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)
PCVHIB001	Monthly count of the number of patients who received a first dose of PCV13 vaccine whilst aged at least 12 weeks and under 1 year, administered by the GP practice within the reporting period.	84 days	Day before 1st birthday
PCVHIB002	Monthly count of the number of patients with asplenia, splenic dysfunction, complement disorder or who are severely immunocompromised, who have received a first dose of PCV13 vaccine whilst aged at least 6 weeks and under 1 year, administered by the GP practice within the reporting period.	42 days	Day before 1st birthday
PCVHIB003	Monthly count of the number of patients with asplenia, splenic dysfunction, complement disorder or who are severely immunocompromised who have received a second dose of PCV13 vaccine whilst aged at least 14 weeks and under 1 year, administered by the GP practice within the reporting period, a minimum of 8 weeks after the first dose.	98 days Previous dose must have been at least 56 days prior	Day before 1st birthday
PCVHIB004	Monthly count of the number of patients who received a booster dose of PCV13 vaccine whilst aged at least 1 year (on or after their first birthday) and under 2 years, administered by the GP practice within the reporting period, a minimum of 4 weeks after the initial dose.	1 year (1st birthday) Previous dose must have been at least 28 days prior	Day before 2nd birthday
PCVHIB005	Monthly count of the number of unimmunised or partially immunised patients at clinical risk (including those with asplenia, splenic dysfunction, complement disorder or severely immunocompromised) who received one dose of PCV13 whilst aged at least 2 years (on or after their second birthday) and under 10 years, administered by the GP practice within the reporting period.	2 years (2nd birthday)	Day before 10th birthday
PCVHIB006	Monthly count of the number of patients aged at least 1 year (on or after their first birthday) and are under 2 years, who received a booster dose of Hib/MenC vaccine, administered by the GP practice within the reporting period.	1 year (1st birthday)	Day before 2nd birthday
PCVHIB007	Monthly count of the number of patients aged 2 years or over and under 10 years who have an incomplete or uncertain vaccine history who have received a dose of Hib/MenC vaccine, administered by the GP practice within the reporting period.	2 years (2nd birthday)	Day before 10th birthday

The main searches closely mirror the business rules to properly reflect the CQRS count, but each search is also based on a denominator (dependency) search designed by PCIT to include patients who may not be picked up by the extraction. These are similarly named, but with square brackets (eg: [PCVHIB002] ). When reviewing the figures prior to CQRS extraction, Practices are looking for the searches to show 100%. When the search is not 100%, Practices can refer to the corresponding report in the Missed Activity folder. It is also possible to use the Check Patient feature to try to understand why a patient has been picked up in the denominator search but not for CQRS. There are several reasons why a patient may not be included in an indicator, and these all need to be considered.

1. The wrong code was added. The business rules are accommodating if the vaccine dose code (eg 1st pneumococcal conjugated vaccination) has been used to record a subsequent dose. There are a number of similarly named legacy EMIS codes which do not count. 'Adult' pneumo codes (used in PPV searches) also do not count. We recommend using a template to minimise the chances of invalid codes being used. 
   
2. Patient was too old or too young. The specification for most babies require that they are at least 84 days old (12 weeks) for their first pneumococcal vaccination. The HIB/MenC vaccine should be given on or after the child's first birthday.
   
3. The code was added too early. The second dose of pneumococcal vaccination (PCVHIB004) must not be given until at least 28 days after the first dose. Since the schedule changed for children born on or after 1st January 2020 this won't often have caused an issue where before there had to be at least 8 weeks between the 1st and 3rd set of primary vaccinations. Payment won't be given if the 2nd dose was administered at a 27 day interval.
   For immunocompromised babies picked up by PCVHIB003, the interval must be at least 56 days. 
4. The patient's historical record is incomplete. Where codes are missing patients won't be picked up, so adding certain pneumococcal conjugated vaccination codes when the first code isn't present may include the patient in the first dose indicators instead of the second dose.
   

Valid Codes

247631000000101 - First pneumococcal conjugated vaccination

247641000000105 - Second pneumococcal conjugated vaccination

247651000000108 -  Third pneumococcal conjugated vaccination

428975001 - Administration of Haemophilus influenzae type B and meningitis C vaccine

Missed Activity

Having run the top folder, check that the report PCVHIB000X - 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.

For some indicators there are additional columns denoting first dose or qualifying conditions for eligibility. First dose is always shown on the left hand side of the report;  qualifying conditions are shown on right hand side of the report.

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.