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Vaccination Deduplication

When patient records are processed through deduplication and merged with other patient records, it becomes necessary to also process the vaccination records through deduplication to create a single master vaccination record. Duplicate vaccinations for the same vaccine family and the same vaccination date may exist for more than one of the merged patient records. Combining the clinical records into a master record aids in preventing the patient from receiving duplicate vaccinations.

Many providers submit historical vaccinations (administered by the provider on past visits or administered by another provider), as well as administered vaccinations (administered by this provider on this visit). During the data entry process, a provider can view the existing vaccinations on a patient record and should not duplicate entries. A provider submitting batch data has no knowledge of the vaccinations already in the registry and may send records that have already been recorded.

Vaccinations submitted as batch data may be submitted as a separate file from the patient data. The vaccination record must contain a unique identifier linking it to the patient record to which it belongs. During the deduplication process, this identifier is maintained so that as patient records are merged or separated, the vaccinations are related to the correct patient. An identifier for the merged patient record is maintained with the vaccination to create a consolidated vaccination record.

Vaccination Merge Rules

Vaccination records are created from a variety of sources. Providers can record vaccinations from a parent's copy of an immunization record, a patient chart, or a school record. The variety of data sources creates unique issues in deduplication of vaccination records.

Vaccination Date Evaluation

The incoming vaccination date should be validated to ensure that it fits the criteria for a valid vaccination. For example, a vaccination date prior to a patient's birth date would not be a valid record. Vaccinations may appear to be duplicates of existing records if they are the same vaccine type but have dates within a day or two of another record. This can represent a valid record and other data elements on the records should be compared to determine which record should be in the master vaccination record.

Historical vs. Administered Vaccines

In an effort to maintain a complete vaccination history for a patient, providers often enter vaccinations that they did not administer into the registry or their patient management system. This type of entry is referred to as a historical vaccination. A vaccination that was given to the patient by the provider at the visit is referred to as an administered vaccination. It is desirable to have the historical vaccinations flagged as such in the registry system. When consolidating the records during deduplication, the type of administration should be considered. In the event that an administered vaccination already exists, it should not be overwritten by historical data.

Vaccine Family vs. Antigen

Duplicate entries can be created by vaccine families or by antigens. For example, a record may include Hib-HbOC administered on 01/01/2006 and Hib-PRP-D administered on 01/01/2006. Although these are different antigens, they belong to the same vaccine family and would be considered duplicate records.

Another consideration in evaluating the vaccine family is that some providers may submit vaccines as an unspecified type. It is desirable to maintain the specific antigen in the record instead of the unspecified antigen.

Combination Vaccine vs. Single Antigen

Incoming combination vaccines must be evaluated against single antigens already present on the record. Many factors must be evaluated in this situation:

Incoming Combination Vaccine vs. Existing Combination Vaccine

Incoming single antigens should be compared to existing combination vaccines, as well as to existing single antigens in the record. If an incoming single antigen is marked as historical and the existing single antigen is administered, it is easy to determine that the existing record should be maintained. The evaluation becomes more complicated when comparing the incoming single antigen to an existing combination vaccine. A combination vaccine represents many vaccine families and should never be replaced by a single antigen unless those same families are already represented by other records for the same date. If the incoming single antigen is administered and the existing combination vaccine is historical, the combination vaccine should be maintained in the master record as it represents more vaccine families.

Deleted Vaccinations

Providers may discover data entry errors, which result in vaccination deletions. The deletions may be done through data entry or by batch submission. If a deletion is processed through batch submission, the incoming record should be matched to the record previously submitted by that provider and the existing record updated with the deletion date. Records deleted through data entry should mark the record that the provider has accessed in the query with the deletion date.

When patient records are merged or separated, the vaccination deletion date should be considered when processing the vaccinations. It is possible that a vaccination that was deleted by Provider 1 was also submitted by Provider 2. Since the vaccination submitted by Provider 2 may be correct and is therefore not marked as deleted, it would appear on the patient record during the merge or separation.

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