Texas Immunization Registry: Data Quality and Error Resolution

Data Quality and Interface Errors are hampering Texas’ ability to accurately track the COVID-19 vaccines.

This document serves to provide a brief overview of Texas Immunization Registry terminology, discuss the importance of data quality and error resolution, examine the different types of online reporting issues with corresponding solutions, present an overview of data exchange reporting, explanations on how to use the HL7 Error Guide (link below), and to offer resources for contacting the state registry when immunization reporting seems overwhelming.

Terminology

BiDX: Bidirectional Data Exchange

FTP: File Transfer Protocol for unidirectional data exchange

Web Services: A Method for reporting data in real-time or BiDX

Registry: Texas Immunization Registry

Orgs: Providers, healthcare entities, organizations, or sites

EHR: Electronic Health Records system

Importance of Data Quality and Error Resolution

ImmTrac2 Identifiers and Org Structures-

Parent Orgs have ties or associations with other orgs. If using data exchange, parent orgs report for themselves and other sites within their parent-child hierarchy. If reporting online, each site reports for themselves but ongoing data quality issues are reported up to the parent org.
Sub-Sites have ties or associations with other orgs and a parent org. If using data exchange, the sub-site’s data is reported through the parent org. If reporting online, the sub-site enters their own data.

Data Entered into ImmTrac2-

Patient and immunization records are reported by Orgs either online via ImmTrac2 or via data exchange.
Reporting Online: Once access has been approved by the registry, users are assigned one user specific ImmTrac2 user account. These accounts can access one or many locations and require three items to log in: Org Code, Username, and Password.
Reporting via Data Exchange: Data exchange reporting uses an Electronic Health Records (EHR) program or a similar system to extract patient and immunization data. Stand-alone or parent orgs are then assigned a data exchange account (not the sub-sites). Data is then reported to the registry utilizing HL7 format, via FTP or Web Services, and using the TX IIS ID for the sites who are reporting patient and immunization data. Data exchange accounts require the below items to login and report:
FTP/Unidirectionality- FTP Username (Import Code), FTP Password, and TX IIS IDs for Parent Org and Child Sites
Web Services/BiDX- Parent Org’s Facility ID, Web Services Username, Web Services Password, and TX IIS IDs for Parent Org and Child Sites

Types of Online Reporting Issues

Logging In with the Wrong Org Code

Users who are associated with multiple orgs log into ImmTrac2 with the wrong Org Code, resulting in adding patients and immunizations to an org that did not see the patient or administer the vaccine.
Registry reports, vaccine decrementation, and other data quality metrics will reflect the correct org as not reporting to the registry.
Resolution: Once logged into the ImmTrac2, users associated with multiple orgs see the Manage Access The yellow banner at the top displays the org name that the user is currently logged in under, name of the user, and the user’s role.

Parent and Sub-Site Relationship

If a parent org notices a sub-site not listed under it, then the sub-site is not associated correctly in ImmTrac2.
If a sub-site notices they are listed under the wrong parent org, then the sub-site is incorrectly associated in ImmTrac2.
Identifying Parent and Sub-Site Relationship- In ImmTrac2, select the registration/renewal tab at the top of the screen. If the user is logged in under a parent site, it appears on top with the sub-sites listed below it. Parent sites can view their org(s) and all of their sub-sites’ information.
Resolution: For both issues above, contact ImmTrac2@dshs.texas.gov and provide: one or more of the sites’ ImmTrac2 identifiers for the parent and sub-site, the Org Code, the TX IIS ID or physical addresses, and information on the issue that needs to be resolved.

Incorrect Lot Number Entered

A user or org identifies that they entered in the incorrect lot number for a vaccine. Example: Lot number allocated to the org was EK5730, but user entered EK0
For COVID-19 administrations, the lot numbers must be entered correctly for proper inventory decrementation.
Resolution: An org who reported the immunizations or an org who administers immunizations have the permissions in ImmTrac2 to edit immunizations. Locate the ImmTrac2 Client’s immunization record and the vaccine with the incorrect lot number. Select the Edit Icon next to the vaccine (appears as a pencil on three blue lines at the far-right side of the screen).

Immunization Entered by Wrong Org Code

A user or org identifies that they entered vaccinations under the wrong org code. Example: Org who administered COVID-19 vaccinations was NORT0321 but org who reported it was WELS0026.
For COVID-19 administrations, the org who was shipped and provided allocations must report in ImmTrac2 that they administered the vaccinations for proper inventory decrementation.
Resolution: Log in with the correct Org Code and locate the ImmTrac2 Client’s immunization record and update the vaccine with the incorrect information. Validate if the immunization is reported correctly. Under the Owned? Column, if it states No, this means that another org reported the immunization. When you select the No hyperlink, a pop-up window appears with the Org information of who reported (“owns”) this immunization. If this window is incorrect, then close the pop-up window. A user from the org who reported it incorrectly must log in and locate the immunization needing to be corrected. Select the Edit Icon next to the vaccine to delete the immunization. The Edit Immunization screen should display. Locate and press the Delete A pop-up window should appear asking “Are you sure you want to delete this immunization?” Press the OK button to proceed with the deletion. The immunization is deleted but verify this by looking at the immunization record. For COVID-19, you must immediately add the correct data to retain the patient in the system. A user associated to the correct Org must log in and enter the immunization immediately.

Incorrect DOB for Patient

If the DOB error does not change the ImmTrac2 Client from a minor to an adult or vice versa, simple edits can be made to correct the issue.
Resolution: Go to the client’s record and verify DOB. Select the Edit Client Make the correction to the DOB and select Save.
If the DOB error does change the ImmTrac2 Client from a minor to an adult or vice versa, then contact the registry for assistance in deleting the data.
Resolution: Contact ImmTracMU@dshs.Texas.gov with the subject line of “COVID DOB Correction—Org Code [Enter Here]” then enter your Org Code. Deletion of clients can only be done at the state level. Once the state has deleted the client, then you must re-add the patient and their immunization to ImmTrac2 correctly.

Data Exchange Reporting Overview

Reporting Via Data Exchange
Uses an Electronic Health Records (EHR) vendor or similar system to extract data
Data is reported to the registry utilizing HL7 format.
Data is reported via FTP or Web Services.
Overview- Messages are reviewed for data quality issues (errors) before being added to ImmTrac2: File Rejection (FIR), Message Rejection (MER), Client Rejection (CLR), Immunization Rejection (IMR), or Informational error or warning (IEE).
Informational Errors: data quality, does not prevent data from being added to ImmTrac2
Rejection Errors: significant problems, prevents data from being added to ImmTrac2 and must be identified and corrected by Orgs
Once ImmTrac2 identifies errors, orgs receive a response for them to identify and resolve these errors. For orgs using FTP, three reports are generated per batch file: HL7 Report (Data Quality Analysis reports), Consent Notification File (CNF), and Response (raw) error report.
For Orgs using BiDX, responses are sent immediately to your Org via your EHR and per message (Response Error Report). Contact your EHR Vendor about accessing and reviewing your error logs.

Data Quality Reports—Data Exchange Reporting

FTP Orgs: At least once per week, a user from your organization must access the registry’s FTP website to download and review any DQA reports. DQAs should be opened using an advanced text editor such as ‘Notepad++’ or ‘Programmer’s File Editor’ (PFE).
Reviewing Errors: Log into the registry’s website and click on the dqa-report Once the dqa-report folder is opened showing all available reports, click on the dqa-report (.HL7.Report.txt) you want to open. See the file structure: HL7 Message, Rejection errors for that message, and Informational Errors for that message. An HL7 message contains one client’s (patient’s) information and any immunizations your organization reported. The patient’s name is in the PID line, and the immunization is in the RXA line. Errors have an alpha numeric code followed by a short description. Example: MER-105::Message Rejected. Required Field PID-11 Missing. The short description can give you additional details to help understand what caused the error.

Using the HL7 Error Guide

The guide can be found using this link: The Texas Immunization Registry: Health Level Seven Error Guide for Electronic Data Exchange
Errors are organized by their error categories (FIR, CLR, IMR, MER, IEE) with a table of contents at the beginning. The table of contents links directly to the error.
The error code will be listed at the top of the error notification, followed by a short description of the error, the acknowledgement code, the explanation of the error, the solution to the error, and an example of the corrected HL7.
Troubleshooting Error Resolution:
Use data exchange resources
ALL errors must be corrected once identified
Review your documentation
Review your workflow
Collaborate with your EHR Vendor
Contact the registry if your EHR and IT Support team cannot resolve the error.

Data Quality Issues—Data Exchange Reporting Continued

Incorrect Parent and Sub-site Relationship

Data Reported via a specific data exchange account must have a Parent/Sub-site relationship in ImmTrac2
If the relationship is missing in ImmTrac2, the sub-site’s records will be rejected.

Example: Error: Message Rejected

Resolution: Correct the Parent/Sub-Site Relationship by submitting a site agreement renewal in ImmTrac2 to set up the missing Parent/Sub-site relationship. The instructions to do this are on page 10 of the ImmTrac2 Site Renewal Guide. If necessary, contact the registry for support. Once the relationship is corrected, resend the rejected messages for reprocessing.

Reporting the Wrong Parent TX IIS ID in Messages

MSH-4 identifies the parent org’s TX IIS ID indicating ownership of the data exchange account. If a sub-site’s TX IIS ID is in MSH-4, the message is rejected:
MER-403::Message Rejected. The “Sending Facility” in MSH-4 is a child organization; it should instead be the parent organization.
Resolution: Report the correct parent TX IIS ID in Messages by contacting your IT support and EHR vendor to update MSH-4 and informing them that the MSH-4 must always be the parent org’s TX IIS ID. Once the issue is corrected, resend the rejected messages for reprocessing.

Reporting the Wrong Code TX IIS ID as “Administered the Immunization”

TX IIS ID populated in RXA-11.4 signifies that org administered the vaccination report.
ImmTrac2 does not validate whether the RXA-11.4 is the correct org based on vaccine reported or lot number.These issues are not flagged as an error in your DQA reports.
ImmTrac2 only validates if the TX IIS ID in RXA-11.4 is associated to the parent org.
COVID-19 immunizations must be reported by the org they were allocated to. COVID-19 immunizations reported by other sites will not decrement from VAOS. The reporting org is identified by the administering org’s TX IIS ID in RXA-11.4
Resolution: Correct the TX IIS ID as “Administered the Immunization” by working with IT support and your EHR vendor to map all sub-sites with the correct TX IIS ID. The Org will then send the incorrect data with a deletion indicator in RXA-21 to remove incorrect data from ImmTrac2. Once this is done correctly, the Org will send the corrected data and the corrected TX IIS ID in RXA-11.4 to add the correct data to ImmTrac2.

Lot Number Entered Incorrectly

ImmTrac2 does not validate whether the lot number reported in RXA-15 is valid or correct, and it will not be flagged as an error in your DQA reports!
Registry staff perform high-level analysis for COVID-19 immunization to determine if the lot numbers reported match what was allocated.
The lot number reported to ImmTrac2 must be exactly as listed on the medication to decrement in VAOS.
For example, the Org received a COVID-19 allocation with lot number EK5730 but reported: unnecessary spaces (EKk5730), swapped characters (EK5370), additional characters (EK05730), incorrect characters (EKS730), or anything other than the lot number (Unknown).
Resolution: Update the correct lot number by retraining staff to enter the lot numbers in EHR as it appears on the medication, make corrections in EHR with the accurate lot number, and resend the immunization records with the corrected lot number. If the only charge made is the corrected lot number, ImmTrac2 updates the existing information and does not create a duplicate immunization.

Incorrect Date of Birth for Patient

Future DOB: DQA Report populates CLR-303::Client Rejected. Invalid date of birth. Must be prior to or equal to today.
Resolution: Retrain staff to enter patient information EHR accurately and make the corrections in EHR with the accurate DOB. Resend the patient and immunization records with the corrected DOB.
Incorrect DOB for age
ImmTrac2 does not validate whether the age is appropriate for the immunization via data exchange.
Not flagged as an error in your DQA report.
Registry staff perform high-level data analysis for COVID-19 patients to determine if the age matches priority groups being immunized.
Resolution: This sometimes causes a change to the ImmTrac2 client from a minor to an adult or vice versa. Contact the registry via ImmTracMU@dshs.Texas.gov for assistance in deleting the data. When you are contacting the registry, use the subject line of “COVID DOB Correction—Org Code [Enter Here]” then enter your Org Code. The deletion of clients can only be done at the state level. Once the state has deleted the client, then you must resubmit the corrected patient and their immunization to ImmTrac2.

Missing or Incorrect County of Residence for Patient

ImmTrac2 does not validate whether the patient’s county of residence is missing or incorrect in PID-11.9 and will not be flagged as an error in your DQA reports.
Registry staff perform high-level data analysis for COVID-19 patients to determine if the county of residence is missing or incorrect.
Results in state and DSHS county level of reporting to be inaccurate.
The patient/client home address county is a required element for COVID-19 reporting, as required by the CDC. The client’s county must be reported using the county FIPS code in PID-11.9
This information is used by the state for reporting to the CDC.
Resolution: Work with IT support and EHR vendor to update systems to include FIPS County Code for patient address in PID-11.9. FIPS County Codes are five digits. The first two are the FIPS code of the state, and the next three are for the county. Send the corrected data via data exchange to have registry records updated with FIPS County Code.

Missing or Incorrect Race and/or Ethnicity for Patient

ImmTrac2 does not validate whether the patient’s race or PID-10 and ethnicity in PID-22 are missing or incorrect. These will not be flagged as errors in your DQA reports.
Registry staff perform high-level data analysis for COVID-19 patients to determine if the information is missing or incorrect. This results in state and DSHS reporting to be inaccurate.
Resolution: Work with IT Support and EHR vendor to update systems to include HL7 Codes for patient race and ethnicity to the PID segment. Send the corrected data via data exchange to have registry records updated with correct race and ethnicity codes.

Major Takeaways

Regardless of reporting online or data exchange, you must always:
Check if you are reporting under and for the correct org
Identify any and all data quality issues
Resolve all data quality issues timely
Resubmit data that rejected or resulted in error
Report lot number accurately, and
Report all required elements, including: Patient County, Race and Ethnicity.
Use Registry Resources available on their website-
https://www.dshs.texas.gov/immunize/immtrac/
Contact the registry by email if IT Support and EHR vendor cannot resolve the issues alone:
ImmTrac2@dshs.texas.gov for access, site registrations or renewals, etc.
ImmTracMU@dshs.texas.gov for data exchange and promoting interoperability