointment exclusion to search SIV-B00.

To check who has booked a flu jab and exclude these from searches, you must first set up slot types for your flu clinic.  If you have done this already then use the slot type you have already created.  If you haven’t, please follow the guide below.   In either case you will need to then amend the list of searches which are detailed after the following section.

If you don't set up the searches using the following instructions they will provide inaccurate results and you may not call in people who need vaccination, you MUST add the slot types to the highlighted searches and set up your local care homes.

Setting up slot types

To do this: go to your appointment book by:


  1. Click on the EMIS button in the top left of your EMIS screen
  2. Click on Appointments
  3. Click on Appointment Book
  4. Now click on the Appts Config: 

The following screen will appear (your slot types will look different):



  1. Click on Slot Types
  2. then click Add

Fill in the box that appears as follows:



For all of these searches, click edit and after the “Appointment Date is on or after the search date” add another criteria, select slot type and select the slot type you have chosen for flu:

On all these searches, they should now look like this (the date bit may be different it's the slot type bit that has to be the same):

 


COVID and Flu combined recall

Whilst there appear to be a lot of similarities between the eligible (18-64) cohort for flu and the equivalent cohort for COVID, there are in fact a number of differences which mean that one search cannot simply be used to define both groups.
Primary Care IT has decided to keep completely separate sets of searches, to be found in folders 005 COVID and 016 Seasonal Influenza. If a Practice wants to combine searches, we are happy to advise on a suitable approach to this exercise.

 A simple approach would be to use SIV-B20 for flu and 6m-64y for COVID invitation. The following rule logics will generate 3 different outcomes:





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