Shingles alert (HP062)
Shingles Alert (HP062)
Overview/Purpose
This shingles alert is a protocol alert for EMIS Web, which has been designed to fill the void of a previously active EMIS authored alert.
The alert is designed to show users that:
- The patient is eligible for a shingles vaccination
- The patient has received their first Shingrix dose (but not the second).
Resource type:
Base | Optional | Localised |
✔ |
Product
This protocol alert is part of the PCIT toolset product
What does it do?
An alert will show on any patients within the following cohorts:
- Patients aged 70-79 who have not previously received a completed shingles vaccination course (either single dose Zostavax or two dose Shingrix)
- Patients aged 65 in the catch up cohort who have not previously received a completed shingles vaccination course (either single dose Zostavax or two dose Shingrix)
- Patients aged 50 and above who have an immunocompromised condition. See section below for further information
- Patients aged 50-80 who have received a first dose of Shingrix, but not the second dose
- Immunocompromised patients aged over 80 who have received a first dose of Shingrix, but not the second dose
What does it look like?
Age recall
This first alert will show for unvaccinated patients in their 70s, patients in the 65 year old catch up cohort, and also patients between 50 and 69 who have been reviewed by a clinician and a code of Requires immunisation against shingles has been added.
The 65 year old catch up cohort is a new group from September 2023. These patients must have been born on or after 1st September 1958 and will remain in this cohort until the day before their 80th birthday.
If there are patients who have had the Requires immunisation against shingles added prior to a vaccination, this alert will display as it shows that they have been clinically assessed and deemed to require a shingles vaccination course. These patients will be treated like the immunocompromised cohort in that their second vaccine could be administered after 8 weeks.
The alert can indicate that a patient eligible by age may also be eligible due to being immunocompromised, but it does not go into detail. Read more about this group below.
Double clicking this alert launches part of OneTemplate NonPrescriber to record the vaccination.
Immunocompromised conditions
The Green Book Chapter 28a and the Enhanced Service business rules are at odds over the definition of eligible patients. The former uses stricter definitions of severely immunocompromised conditions, whereas the latter has probably been designed more around what core clinical systems are capable of searching for.
The HP062 alert has been designed using the broader scope of the Enhanced Service business rules to capture as many patients as possible. As a consequence the alert has been written as a guide to clinical staff to review the record and determine for themselves whether the patient meets the criteria specified in the Green Book or their PGD.
The following groups and clusters are used:
| Description | Cluster ID | Comments |
| Autograft stem cell transplant in the last 2 years | AUTOTRANSP_COD | Transplant may have happened more than 2 years ago, but subsequent review code can trigger inclusion |
| Allograft stem cell transplant in the last 2 years | ALLOTRANSP_COD | Transplant may have happened more than 2 years ago, but subsequent review code can trigger inclusion |
| History of graft versus host disease | GVHD_COD | |
| HIV | HIV_COD | |
| AIDS | AIDS_COD | |
| DMARD code in the last 6 months | DMARDS_COD | This is not the same as DMARD medication issues (see bottom of table) |
| History of haematological malignancy | EPPHAEMCAN_COD | |
| History of Lymphoproliferative disorder | LYMPHOPROLDIS_COD | |
| Radiotherapy treatment in the last 6 months | RADIOTHERAP_COD | |
| Long term immunocompromised condition | IMATRISK1_COD | |
| Expiring immunocompromised condition in the last 6 months | IMTEMP_COD | |
| Immunosuppression procedure in the last 6 months | IMTRTATRISK1_COD | Procedure may have happened more than 6 months ago, but subsequent review code can trigger inclusion |
| Immunosuppression drug issue in the last 6 months | IMTRTATRISKDRUG_COD | Picks up all issues irrespective of daily dose as clinical systems unable to filter this. |
Patients aged 70-79 as well as those in the 65 year old catch up cohort are automatically eligible due to age. The alert for these patients is far more simple, advising that there is also an immunocompromised condition. It will be for clinical staff to determine whether the immunocompromised condition meets the criteria to allow the second dose to be given after 8 weeks rather than 6 months. To ensure payment under the Enhanced Service for a second vaccination given between 8 and 26 weeks after the first, it may be advisable to add the code Requires immunisation against shingles BEFORE the date of the first dose.
Second dose
Any patient who has received a correctly coded first Shingrix dose will trigger this alert to remind staff that the shingles vaccination course is incomplete. When hovering the mouse pointed over the alert, it will advise of the date of the first dose as well as whether the second dose can be given after 8 weeks or 6 months.
The second dose advice is based on the Enhanced Service immunocompromised conditions, meaning payment should be guaranteed even if the patient's severity does not meet the threshold defined by the Green Book or the PGD.
Double clicking this alert launches part of OneTemplate NonPrescriber to record the vaccination.
How to get it
You can request an optional protocol to be installed. If you would like to request installation please click here to submit a ticket.
Installation
EMIS originally released their own shingles eligibility alert in October 2023, then released a second version in April 2024. If Practices have previously deactivated this alert, it may have been reactivated. If the EMIS shingles protocol alert is active in your organisation, follow the below steps:
- Go to Resource Publisher
- Expand the EMIS Library > EMIS Protocols > Immunisation Protocols to locate "Shingles (herpes zoster) alert"
- Right click Shingles alert, click Status, then Deactivate
- Expand Shared folders on the navigation tree (below EMIS Library)
- Expand the Primary Care IT folder > Handy Protocols > Optional
- Within the folder, right click on
- Then click Status, then Activate
EMIS will pause and then the alert will activate and change to black text. Other users will begin to see the alert when they next login to EMIS.
FAQs
Q: A patient in their 70s was vaccinated several years ago, but the Eligible alert is still showing.
A: Look at the coding of the vaccination entry. An EMIS code of Herpes zoster vaccination did exist briefly which may have been used, or Herpes zoster vaccination given, but these are not picked up by the protocol. If the patient was vaccinated at their previous surgery which was on SystmOne, make sure the degraded entries have been re-coded.
Q: A patient received their first Shingrix dose, but there is no alert to show an incomplete course.
A: Ensure that the first dose was recorded using the correct code. We are aware of instances where the code representing a single dose has been used (with Shingrix written in the associated text). The system is not able to distinguish which vaccine was given, and consequently will also ignore any second dose for payment purposes.
Q: Why is a 65 year old patient not showing as eligible?
A: The catch up cohort only includes patients who were born on or after 1st September 1958 AND have had their 65th birthday. Patients born before this date will not be eligible until their 70th birthday unless national policy changes sooner.
Q: The patient has previously declined the shingles vaccination so why is the alert still showing?
A: An immunocompetent patient remains eligible until their 80th birthday; an immunocompromised patient remains eligible for life. Coding patient declined will downgrade the priority of the alert from medium to low.
Q: What is the difference between EMIS' shingles alert, and PCIT's alert?
A: Whilst both alerts display patients who are eligible, HP062 is more detailed in suggesting immunocompromised patients who are eligible to receive a vaccine, while ensuring immunocompromised patients also eligible by age are always confirmed as eligible. Information displayed around an incomplete course offers more guidance to suggest whether an 8 week or 6 month interval is indicated.
Q: The alert is showing for a patient over the age of 80 but I thought patients could not have a vaccine beyond their 80th birthday?
A: Patients over the age of 50 who are immunocompromised are eligible to receive a Shingrix vaccine beyond their 80th birthday.
System Triggers
System trigger: Load patient record
Run mode: Always run
Enable trigger for: All job categories
Change management considerations
If there is an existing EMIS protocol alert for shingles eligibility, you will want to deactivate this before activating/using this protocol alert (HP062): See the installation section further up in this article for details on how to do this.
HP current version number: 1.1.0
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