BC has a 4 phase approach to immunization planning. Below are some general instructions to create a search query in your EMR that align with criteria in each phase.
Phase 1 (Current)
Phase 1 is focused on highest risk people in long-term care, hospital healthcare workers and remote communities. General primary care is not involved at this phase.
Identifying your patients in this phase would consist of querying your EMR for patients with:
- Address in a specific long-term care facility OR in a remote community that has been identified for phase 1.
- OR some practices use a flag to identify “long-term care patients”.
- OR you could create a query to show all patients with any long-term care specific billing code (e.g. 00114, 00115).
Likely though, all qualified patients in this phase will be engaged through the facilities and remote communities where they reside. You should consider how to engage with your patients in those communities who are vaccine hesitant.
Phase 2 is focused on highest risk people in community age 80+, Indigenous seniors 65+ and Elders.
Also included in phase 2 are people in select congregate living and working conditions and healthcare providers not immunized in phase 1. Immunizations in this phase are managed by health regions and Public Health; however, primary care will still have a roll to play in either working in the standalone immunization clinics or engaging patients who are eligible but hesitant.
Three types of EMR queries will be helpful in phase 2:
- Age query to include all patients with age ≥80 years.
- Age query with the age cut off to be ≥65 AND Indigenous. NOTE: most EMRs and practices do not record race or ethnicity.
- Query by address: it may be possible to identify patients in select congregate living locations by searching addresses or postal codes in your EMR. Likely, however, people living at these locations will be made aware by staff or support people at those locations.
Phase 3 is where more of the general population will be immunized (plus anyone not immunized from previous phases). There are two groups included in phase 3:
- Those 60+ years of age
- Those 16+ years of age who are clinically extremely vulnerable (see table).
Group 1 will qualify by decreasing 5 year age brackets, the specific timing will be dependent on vaccine supply. These are generally simple queries to make using patient age bracketing in your EMR as in phase 2. For example:
- Age query with the age in each age range bracket (e.g. 80-75, 74-70, etc.).
Group 2 will be harder to identify with your EMR data and will likely require more than one query. This will depend on your EMR reporting tools. Some EMRs will not be able to do the required logic all at once, so multiple queries may be needed.
You can use three different sets of criteria to identify eligible patients in this group:
- Patients aged 16-69 who:
- Have a specific condition
- OR are on a medication that indicates that they likely have that condition
- OR have a lab result that indicates that they have that condition.
The codes needed are provided in the table below.
Some EMRs cannot do the “OR” between concepts and you would have to do separate queries.
- First identify patients who have the specifically identified conditions in their problem list (or in the encounter/billing codes).
- Then identify patients who may have those conditions based on their medications.
- Then identify patients who may have those conditions based on their lab results.
You could also use your EMR billing tables to look for patients with the same diagnostic codes. If you are not able to do queries to look for ICD9 codes but want to identify patients, you would have to instead manually review your lists of patients in the 16-69 age bracket.
Phase 4 will include the remainder of the general population from 59 to 18 years of age, in decreasing 5 year increments (59-55, 54-50, etc. down to 24-18). There are currently no other criteria for eligibility in phase 4. Also, we recommend you review eligible patients from previous phases who may have declined immunizations.
Children and Youth
Children and Youth are currently not in the BC plan as the immunization studies are not yet completed for people under the age of 16-18. These studies are ongoing and the guidance will be updated when the evidence is clear.
Identified Clinical Diagnoses that Increase Risk
We have summarized the clinical diagnoses known to increase risk for mortality along with their codes and some ways to find them in EMR data here:
|Risk Condition||Diagnostic Codes (ICD-9)||Medications (ATC)||Lab Values or other results|
|Cancer and undergoing active chemotherapy||140-239|
|AND (L01 OR LO4)|
|Lung cancer who are undergoing radical radiotherapy||212.3, 212.9, 162-165||Would need chart review for radiotherapy|
|Immunosuppression (acquired, medication related or hereditary)||279, 288||OR L01AA OR L04|
|Down’s Syndrome and other congenital disorders||758|
|Advanced Chronic Kidney Disease||5855, 5856||AND eGFR<15|
|Uncontrolled Diabetes||250||AND A1c > 7.5%|