VA-PNEUMOCOCCAL IMMUNIZATION PPSV23 (1598)    REMINDER DEFINITION (811.9)

Name Value
NAME VA-PNEUMOCOCCAL IMMUNIZATION PPSV23
PRINT NAME Pneumococcal PPSV23 (Pneumovax)
CLASS NATIONAL
SPONSOR VA National Center for Health Promotion and Disease Prevention (NCP)
USAGE CR
EDIT HISTORY
  1. EDIT DATE:   2016-05-23 13:05:54
    EDIT BY:   USER,FIFTYFOUR
    EDIT COMMENTS:   
    Exchange Install
    
DESCRIPTION
Updated guidelines Fall 2014 - patients age 65 and older should received 
anatomic asplenia, CSF leaks, or cochlear implants, and who have not
previously received PCV13 or PPSV23, should receive a dose of PCV13 first,
followed by a dose of PPSV23 at least 8 weeks later if <age 65 or 
immunocompromised and at least 1 year later if 65 or older AND not 
immunocompromised.
 
Subsequent doses of PPSV23 should follow current PPSV23 recommendations
for adults at high risk. Specifically, a second PPSV23 dose is recommended
5 years after the first PPSV23 dose for persons aged 19-64 years with
functional or anatomic asplenia and for persons with immunocompromising
one dose of PCV13, if possible, this dose should be given prior to 
conditions. Additionally, those who received PPSV23 before age 65 years
for any indication should receive another dose of the vaccine at age 65
years, or later if at least 5 years have elapsed since their previous
PPSV23 dose. 
 
Previous vaccination with PPSV23. Adults aged >=19 years with 
immunocompromising conditions, functional or anatomic asplenia, CSF 
leaks, or cochlear implants, who previously have received >=1 doses of 
PPSV23 should be given a PCV13 dose >=1 year after the last PPSV23 dose 
was received. For those who require additional doses of PPSV23, the first 
PPSV23. Persons vaccinated with PCV13 prior to age 65 do not need a 
such dose should be given no sooner than 8 weeks after PCV13 for ages 
<65 or if immunocompromised, no sooner than 1 year after PCV13 for ages 65
and older, not immunocompromised and at least 5 years after the most
recent dose of PPSV23.
 
 
Pneumococcal polysaccharide (PPSV) vaccination - Vaccinate all persons
with the following indications:
Medical: Chronic lung disease (including asthma); chronic cardiovascular 
diseases; diabetes mellitus; chronic liver diseases; cirrhosis; chronic 
second dose after age 65 (this applies to PCV13 only and not to PPSV23).
alcoholism; functional or anatomic asplenia (e.g., sickle cell disease or 
splenectomy [if elective splenectomy is planned, vaccinate at least 2 
weeks before surgery]); immunocompromising conditions (including chronic 
renal failure or nephrotic syndrome); and cochlear implants and 
cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as 
possible.
 
Other: Residents of nursing homes or long-term care facilities and 
persons who smoke cigarettes. Routine use of PPSV is not recommended for 
American Indians/Alaska Natives or persons aged less than 65 years unless 
 
they have underlying medical conditions that are PPSV indications. 
However, public health authorities may consider recommending PPSV for 
American Indians/Alaska Natives and persons aged 50 through 64 years who 
are living in areas where the risk for invasive pneumococcal disease is 
increased.
 
Revaccination with PPSV23
One-time revaccination after 5 years is recommended for persons aged 19 
through 64 years with chronic renal failure or nephrotic syndrome; 
functional or anatomic asplenia (e.g., sickle cell disease or 
Updated guidelines October 2012
splenectomy); and for persons with immunocompromising conditions. 
 
For persons aged 65 years and older, one-time revaccination is 
recommended with PPSV23 if they were vaccinated 5 or more years previously
and were aged less than 65 years at the time of primary vaccination.
 
Pneumococcal vaccine-na´ve persons. ACIP recommends that adults aged 19 
years of age and older with immunocompromising conditions, functional or
FINDINGS
  1. FINDING ITEM:   VA-DATE OF BIRTH
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  2. FINDING ITEM:   VA-PNEUMOC PCV13 DX INCORRECT
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  3. FINDING ITEM:   VA-PNEUMOC PPSV23 INCORRECT DIAGNOSIS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  4. FINDING ITEM:   VA-PNEUMOC PPSV23 DEFERRALS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-3M
  5. FINDING ITEM:   VA-PNEUMOC PCV13 CONTRAINDICATION
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  6. FINDING ITEM:   VA-PNEUMOC DZ RISK - CHEMO/IMMUNOSUPP DRUGS
    OCCURRENCE COUNT:   4
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   5Y
    RANK FREQUENCY:   4
    BEGINNING DATE/TIME:   T-6M
  7. FINDING ITEM:   VA-BL PNEUMOC RISK IC/CH
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  8. FINDING ITEM:   VA-PNEUMOC DZ RISK - LONG TERM STEROIDS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   5Y
    RANK FREQUENCY:   4
  9. FINDING ITEM:   VA-PNEUMOC PCV13 IMMUNIZATION
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    BEGINNING DATE/TIME:   5/31/12
  10. FINDING ITEM:   VA-PNEUMOC DZ RISK - HIGH
    OCCURRENCE COUNT:   2
    NO. OF FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   99Y
    FOUND TEXT:   
    High risk for pneumococcal disease.  
    \\
    
    RANK FREQUENCY:   4
    USE IN PATIENT COHORT LOGIC:   OR
    BEGINNING DATE/TIME:   T-4Y
  11. FINDING ITEM:   VA-PNEUMOC DZ RISK - IMMUNOCOMPROMISED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   5Y
    RANK FREQUENCY:   4
    USE IN PATIENT COHORT LOGIC:   OR
    BEGINNING DATE/TIME:   T-2Y
  12. FINDING ITEM:   VA-PNEUMOC DZ RISK - HIGHEST/NOT IMMUNO COMP
    OCCURRENCE COUNT:   2
    MAXIMUM AGE:   64
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   99Y
    RANK FREQUENCY:   4
    USE IN PATIENT COHORT LOGIC:   OR
    BEGINNING DATE/TIME:   T-10Y
  13. FINDING ITEM:   VA-PNEUMOC PPSV23 IMMUNIZATION
    OCCURRENCE COUNT:   3
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   2
    NOT FOUND TEXT:   
    No immunization with pneumococcal polysaccharide vaccine (PPSV23) has
    been recorded.
    
  14. FINDING ITEM:   VA-PNEUMOC PPSV23 ORDERS
    ENDING DATE/TIME:   T+14
    STATUS LIST:
    1. STATUS:   ACTIVE
    2. STATUS:   PENDING
    3. STATUS:   SCHEDULED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE START DATE:   YES
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-14
  15. FINDING ITEM:   VA-AGE
    CONDITION:   I V>64
    INTERNAL CONDITION:   I V>64
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  16. FINDING ITEM:   VA-PNEUMOC PPSV23 CONTRAINDICATIONS
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  17. FINDING ITEM:   VA-PNEUMOC PPSV23 IMMUNIZATION
    CONDITION:   I V="B"!(V="2")!(V="3")!(V="4")
    CONDITION CASE SENSITIVE:   NO
    INTERNAL CONDITION:   I V="B"!(V="2")!(V="3")!(V="4")
    NO. OF FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FOUND TEXT:   
    More than one dose of pneumococcal polysaccharide vaccine (PPSV23) has
    been recorded.
    
FUNCTION FINDINGS
  1. FUNCTION FINDING NUMBER:   1
    FOUND TEXT:   
    The patient has received more than one dose of pneumococcal 
    polysaccharide vaccine (PPSV23).
     
    Additional doses of PPSV23 before age 65 are not recommended.
    \\
    
    LOGIC:   ((FN(1)&(FN(2)>1)&(FN(3)>1460))!FN(4))&'FN(5)
    REMINDER FREQUENCY:   99Y
    RANK FREQUENCY:   1
    FUNCTION STRING:   ((FI(5)&(COUNT(5)>1)&(DTIME_DIFF(5,1,"DATE",5,2,"DATE","D","A")>1460))!FI(9))&'FI(7)
    NO. FOUND TEXT LINES:   5
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   COUNT
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   DTIME_DIFF
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   DATE
      2. FUNCTION PARAMETER:   DATE
      3. FUNCTION PARAMETER:   D
      4. FUNCTION PARAMETER:   A
    4. FUNCTION NUMBER:   4
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    5. FUNCTION NUMBER:   5
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  2. FOUND TEXT:   
    Recorded doses of pneumococcal polysaccharide vaccine (PPSV23) were not
    given a full 5 years apart.  Assess for need for repeat.
    
    LOGIC:   ((FN(1)&(FN(2)<1460)))&(FN(3)>1)
    FUNCTION STRING:   ((FI(5)&(DTIME_DIFF(5,1,"DATE",5,2,"DATE","D","A")<1460)))&(COUNT(5)>1)
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   DTIME_DIFF
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   DATE
      2. FUNCTION PARAMETER:   DATE
      3. FUNCTION PARAMETER:   D
      4. FUNCTION PARAMETER:   A
    3. FUNCTION NUMBER:   3
      FUNCTION:   COUNT
      FUNCTION PARAMETER LIST:
  3. LOGIC:   FN(1)>FN(2)
    FUNCTION STRING:   MRD(3)>MRD(12)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  4. LOGIC:   FN(1)>FN(2)
    FUNCTION STRING:   MRD(2)>MRD(13)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  5. LOGIC:   (FN(1)>0)!(FN(2)>0)!(FN(3)>0)!(FN(4)>0)
    FUNCTION STRING:   (NUMERIC(16,1,"CODE")>0)!(NUMERIC(16,2,"CODE")>0)!(NUMERIC(16,3,"CODE")>0)!(NUMERIC(16,4,"CODE")>0)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   NUMERIC
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   CODE
    2. FUNCTION NUMBER:   2
      FUNCTION:   NUMERIC
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   CODE
    3. FUNCTION NUMBER:   3
      FUNCTION:   NUMERIC
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   CODE
    4. FUNCTION NUMBER:   4
      FUNCTION:   NUMERIC
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   CODE
  6. LOGIC:   ((FN(1)>0))&'(((FN(2)="INTRAVITREAL")!(FN(3)="INTRAVITREAL")!(FN(2)="TOPICALLY")!(FN(3)="TOPICALLY")))
    FUNCTION STRING:   ((VALUE(16,1,"START DATE")>0))&'(((VALUE(16,1,"MR")="INTRAVITREAL")!(VALUE(16,1,"MEDICATION ROUTE")="INTRAVITREAL")!(VALUE(16,1,"MR")="TOPICALLY")!(VALUE(16,1,"MEDICATION ROUTE")="TOPICALLY")))
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   START DATE
    2. FUNCTION NUMBER:   2
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MR
    3. FUNCTION NUMBER:   3
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MEDICATION ROUTE
    4. FUNCTION NUMBER:   4
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MR
    5. FUNCTION NUMBER:   5
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MEDICATION ROUTE
  7. LOGIC:   ((FN(1)>0))&'(((FN(2)="INTRAVITREAL")!(FN(3)="INTRAVITREAL")!(FN(2)="TOPICALLY")!(FN(3)="TOPICALLY")))
    FUNCTION STRING:   ((VALUE(16,2,"START DATE")>0))&'(((VALUE(16,2,"MR")="INTRAVITREAL")!(VALUE(16,2,"MEDICATION ROUTE")="INTRAVITREAL")!(VALUE(16,2,"MR")="TOPICALLY")!(VALUE(16,2,"MEDICATION ROUTE")="TOPICALLY")))
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   START DATE
    2. FUNCTION NUMBER:   2
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MR
    3. FUNCTION NUMBER:   3
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MEDICATION ROUTE
    4. FUNCTION NUMBER:   4
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MR
    5. FUNCTION NUMBER:   5
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MEDICATION ROUTE
  8. LOGIC:   ((FN(1)>0))&'(((FN(2)="INTRAVITREAL")!(FN(3)="INTRAVITREAL")!(FN(2)="TOPICALLY")!(FN(3)="TOPICALLY")))
    FUNCTION STRING:   ((VALUE(16,3,"START DATE")>0))&'(((VALUE(16,3,"MR")="INTRAVITREAL")!(VALUE(16,3,"MEDICATION ROUTE")="INTRAVITREAL")!(VALUE(16,3,"MR")="TOPICALLY")!(VALUE(16,3,"MEDICATION ROUTE")="TOPICALLY")))
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   START DATE
    2. FUNCTION NUMBER:   2
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MR
    3. FUNCTION NUMBER:   3
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MEDICATION ROUTE
    4. FUNCTION NUMBER:   4
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MR
    5. FUNCTION NUMBER:   5
      FUNCTION:   VALUE
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   MEDICATION ROUTE
  9. FUNCTION FINDING NUMBER:   2
    FOUND TEXT:   
    The patient has received a pneumococcal polysaccharide vaccination 
    (PPSV23) after age 65.
    
    LOGIC:   FN(1)&(FN(2)>23740)
    MINIMUM AGE:   65
    REMINDER FREQUENCY:   99Y
    RANK FREQUENCY:   1
    FUNCTION STRING:   FI(5)&(DIFF_DATE(1,5)>23740)
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
  10. FOUND TEXT:   
    Immunocompromised and no prior dose of PCV13.  PCV13 should be 
    administered before PPSV23 if possible.
    
    LOGIC:   FN(1)&'(FN(2)!FN(3))
    FUNCTION STRING:   FI(17)&'(FI(19)!FI(15))
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  11. FOUND TEXT:   
    Age 65 or older and no prior dose of PCV13. PCV13 should be given prior 
    to PPSV23 if possible.
    
    LOGIC:   FN(1)&'(FN(2)!FN(3))
    FUNCTION STRING:   FI(7)&'(FI(19)!FI(15))
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  12. LOGIC:   (((FN(1)>55)&(FN(2)!(FN(3)<23742)))!(FN(1)>364)&FN(5))!(FN(6)&'FN(5))
    FUNCTION STRING:   (((DTIME_DIFF(7,1,"DATE",19,1,"DATE","D","A")>55)&(FI(17)!(DIFF_DATE(19,1)<23742)))!(DTIME_DIFF(7,1,"DATE",19,1,"DATE","D","A")>364)&FI(19))!(FI(15)&'FI(19))
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   DTIME_DIFF
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   DATE
      2. FUNCTION PARAMETER:   DATE
      3. FUNCTION PARAMETER:   D
      4. FUNCTION PARAMETER:   A
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   DTIME_DIFF
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   DATE
      2. FUNCTION PARAMETER:   DATE
      3. FUNCTION PARAMETER:   D
      4. FUNCTION PARAMETER:   A
    5. FUNCTION NUMBER:   5
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    6. FUNCTION NUMBER:   6
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    7. FUNCTION NUMBER:   7
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  13. FUNCTION FINDING NUMBER:   23
    LOGIC:   ((FN(1)>55)&FN(2))!'FN(2)
    MINIMUM AGE:   19
    MAXIMUM AGE:   64
    FUNCTION STRING:   ((DTIME_DIFF(7,1,"DATE",19,1,"DATE","D","A")>55)&FI(19))!'FI(19)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   DTIME_DIFF
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   DATE
      2. FUNCTION PARAMETER:   DATE
      3. FUNCTION PARAMETER:   D
      4. FUNCTION PARAMETER:   A
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  14. FUNCTION FINDING NUMBER:   3
    FOUND TEXT:   
    Very high risk for pneumococcal disease, 2nd dose of PPSV23 (Pneumovax)
    should be given after 5 years.\\
    
    LOGIC:   (FN(1)'>23740)&FN(2)&'((FN(3)&(FN(4)>1)&(FN(5)>1460))!FN(6))
    REMINDER FREQUENCY:   5Y
    RANK FREQUENCY:   2
    FUNCTION STRING:   (DIFF_DATE(1,5)'>23740)&FI(17)&'((FI(5)&(COUNT(5)>1)&(DTIME_DIFF(5,1,"DATE",5,2,"DATE","D","A")>1460))!FI(9))
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   COUNT
      FUNCTION PARAMETER LIST:
    5. FUNCTION NUMBER:   5
      FUNCTION:   DTIME_DIFF
      FUNCTION PARAMETER LIST:
      1. FUNCTION PARAMETER:   DATE
      2. FUNCTION PARAMETER:   DATE
      3. FUNCTION PARAMETER:   D
      4. FUNCTION PARAMETER:   A
    6. FUNCTION NUMBER:   6
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  15. FUNCTION FINDING NUMBER:   4
    FOUND TEXT:   
    Pneumococcal polysaccharide vaccine (PPSV23) given before age 65.  The
    patient is now over age 65 and should have an additional dose of PPSV23 at
    least 5 years after the prior dose and after age 65.
    
    LOGIC:   FN(1)'>23740&(FN(2)&'FN(3)&FN(4))
    REMINDER FREQUENCY:   5Y
    RANK FREQUENCY:   2
    FUNCTION STRING:   DIFF_DATE(1,5)'>23740&(FI(5)&'FI(17)&FI(7))
    NO. FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  16. FOUND TEXT:   
    The patient received the most recent pneumococcal polysaccharide
    immunization (PPSV23) prior to age 65.  An additional dose of PPSV23 is
    recommended after age 65.
    
    LOGIC:   FN(1)&(FN(2)<23741)&'(FN(3))
    FUNCTION STRING:   FI(5)&(DIFF_DATE(1,5)<23741)&'(FI(17))
    NO. FOUND TEXT LINES:   3
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  17. FUNCTION FINDING NUMBER:   6
    LOGIC:   (FN(1)&(FN(2)>FN(3)))!FN(4)&'FN(5)&'FN(6)
    MAXIMUM AGE:   64
    REMINDER FREQUENCY:   99Y
    RANK FREQUENCY:   3
    FUNCTION STRING:   (FI(2)&(MRD(2)>MRD(13)))!FI(4)&'FI(7)&'FI(17)
    NO. FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    5. FUNCTION NUMBER:   5
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    6. FUNCTION NUMBER:   6
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  18. FOUND TEXT:   
    \\
    \\
    The patient received the most recent pneumococcal 
    polysaccharide immunization (PPSV23) prior to age 65.  The patient is
    immunocompromised and has received the pneumococcal conjugate vaccine
    (PCV13).
      
    An additional dose of pneumococcal polysaccharide vaccine 
    (PPSV23-Pneumovax) is recommended after age 65 and at least 5 years 
    after the most recent dose no matter how many prior doses have been given.
    
    LOGIC:   FN(1)&(FN(2)<23741)&(FN(3))&(FN(4))
    FUNCTION STRING:   FI(5)&(DIFF_DATE(1,5)<23741)&(FI(17))&(FI(19))
    NO. FOUND TEXT LINES:   10
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
  19. FUNCTION FINDING NUMBER:   8
    FOUND TEXT:   
    The patient is at high risk for pneumococcal disease, has had PCV13 but 
    is now over age 65 and has not received a dose of PPSV23 after age 65.  
    The patient should be should be given a final dose of PPSV23 5 or more
    years after the most recent dose.
    
    LOGIC:   FN(1)&FN(2)&FN(3)&(FN(4)'>23740)
    MINIMUM AGE:   65
    REMINDER FREQUENCY:   5Y
    RANK FREQUENCY:   2
    FUNCTION STRING:   FI(17)&FI(19)&FI(7)&(DIFF_DATE(1,5)'>23740)
    NO. FOUND TEXT LINES:   4
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   FI
      FUNCTION PARAMETER LIST:
    4. FUNCTION NUMBER:   4
      FUNCTION:   DIFF_DATE
      FUNCTION PARAMETER LIST:
TECHNICAL DESCRIPTION
Fall 2014 - add age >=65 as indication for PCV13.  Adjust this reminder 
disease) 
which compares the date of birth to the date of administration of PCV13.
The DTIME_DIFF function in FF(22) and FF(23) compares the date of the most
recent dose to today's date.
 
FF(22)
  (((DTIME_DIFF(7,1,"DATE",19,1,"DATE","D","A")>55)&(FI(17)!
(DIFF_DATE(19,1)<23742)))!(DTIME_DIFF(7,1,"DATE",19,1,"DATE","D","A")>364)
&FI(19))!(FI(15)&'FI(19))
 
  PCV13 >55 days ago if administered <65 or immunocompromised, 
 Chemo=CH : taxonomy and drugs  
  PCV13 over 1 year ago, or 
  contraindication to PCV13 and has not had PCV13
 
 
FF(23)
  ((DTIME_DIFF(7,1,"DATE",19,1,"DATE","D","A")>55)&FI(19))!'FI(19)
 
  PCV13 over 56 days ago, 
  Or has not had PCV13
        (since this FF is used only on patients <65, it does not need to 
 LTS=Long term steroids 
        explicitly include an age like FF(22) does)
 
 
The cohort logic is divided into 2 sections - 1. for patients who need 
PCV13 first and 2. for patients who do not need PCV13.
 
1. 
(((FI(3)&FF(12))!FI(4)!FI(7)!FI(18)!(FI(16)&(FF(16)!FF(17)!FF(18)!FF(19)))
)&FF(22))
 
   
2.
!(((FI(2)&FF(13)&FF(23)))&'((FI(3)&FF(12))!FI(4)!FI(7)!FI(18)!(FI(16)&(FF(
16)!FF(17)!FF(18)!FF(19)))))&'FI(8)
 
Part 1 will not be true if unless PCV13 was given outside the required 
time periods (2M for <65 or IC, 1Y for >64 not IC), so PCV13 must be 
given and the time period must have elapsed or the patient has a 
contraindication and then FF(22) will be true.  
 
 
 
Part 2 will not be true if PCV13 was administered in the past 2 months, 
this part of the logic only applies to patients less than 65 who do not 
require PCV13.
  Cohort: 
     1. (IC or HstR or CH or LTS) and either already got PCV13 but not in 
the past 8 weeks or has contraindication to PCV13 
     2.  Other dx or age>64 and not IC/HstR/CH/LTS or has 
contraindication to PCV13 
to be due after that dose is given.
   
 
Baseline frequencies 
  1.      >65             99Y 
  2.      IC               5Y 
  3.      HstR            99Y 
  4.      HR              99Y 
  5.      LTS              5Y 
  6.      CH               5Y 
 
 
                                                
Function Findings                           Frequency  Rank 
 1    <age 65 and 2 or more doses*:               99Y     1 
 2    >age 64 and 1 dose after age 64:            99Y     1 
 3    no dose >64, IC/CH/LTS and no 2nd dose       5Y     2 
 8    >age 64, IC/CH/LTS, has PCV13, no dose>64    5Y     2 
 
 
 2    >age 64 and 1 dose after age 64:            99Y     1 
 4    >age 64,dosed <65, no dose>64, not IC/CH     5Y     2 
PPSV23 
 6    (HR or Other dx) not IC/CH and <age 65:     99Y     3 
    
 
  *2 doses are counted only if given more than 1460 days apart (4Y) or 
one is   marked as a booster dose.  
   
 
For IC/CH/LTS: FF 1,2,3,8 
 
  FF3 above can be explained this way - Patient is IC and has had a dose 
   
before age 65, needs a second dose 5 years later. FF(3) is true and the 
reminder is due 5Y after the recorded dose.  
   
  If that second dose is given, then FF(1) takes over and the reminder is 
resolved (99Y).  
   
  If the patient turns 65, then FF(8) is true and the reminder is due 
again 5Y after the last dose.  Once that dose after age 65 is given, then 
FF(2) takes over and the reminder is resolved (99Y).  
   
 IC: immunocompromised (HIV, renal failure, nephrotic syndrome, splenic 
   
For no IC/CH/LTS 
  Baseline dose due for HR and HstR, FF6 sets for patients <age 65 who 
are not IC/CH/LTS. Once they turn 65, then FF4 is applicable and the 
reminder is due 5 years after the prior dose.  Once a dose is given after 
age 65, then FF2 is applicable and any dose after age 65 will resolve.  
 
 
Resolution: PPSV23 or deferral or an order 
 
dysfx, etc. 
 
 
FF5 provides a message about the need for an additional dose after age 65 
if the patient's most recent dose was prior to age 65 for non-IC/CH/LTS 
patients.  
 
FF7 provides a message about the need for an additional dose after age 65 
for IC/CH/LTS patients who have already gotten PCV13.  
  
FF10 assesses the last 2 doses of pneumococcal vaccine to be sure that 
 Highest Risk= HstR: cochlear implant, CSF leak 
they were more than 4 years apart 
  
FF16, 17, 18 and 19 look at finding 16 and evaluate to see if it is an 
ICD code, an outpatient drug or a non-intravitreal administration of a 
chemotherapy drug.  
  
FF20 provides a message if PCV13 is needed.  This is just in case someone 
looks at this reminder to see why it is NOT due.  
 
 
 High Risk=HR - Other Diagnoses: (cardiac, pulmonary, smoking, liver 
Update June 2015 - ACIP changes recommendations to increase time period 
from PCV13 to PPSV23 to one year for patients age 65 and older who are 
not immunocompromised. Remains 8 weeks for patients <65 or who are 
immunocompromised.
 
Two new function findings are added:  FF(22) and FF(23)
 
The time period for waiting ((2M for <65 or IC, 1Y for >64 and not IC) 
is based on the age of the patient at the time of the vaccine 
administration.  In FF(22) this is represented by the DIFF_DATE function 
CUSTOMIZED COHORT LOGIC (((FI(3)&FF(12))!FI(4)!FI(7)!FI(18)!(FI(16)&(FF(16)!FF(17)!FF(18)!FF(19))))&FF(22))!(((FI(2)&FF(13)&FF(23)))&'((FI(3)&FF(12))!FI(4)!FI(7)!FI(18)!(FI(16)&(FF(16)!FF(17)!FF(18)!FF(19)))))&'FI(8)
INTERNAL PATIENT COHORT LOGIC (((FI(3)&FF(12))!FI(4)!FI(7)!FI(18)!(FI(16)&(FF(16)!FF(17)!FF(18)!FF(19))))&FF(22))!(((FI(2)&FF(13)&FF(23)))&'((FI(3)&FF(12))!FI(4)!FI(7)!FI(18)!(FI(16)&(FF(16)!FF(17)!FF(18)!FF(19)))))&'FI(8)
PATIENT COHORT FINDINGS COUNT 25
PATIENT COHORT FINDINGS LIST 3;FF12;4;7;18;16;FF16;FF17;FF18;FF19;FF22;2;FF13;FF23;3;FF12;4;7;18;16;FF16;FF17;FF18;FF19;8
CUSTOMIZED RESOLUTION LOGIC FI(5)!FI(6)!FI(14)
INTERNAL RESOLUTION LOGIC FI(5)!FI(6)!FI(14)
RESOLUTION FINDINGS COUNT 3
RESOLUTION FINDINGS LIST 5;6;14
AGE FINDINGS COUNT 11
AGE FINDINGS LIST 2;3;4;16;18;FF1;FF2;FF3;FF4;FF6;FF8
INFORMATION FINDINGS COUNT 12
INFORMATION FINDINGS LIST 1;9;12;13;15;17;19;FF10;FF20;FF21;FF5;FF7
WEB SITES
  1. URL:   http://www.cdc.gov/mmwr/preview/mmwrhtml/00047135.htm
    WEB SITE TITLE:   CDC Site on Pneumococcal Immunization
  2. URL:   http://odphp.osophs.dhhs.gov/pubs/guidecps/text/CH66.txt
    WEB SITE TITLE:   Dept HHS Information on Pneumococcal Vaccination
  3. URL:   http://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.html
    WEB SITE TITLE:   Patient Handout (VIS) for Pneumococcal Vaccine
  4. URL:   http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm
    WEB SITE TITLE:   CDC Recommendations on use of PPSV23 for Adults (Oct 2012)
  5. URL:   http://vaww.prevention.domain.ext/Pneumococcal_Immunization.asp
    WEB SITE TITLE:   VHA Pneumococcal Immunization Guidance Statement
  6. URL:   http://vaww.prevention.domain.ext/docs/PneumococcalImmunizationsAlgorithm.pdf
    WEB SITE TITLE:   Pneumococcal Immunization Algorithm for PPSV23 and PCV13
# OF GEN. COHORT FOUND LINES 0
# GEN. COHORT NOT FOUND LINES 0
# GEN. RES. FOUND LINES 0
# GEN. RES. NOT FOUND LINES 0
BASELINE AGE FINDINGS
  1. REMINDER FREQUENCY:   99Y
    MINIMUM AGE:   65
    AGE MATCH TEXT:   
    Pneumovax due once for patients 65 and over.
    
    NO. OF AGE MATCH LINES:   1
    NO. OF AGE NO MATCH LINES:   0
  2. REMINDER FREQUENCY:   0Y
    MINIMUM AGE:   0
    MAXIMUM AGE:   64
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
# SUM. COHORT FOUND LINES 0
# SUM. COHORT NOT FOUND LINES 0
# SUM. RES. FOUND LINES 0
# SUM. RES. NOT FOUND LINES 0