Urgent Clinical Safety Notification - Flu Indicators

Cegedim has been made aware of a number of issues relating to the ‘Seasonal Flu Vaccination’ and ‘Flu Clinic Under 65y’ pathways available in Vision+, with one that also affected Clinical Audit, resulting in any of the following across the 4 home nations of the UK:

(1) – Some patients incorrectly being included in the output of these pathways as suggested to be invited for a flu vaccination because they have been identified as ‘high risk’ when they are not - e.g. patients with hay fever, allergic rhinitis, psoriasis, conjunctivitis, etc (Vision+ England only; Clinical Audit Wales, England and Northern Ireland)

(2) – Some patients <65 years old not being included in the output of these pathways as suggested to be invited for a flu vaccination when they should be (Vision+ all 4 UK home nations)

(3) – Some patients >65 years old erroneously being invited for a second flu vaccination when they have already had one (Vision+ all 4 UK home nations)

(4) – Discrepancies in Quality Assurance and Improvement Framework (QAIF) reporting of flu vaccination data (Vision+ Wales only)

Issue (1) is as a result of an erroneous version of the PRIMIS specification. Issues (2), (3) are as a consequence of pathway authoring errors. Issue (4) was caused by a misinterpretation of the QAIF business rules.

Both Vision+ pathways have been corrected, including in line with the latest version of the PRIMIS specification, to address issues (1), (2) & (3) - version 87 of the ‘Seasonal Flu Vaccination’ and version 5 of the ‘Flu Clinic Under 65y’ pathways have been uploaded and are available for download and use by practices. The use of these latest versions of both pathways will ensure that patients are appropriately included in the output for invitation for a flu vaccination. Because issue (1) was due to problems with the PRIMIS specification, this also affected Clinical Audits. Updated Clinical Audits were published on the Influenza Seasonal Campaign Help Centre and a communication was posted via the Vision front screen on 12th October 2020 here.

Regarding issue (4), QAIF reporting for flu vaccination is picking up vaccinations done in last year’s (2019-20) season, so showing patients have been vaccinated when they haven’t. An urgent update is being prepared and will be deployed in a future Vision+ release which will correct any QAIF reporting discrepancies. In the meantime, it is recommended that alternative reporting method (such as the latest available version (87) of the ‘Seasonal Flu Vaccination’ pathway) is used by practices across NHS Wales.

In the event that any patients have been invited for flu vaccination who should not have been as a result of the issues above, Cegedim would request that such invitations are cancelled by GP practices with an explanation given to those patients that they were incorrectly invited as a result of an error with the original influenza reporting lists.

It is very unlikely that any ‘low risk’ patients who have had a flu vaccination as a consequence of erroneously being identified as ‘high-risk’ (as per issue (1)) will come to harm as side-effects from the vaccine are rare and usually mild, and the patient will have the benefit of vaccination that they wouldn’t usually have.

Please note that the purpose of the flu vaccination lists and alerts generated by Vision+ and Clinical Audit is to assist practices and clinicians in inviting and discussing flu vaccination with candidate patients. It remains the responsibility of the clinician administering the vaccine to ensure they are comfortable that the patient they are giving a vaccine to is eligible.

Cegedim Healthcare Solutions and PRIMIS apologise for any inconvenience caused.