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Issue 48: RXA 11 modification
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Project Member Reported by cectow...@gmail.com, Feb 25, 2014


I just joined the IHS call with ASIIS. They are now telling us that they can live with our current RXA-11.4 functionality for the time being. If they don't recognize RXA-11.4 for historical shots then they just blank out the value. Since they have nearly all the historical vaccinations already they think this issue does not warrant waiting months for IHS to make the fix. 

I told them that my advice to IHS was to remove the value of RXA-11.4 for historical vaccinations, and that I thought it could be a change considered for some future release. My advice is to wait and change this as part of a new version, and not as a patch. 

Jul 21, 2014
Project Member #1 cectow...@gmail.com
Despite our efforts to bring this to community attention, it doesn't seem an alternative to RXA 11.4 is coming....  I thought Tom's very valid thoughts on the matter should be documented here as we can refer to them going forward.
From the conversation today and others, I'm afraid that development has gone well beyond the point at which my thoughts regarding RXA-11.4 will be of any value.  Please don't read any further if my 'soap box' will bother you or is completely irrelevant:

I was a PHN for many years; have given immunizations all over the US and in Central America, in migrant labor camps, on Reservations, in homes and hospitals, clinics, nursing homes, schools, shopping centers, etc., etc., etc.  For any of you old enough to know who Russell Means was, I actually "shot" Russell Means (he was the one who bragged that I "shot" him) and it was a great joke between us. When I'm with a patient, getting ready to stick a needle wherever it needs to be stuck, THE thing that is most important for me is to know as much as possible about the health status and immunization history of the patient.  Knowing/seeing '36001' doesn't mean a whole lot to me.  Seeing 'ADVANCE PEDS' or 'SLWC' or 'Ped ao' probably means nothing to someone in the ASIIS office but may have exactly the info that I need in order to know the:


RXA-11 Administered-at Location (LA2) 00353 
Definition: The name and address of the facility that administered the immunization. Note that the components used are: 
Component 4: The facility name/identifier. 


I may go to church with the nurse who works at 'Ped ao'; my kids may play soccer with the kids of the doctor at 'SLWC'; I may have done a clinical rotation at ADVANCE PEDS and the DON there gave me a very nice recommendation.

I'm seeing a kid today, I'm visiting grandma in the nursing home tomorrow, I'm going to the Russell Means home site next week and remember that there was something about an allergy or a major reaction and I don't see anything about it in the chart.  Since we have a great data exchange system that sends me info from other locations, I know we've received from the data exchange immunizations that my patient received elsewhere and at least some info on where the immunizations were "administered-at".  And, since that data exchange info gives me some information on where those immunizations were administered, I'll call my friend at 'Ped ao' or I'll call the doc who I know still works at 'SLWC' or I'll call the DON at 'ADVANCE PEDS' - and do a bit more checking before I administer an immunization that may have very detrimental consequences.

Does it matter that ASIIS knows what SLWC means or does it matter that I have a clue as to where the that shot was given?  ASIIS needs to know whom to charge and how to account for the vaccine;  I need to know whom to contact to get additional information that might be critical to the health of my patient.

Two very crucial data information needs have been conflated into one data location:  RXA-11.4

The crucial pieces of data: 1) where the immunization was administered - crucial for optimizing clinical information and maximizing the health of my patient;  2) how to account for the vaccine for financial and supply management - crucial for getting the vaccines we need.

The current approach seems to me to change the potentially very valuable "Administered-at Location" information - "ADVANCE PEDS" - into useless clinical information but relevant supply management information - '36001'.

My humble and probably irrelevant opinion:  there needs to be 2 separate places in the data exchange message to clearly and accurately convey two related but very separate and very distinct pieces of data: 1) where the immunization was administered-at; 2 ) what account to charge the vaccine to.

Without a place for both there will always be a problem with RXA-11.4, it can address one info need or the other but not both.  ORC-17 doesn't help as currently defined.  End of soap box!!


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