Having downloaded the xml search file somewhere easy like your desktop, open EMIS Web and select Population Reporting.
Select an existing folder or create a new one. Then click on the Import button on the ribbon, and press the 3 dots to find the xml file. You can untick the top folder.
You’ll notice that there are 5 sub folders containing different searches; start by looking at results in the Q) Data quality folder. Right click the folder and press run.
Patients appearing in this list should be clinically reviewed as soon as possible to determine whether or not they are suitable to receive the vaccine. When you open the report you will notice that patients are sorted in age order so you can pull out blocks of data according to which priority cohort you are working on.
We have been cautious with the history of adverse reaction to a vaccine by including all codes, despite the green book stating that the vaccine should not be given to patients who have had a… ”confirmed anaphylactic reaction to any components of the COVID-19 vaccine”
Anybody who has been clinically reviewed and determined to have a contraindication to the COVID vaccine needs to be coded with SARS-CoV-2 immunisation course contraindicated.
CVP-Q2 is to review for clinically extremely vulnerable status. This is the group borne out of the shielding patients who have the code high risk category for developing complication from COVID-19 infection. Patients appearing in this data quality search will be under 70 since anybody aged 70 or over is already included in higher priority groups.
Anybody who features in this search has a code which may indicate that they could be coded with the high risk code. The codes have been drawn from the Department of Health and Social Care’s most recent recommendations from early November. You will see from the definition of the search that this includes patients with a history of solid organ transplant, cystic fibrosis, asplenia, Down’s syndrome, CKD stage 5, dialysis, and currently pregnant women with an underlying heart condition.
Again, the report will help you identify what codes are including them in the search, and after clinical review the addition of a high risk code will elevate the priority.
CVP-Q3 Possible frontline health & social care workers is a bit of a challenge due to the historic use of occupation codes to document that the patient has seen a particular type of clinician such as a pharmacist or physiotherapist. Not every frontline worker will have had their current occupation coded on their medical record so it’s never going to be completely accurate. On this basis, occupation has been omitted from priority group 2, but you could manually include patients if they prove their occupation. The report will reveal any occupation code from the patient's record to help identify some of the frontline workers.
CVP-Q5 highlights patients who received the second dose less than 21 days after the first dose. 21 days is the minimum interval for the Pfizer BioNTech vaccine, while the Oxford-Astra Zeneca vaccine has a minimum interval or 28 days. Once the AZ vaccine comes online, this search is really aimed at picking out anybody who had the Pfizer vaccine doses too close together, but it may also indicate a coding problem.
CVP-Q12 highlights patients with thrombocytopenia codes which is a contraindication to receiving the AZ jab.
CVP-Q13 helps to keep problem lists clean by listing patients who have had a vaccine added as a problem, so the problem status can be removed.
CVP-Q14 lists patients who are aged between 17 years and 9 months and 18 to help invite them as soon as possible after their 18th birthday.
CVP-Q15 shows patients who had their first jab 7 weeks ago, to help target patients for reminder that their second jab is due next week.
CVP-Q16 lists all patients whose first jab was at least 8 weeks ago, but they haven’t had a second jab yet.
CVP-Q17 lists codes which are not part of the official NHS set of vaccination codes. This includes some SNOMED International procedure codes ‘Administration of SARS-CoV-2 mRNA vaccine’ which are not recognised by NHS Digital.
CVP-Q18 identified problems with coding which should be checked, such as more than 2 of the same vaccination code. User the report to check dates and review the record.
Each of the searches in this folder break down your eligible patient list into the first 9 priority groups. They also serve as parent searches for all searches in COMPLETED, PARTIAL, OUTSTANDING.
Finally, it is really important to make sure that the outcomes of each rule are correct – If rule passed must always be ‘Include in final result’. If rule failed will show 'Goto next rule' for each rule apart from the final rule which must be 'Exclude from final result'.
Most of these searches (A2, A3, A5, A7, A8, A9, A11, A12, A13) are self-explanatory as age groups.
CVP-A6 identifies the patients with underlying health conditions. This has been built in line with JCVI and Green Book recommendations, while the codeset generally uses the same codes used for flu at risk groups with the addition of SMI. Patients coded as clinically extremely vulnerable will not appear since they will already have been picked up in CVP-A4.
The searches in here find everybody who has received 2 vaccines, broken down into the 9 phase 1 priority groups and 3 phase 2 priority groups. You will be able to use the percentage to track the uptake within that priority group.
You can re-run the searches in this folder periodically to find additional patients to invite or re-invite. In particular patients turning 55, 60, 65, 70, 75, and 80, may fall between the cracks due to the likely time gap between re-running each cohort to invite them. In mid-December 2020 there is only a code for a text message invitation, and nothing by phone or letter, so tracking patients who have never been invited may be a bit of a challenge in EMIS alone.