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Immunization records are available on-line through the Primary Care Center's GURU application for display, analysis, and printing. The immunizations are entered into the database through a process of uploading ICD-9 codes. Specifically:

• Administered immunizations are marked on a Primary Care Center Charge Requisition Form.

• The associated ICD-9 codes are entered into the hospital billing system (SMS).

• On a weekly basis, SMS automatically generates a report which searches through all patients entered from a defined, recent 2-week period, selects those who have been seen in a Primary Care Center clinic (including Braddock, Turtle Creek, Wilkinsburg, and FIC) plus any other additional children who have received immunizations within the hospital system (thereby having billing information entered), and saves all relevant information to a download file.

• This weekly download file is available for processing by GURU to upload the report information into all of the appropriate clinical database fields, which includes not only immunizations but also problem lists, insurance info, and demographic info.

There are, however, several disadvantages:

• There is a delay between when the immunization is administered and when it appears in the GURU database. This could be up to 2-3 weeks, depending on how long it takes for the billing information to be entered, and how long after that it appears in a SMS report file.

• Additional immunization information which may need to be tracked is not captured: manufacturer, lot number, etc.

• ICD-9 codes are rather patchwork in nature, usually behind the times and minimally satisfactory to represent the current broad spectrum of immunizations. Some vaccines need to be coded as "Unspecified" or "Other". There are also no distinctions between "DTP" and "DTaP" or "OPV" and "IPV" or the various kinds of "Hib" vaccines.

  The following table illustrates some of the current vaccine-relevant ICD-9 codes. Not all vaccines or ICD-9 codes are listed - just the ones usually encountered in a clinic setting:

If the download method of immunization data entry is continued at CHP, the accuracy and integrity of the ICD-9 codes on the Charge Requisition Form is critical for the successful creation of valid patient immunization records.

The following table summarizes past and present ICD-9 immunization codes and includes proposals for changes to the current (7/99) Charge Requisition Form which will help maintain this data integrity.