CQRS: Shingles vaccination programme
The current version of CQRS: Shingles vaccination programme is v5.1
The Shingles vaccination programme indicators are extracted automatically from your system approximately 10 days after the end of the monthly reporting period. Practices have a short opportunity to check their data prior to extraction and maximise their income potential. For reviewing data in historic months, the relative run date may be any date in the month following the achievement period (eg: for the achievement period of April, any date in May can be selected).
For more information on identifying eligible patients, refer to this article.
This support article makes several references to Zostavax which is no longer available. This is intentional in the context of historic coding, and that CQRS indicator SHROU05
is still officially active and looking at Zostavax vaccinations given in the previous month.
is still officially active and looking at Zostavax vaccinations given in the previous month.
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) |
| SHROU05 | Monthly count of the number of registered immunocompetent patients aged 70-79 (inclusive) on 31st August 2023 who have a record of receiving a dose of Zostavax carried out by the practice within the reporting period whilst the patient was aged 70-79 (inclusive). | Born before 01/09/1953 | Day before 80th birthday |
| SHROU06 | Monthly count of the number of registered immunocompromised patients aged 50 and over at the point of vaccination, who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period. | 50 years (50th birthday) | No upper age limit |
SHROU07 | Monthly count of the number of registered immunocompromised patients aged 50 and over at the point of vaccination, who have a record of receiving a second dose of Shingrix 8 weeks to 6 months after the first dose carried out by the practice within the reporting period. | 50 years (50th birthday) | No upper age limit |
SHROU08 | Monthly count of the number of registered immunocompromised patients aged 50 and over at the point of vaccination, who have a record of receiving a second dose of Shingrix more than 6 months after the first dose carried out by the practice within the reporting period. | 50 years (50th birthday) | No upper age limit |
SHROU09 | Monthly count of the number of registered patients aged 50 and over at the point of vaccination, who are identified as immunocompromised by a clinical code indicating that the patient requires a shingles vaccination, who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period. | 50 years (50th birthday) | No upper age limit |
SHROU10 | Monthly count of the number of registered patients aged 50 and over at the point of vaccination, who are identified as immunocompromised by a clinical code indicating that the patient requires a shingles vaccination, who have a record of receiving a second dose of Shingrix 8 weeks to 6 months after the first dose carried out by the practice within the reporting period. | 50 years (50th birthday) | No upper age limit |
SHR0U11 | Monthly count of the number of registered immunocompromised patients aged 50 and over at the point of vaccination, who are identified as immunocompromised by a clinical code indicating that the patient requires a shingles vaccination, who have a record of receiving a second dose of Shingrix more than 6 months after the first dose carried out by the practice within the reporting period. | 50 years (50th birthday) | No upper age limit |
SHROU12 | Monthly count of the number of registered immunocompetent patients aged 70-79 (inclusive) at the point of vaccination, who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period. | 70 years (70th birthday) | Day before 80th birthday |
SHROU13 | Monthly count of the number of registered immunocompetent patients aged 70-80 (inclusive) at the point of vaccination, who have a record of receiving a second dose of Shingrix between 6 to 12 months after the first dose carried out by the practice within the reporting period. | 70 years (70th birthday) | Day before 81st birthday |
SHROU14 | Monthly count of the number of registered immunocompetent patients aged 70-80 (inclusive) at the point of vaccination, who have a record of receiving a second dose of Shingrix more than 12 months after the first dose carried out by the practice within the reporting period. | 70 years (70th birthday) | Day before 81st birthday |
SHROU15 | Monthly count of the number of registered immunocompetent patients who turn 65 or 66 in the reporting year and who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period whilst aged at least 65. | 65 years (65th birthday) | Born after 01/09/1958 (inclusive) |
SHROU16 | Monthly count of the number of registered immunocompetent patients who turn 65 or 66 in the reporting year and who have a record of receiving a second dose of Shingrix between 6 to 12 months after the first dose carried out by the practice within the reporting period whilst aged at least 65. | 65 years 6 months | Born after 01/09/1958 (inclusive) |
SHROU17 | Monthly count of the number of registered immunocompetent patients who turn 65 or 66 in the reporting year and who have a record of receiving a second dose of Shingrix more than 12 months after the first dose carried out by the practice within the reporting period whilst aged at least 65. | 66 years | Born after 01/09/1958 (inclusive) |
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: [SHROU05] ). When reviewing the figures prior to CQRS extraction, Practices are looking for the searches in the top folder 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.
- The wrong code was added. Herpes zoster vaccination and the identically named legacy EMIS code does not count. We recommend using an up-to-date template to minimise the chances of this occurring.
The single dose Zostavax and double dose Shingrix vaccines have separate codes; Herpes zoster vaccination cannot be used as the first dose code for Shingrix as the second dose will not be recognised. - Patient was too old or too young. There are now multiple cohorts to think about; patients must be at least 70 years of age to receive their first shingles vaccination (Zostavax or Shingrix) and before their 80th birthday, or patients must be exactly 65 years of age, or for immunocompromised patients they may be at least 50 years of age. The second dose of Shingrix may be given to immunocompetent patients aged 80 if their first dose was administered within 6 months of their 80th birthday.
- The code was added too early or late. For immunocompromised patients the second dose of the double dose Shingrix vaccine must not be given until at least 8 weeks after the first dose. Immunocompetent patients cannot have their second dose until at least 6 months after the first dose. There is no maximum interval between doses for payment (as long as the immunocompetent patient has not had their 81st birthday. There are recommendations in the Green Book about a suitable window for the second dose.
From September 2024, a new business rule was added which allowed patients coded for (Zostavax) vaccination before their 70th birthday to be recognised for a first dose of Shingrix last month. This may allow some patients who previously had a shingles vaccination privately outside of the national programme to be recognised for payment of a first dose of Shingrix. The second dose should not be affected as the main factor
Valid codes
SHROU05 - the code to document a Zostavax vaccination has been changed for September 2023 onwards. The old code was 'Herpes zoster vaccination [859641000000109] . It should only be used for the single dose Zostavax.
Administration of live attenuated Human alphaherpesvirus 3 vaccine [871898007]
The code above is the preferred term of Administration of vaccine product containing only live attenuated Human alphaherpes 3 antigen.
We are aware that a GP toolkit has stressed the importance of using this exact code, but as they share a Concept ID it does not matter.
SHROU06 - SHROU17 - the two dose vaccination Shingrix has a different set of vaccine administration codes, so if Herpes zoster vaccination or Administration of live attenuated Human alphaherpesvirus 3 vaccine was used for the first dose then the second dose won't be counted as part of a two dose schedule.
Administration of first dose of Varicella-zoster vaccine for shingles [1326101000000105]
Administration of second dose of Varicella-zoster vaccine for shingles [1326111000000107]
The codes above are the preferred terms of Administration of first/second dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles. We are aware that a GP toolkit has stressed the importance of using these exact codes, but as each shares a Concept ID it does not matter.
SHROU06 - SHROU08 - the business rules also specify the immunocompromised patients should have a code for immunosuppression on their record; these are too numerous to list (1000+) so refer to the business rules codelist or the definition of [SHROUCX002] for valid codes. If a patient does not meet those criteria, they may qualify if another code is added to their record.
Requires vaccination against shingles [1730561000000103]
Missed Activity
Having run the top folder, check that the report SHROU00X - 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.
The missed activity reports SHROU03X and SHROU04X may display patients who also appear in SHROU02. Such patients have an immune suppression code which makes them eligible for Shingrix, so it is important to check the manufacturer column to see whether they received Zostavax or Shingrix; those receiving Shingrix but coded with Herpes zoster vaccination need the vaccination recoding to achieve payment and make the patient eligible for SHROU04.
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.
Interpreting CQRS
The complexities of the 2023-24 Shingles Enhanced Service mean there could be a number of reasons why patients appear in the missed activity searches. Read on for a summary of each report.
SHROU05X | (Immunocompetent patients aged 70-79 receiving Zostavax) - likely incorrect code used. Patients younger than 70 or older than 80 will also appear if Zostavax has been given/coded. |
SHROU06X | Immunocompromised patients aged 50+ who have been given Zostavax, or the old Zostavax code (Herpes zoster vaccination) has been used. Patients under the age of 50 may also be included. |
SHROU07X | Immunocompromised patients whose second dose has been given too early. Coding error also possible, as well as patients under 50 receiving a second dose. |
SHROU08X | Immunocompromised patients whose second dose has been coded incorrectly. Patients under 50 receiving a second dose is also possible. |
SHROU09X | (Patients aged 50+ marked as requiring a shingles vaccination) - likely incorrect code used. |
SHROU10X | (Patients aged 50+ marked as requiring a shingles vaccination) - second dose has been given too early. Coding error also possible, as well as patients under 50 receiving a second dose. |
SHROU11X | (Patients aged 50+ marked as requiring a shingles vaccination) - second dose has been coded incorrectly. Patients under 50 receiving a second dose is also possible. |
SHROU12X | Immunocompetent patients 70-79 receiving Shingrix - likely incorrect code used. Patients younger than 70 or older than 80 will also appear. |
SHROU13X | Immunocompetent patients 70-79 whose second dose of Shingrix has been given too early. Coding error also possible. |
SHROU14X | Immunocompetent patients 70-79, second dose - likely incorrect code used. This indicator should return 0 until October 2024. |
SHROU15X | Patients aged 65 given Zostavax in error, or the old Zostavax code has been used. |
SHROU16X | Patients aged 65 whose second dose of Shingrix has been given too early (before 6 months). Coding error also possible. |
SHROU17X | Patients aged 65 whose second dose of Shingrix has been coded incorrectly. This indicator should return 0 until October 2024. |
Missed activity data offers some opportunities for learning. Hopefully most entries highlighted by the Missed Activity reports are due to coding which can easily be fixed. Whilst it isn't possible to 'fix' where a Zostavax dose has been given where the programme calls for Shingrix (such as in immunocompetent patients aged 65), there is an opportunity for reflection, as would be second doses given too early (SHROU07X and SHROU10X prior to 8 weeks; SHROU13X and SHROU16X prior to 6 months).
Version Control
v5.0 - Updated dates of birth to reflect annual eligibility change in September
v5.1 - Added criteria to ignore future auto-filed reports
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