The current version of CQRS: MMR vaccination programme is v4

This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators; only payment indicator codes are used below.

Indicator	Description	Lower age limit	Upper age limit (inclusive)
MMRV001	Monthly count of the number of patients who are aged 16 years and over and have not previously been fully vaccinated against MMR, or with unknown or incomplete vaccination histories, who received a first MMR vaccination administered by the GP within the reporting period.	16 years (16th birthday)	No upper age
MMRV002	Monthly count of the number of patients who are aged 16 years and over and have not previously been fully vaccinated against MMR, who received a second MMR vaccination administered by the GP within the reporting period.	16 years (16th birthday) Previous dose must have been given after 1st birthday	No upper age
MMRV003	Monthly count of the number of patients aged less than 1 year who received an MMR vaccination administered by the GP within the reporting period.	No lower age	Day before 1st birthday
MMRV004	Monthly count of the number of patients who are aged 1 to 5 years and have not previously been fully vaccinated against MMR, who received a first MMR vaccination administered by the GP within the reporting period.	1 year (1st birthday)	Day before 6th birthday
MMRV005	Monthly count of the number of patients who are aged 1 to 5 years and have not previously been fully vaccinated against MMR, who received a second MMR vaccination administered by the GP practice within the reporting period.	1 year (1st birthday) Previous dose must have been given at least 28 days prior	Day before 6th birthday
MMRV006	Monthly count of the number of patients who are aged 6 to 15 years and have not previously been fully vaccinated against MMR, or with unknown or incomplete vaccination histories, who received a first MMR vaccination administered by the GP practice within the reporting period.	6 years (6th birthday)	Day before 16th birthday
MMRV007	Monthly count of the number of patients who are aged 6 to 15 years and have not previously been fully vaccinated against MMR, who received a second MMR vaccination administered by the GP practice within the reporting period.	6 years (6th birthday) Previous dose must have been given at least 28 days prior	Day before 16th birthday

1. The wrong code was added. The business rules are accommodating if the same MMR vaccine code has been used twice, as long as the code relates to a first dose. There are a number of legacy EMIS codes which do not count. We recommend using a template to minimise the chances of this occurring. 
   
2. Patient was too old or too young. The MMR vaccine should be given on or after the child's first birthday. MMRV03 does check for at-risk patients who received a first dose before their first birthday, but for the purposes of a complete schedule any doses given before the first birthday should be ignored (see Green Book Chapter 21). Consider the implications on where a patient may appear - the first dose given after their first birthday is counted as the first dose, not second dose, for most indicators. There is no upper age limit claiming payment on MMR. 
   
3. The code was added too early. The second dose of MMR vaccination (MMRV002, MMRV005, MMRV007) must not be given until at least 28 days after the first dose. In practice the second dose isn't given until the patient is 40 months old, but if the first dose is given at 39 months + 2 weeks the second dose can be given 4 weeks later. Payment won't be given if the 2nd dose was administered at a 27 day interval.
   
4. The patient's historical record is incomplete. Where codes are missing patients won't be picked up, so adding certain MMR vaccination codes when the first code isn't present may include the patient in the first dose indicators instead of the second dose.
   
5. The patient has previously had single doses. Previously administered single doses of measles or mumps or rubella are ignored as the 'first dose', so only doses of MMR vaccine are counted. In a patient who had single vaccines for measles mumps and rubella 15 years ago, a dose of MMR now is considered the first dose rather than the second.
   

	1st MMR dose	2nd MMR dose
Age under 1 year	MMRV003	x
Age 1 - 5 years	MMRV004	MMRV005
Age 6 - 15 years	MMRV006	MMRV007
Age 16+ years	MMRV001	MMRV002

Valid codes

1st & 2nd dose codes

1050971000119104 - Measles, mumps and rubella vaccination given

308081000000105 - Measles mumps and rubella vaccination - first dose

38598009 - Administration of measles and mumps and rubella vaccine

505001000000109 - Measles mumps rubella catch-up vaccination

2nd dose codes

170431005 - Administration of booster dose of measles and mumps and rubella vaccine

170432003 - Administration of pre-school booster dose of measles and mumps and rubella vaccine

170433008 - Administration of second dose of measles and mumps and rubella vaccine

Missed Activity

Having run the top folder, check that the report MMRV000X - medication issued but no codes is empty; all of the claiming searches have been built primarily around codes rather than medication issues, and this search/report will identify any patients who had a medication issue last month but there was no corresponding clinical code in the same period. The reason for this is to support good practice of coding vaccinations; not only does this make future reporting easier, it ensures whenever the patient requests their vaccination history that everything is included from the vaccination filter in Care History.

Reports to help review potential data can be found in the Missed Activity folder, named with the indicator code followed by an X. If the searches have run, highlight the report and press View Results from the ribbon or right click for the quick menu.

The missed activity reports for CQRS have been designed in a standard fashion for ease of understanding.

      CHECK - data in the CHECK column means that the codes used are correct, but the patient was either too old or young, or a subsequent dose was given too early or too late. It may be necessary to refer to 

      INVALID - data in the INVALID column means that activity has been found but with a different code that may indicate claimable activity. This column only focuses on the code and not on the age or the interval, meaning the report may need to be re-run or work out the time criteria yourself offline.

There may be a few scenarios where data appears in both CHECK and INVALID columns due to the way missed activity reports have been configured; prioritise CHECK before considering wither INVALID contains claimable activity.

The MMR reports contain a column on the right hand side which will list any single dose vaccinations coded to support decision making.

Always check the 0% searches to ensure that single patients from the denominator are not missed!

The Full Hierarchy button on the ribbon can make checking the parent searches of 0% searches easier.

Review the CQRS article for points to consider when using these searches.

While the main searches have been built to closely mirror the business rules, there is a creative element to the denominator searches. Where the main search isn't 100%, don't discount that there are other factors which erroneously brought the patient into the denominator search. PCIT is always happy to hear about problems, but is unable to assist with every query why a specific patient is/isn't included.

Version History