Medical Configuration

This is an Important section that you should read carefully.¹⁾

Inca Clinic can be configured with a complete list of countries, diseases, vaccines and medications. If you are responsible for managing the medical protocols in your clinic, you should input and maintain this information.

This page contains very important concepts you need to understand:

1. Vaccines and Contraindications
2. Vaccine Schedules
3. The relationship between Countries, Risk Levels and Diseases. This is useful for some travel clinics.

Vaccine management is a complex area; the advice, vaccine schedules and medication that you give to your patients are influenced by national policies, recommendations from organisations like the WHO and CDC, peer groups, and your personal knowledge and preferences. Economic factors also influence which vaccines and medications may be recommended to a patient, from both the clinic's perspective and the patient's. And, of course, certain vaccines and medicines may not be available in your country.

Inevitably, this creates differences in what is prescribed and how, and it must be acknowledged that not everyone shares the same opinion on certain protocols. This may occur because there is insufficient data on the efficacy of a vaccine over time (e.g., if a patient receives a Hep A booster, does this give them cover for next 10 or 25 years, or is it lifetime cover, or is the answer, it depends?, probably?). Other questions arise for Rabies IM v ID, Varicella vaccine for travellers, and so on.

One of our long-term goals is to help improve research in these and related areas. As electronic healthcare management has never been widely used in vaccine management, so this data has been difficult to gather. By you using Inca Clinic, we can all begin this process.

You have in complete control over all the information in Inca Clinic, which is why it is important for you to decide how Inca is configured.

Your instances of Inca Clinic may initially be configured with some data on vaccines, medications, contraindications, relationship between countries, diseases and vaccines, and so on. This is Test Configuration Data that we use to test the system. You need to configure your instance of Inca Clinic to suit your needs and your preferences. If you start your configuration by using any of the Test Configuration Data then you must check, and where necessary correct, that data before using it.

You can access Information on Countries, Disease and Contraindication information by clicking on the Inca Administration tab. To access Vaccine and Medication data, use the Inca Product tab²⁾. You must be a Medical Director or System Administrator to access and edit this information.

The Medical Conditions link in the Inca Administration tab lists all of the medical conditions known to Inca Clinic. Opening a medical condition from the list shows its details, and a list of contraindications.

The Medical Conditions detail page lets you edit certain behaviours. The key fields are:

• Medical Condition: This is the name of the medical condition, medication or medical history as it will appear on the list.
• Related Gender: This control if the condition appears only for one gender. This is useful for conditions such as Pregnancy.
• Common: If checked, the Medical Condition will appear as a blue Quick-Link button on the Medical History step in a consultation.
• Active: If unchecked, the condition will not be available as a searchable term or as a Quick-Links button. When a user enters a new (previously unknown to Inca Clinic) term using the patient's medical history page, the new term's Active checkbox will not be ticked. ³⁾
• User Defined: Indicates that the user added the term during a consultation.

For reporting purposes, you can also add ICD-10 and SNOMED codes. (The Always Show field is for future use.)

The system's list of vaccines that are contraindicated for people with certain medical conditions is available via the Contraindications link in the Inca Administration tab:

This is a useful overall list. However, there are two other ways to find individual contraindications:

• if you wish to see the contraindications for a particular vaccine then you should open that vaccine (in the Inca Products tab) and scroll down to the Contraindications section.
• Alternatively, you can open a medical condition (in the Inca Administration tab) and scroll down to the Contraindications section.

To add a new contraindication, you should do one of the above alternatives, scroll down to the Contraindications section, and hit the New Contraindication button.

To remove a contraindication, you should do one of the above alternatives, scroll down to the Contraindications section, and hit the Del button on the particular contraindication you want to remove.

The Diseases link in the Inca Administration tab lists all of the diseases known to Inca Clinic. Opening a disease from the list shows its details, plus a list of vaccines/medications associated with it (in the Association with Diseases section).

Alternatively, you can open a vaccine/medication in the Inca Products tab, and scroll down to see a list of diseases associated with it (in the Association with Diseases section).

If you want to add a new association between a disease and a vaccine/medication, then you should do one of the above alternatives, scroll down to the Association with Diseases section, and hit the New Association with Diseases button. (You need only do one of these; the link in the opposite direction will be added automatically.)

To remove an association (so that Inca Clinic will no longer have a record that a particular vaccine/medication provides cover for a particular disease), do one of the above alternatives, scroll down to the Association with Diseases section, and hit the Del button on the particular entry that you want to remove.

Vaccines are a type of Product in Inca Clinic. Vaccine products have certain attributes and fields associated with them. One of the key attributes is the Vaccine Schedule: i.e., Primary, Booster and Accelerated Schedules. See how to manage vaccine administration schedules in more detail.

This feature is used by some travel clinics.

Inca Clinic has the ability to use information gathered about a traveller's itinerary to create a list of diseases that might be considered for vaccination (the “To be considered” list). Some vaccines, such as Yellow Fever, can be marked as Required for certain countries (based, for example, on the list published by WHO). You can cross-check the list in Inca Clinic with the WHO list here WHO Yellow Fever and Malaria Recommendations. It also advisable to check with the Center for Disease Control (CDC); while they follow WHO guidelines there are some variations CDC Recommendations.

Inca Clinic providers the Risk Visualiser page, which is designed to let you quickly and easily view and manage how Inca Clinic interprets disease and travel risks.

We strongly advise the you review the Managing Country Diseases and Vaccines help page and learn how to use the Risk Visualiser.

For travel clinics that wish to use this feature, the Medical Director must configure this data (the initial settings and changes to these as required over time).

The Countries link in the Inca Administration tab lists all of the countries known to Inca Clinic (if you find any more then please let us know ). For each, it lists:

• both the numerical and two letter country codes,
• the world region and the world region code,
• the Official Name, from the ISO Standard ISO-3166,
• an “Alias” name: Inca Clinic also allows an “Alias” name to be recorded for each country. You may use this, for example, to list UK as an alias name for United Kingdom. You can use the “Name Preference” field to determine whether the Official Name, the Alias or both appear as the country name (and when both appear, you can decide their order).

Here are some of the aliases in the system:

• “British Virgin Islands” is an alias in Inca Clinic for “Virgin Islands, British”,
• “Burma” is an alias in Inca Clinic for “Myanmar”
• “Holy Sea” is an alias in Inca Clinic for “Vatican City State”
• “UK” is an alias in Inca Clinic for “Unitied Kindom”
• “US” is an alias in Inca Clinic for “United States of America”
• “Laos” is an alias in Inca Clinic for “Lao People's Democratic Republic”,
• “Libya” is an alias in Inca Clinic for “Libyan Arab Jamahiriya”
• “North Korea” is an alias in Inca Clinic for “Korea, Democratic People's Republic of”,
• “South Korea” is an alias in Inca Clinic for “Korea, Republic of”.

If you feel strongly about any alias, then you can delete it; let us know and we'll help you.

The Home Country checkbox allows you selected a default country (usually your home country). When a new Patient Record is created the value of the country field will default to your home country. You can only have one home country. ⁴⁾

Inca provides a set of reports that show you how it is configured in terms of Vaccines, Contraindications and Country Recommendations. Click the Reports tab to see the full list of reports. See the current set of medical configuration reports.

These are useful additions to the supports explained elsewhere in this help page. If you are a Medical Director, Clinic Manager, or System Administrator, you should familiarise yourself with these reports. (The other reports shown relate to the underlying platform, Salesforce.com, and in particular its customer relationship management (CRM) capabilities. If you are interested in using Salesforce.com to manage parts of your clinic that Inca Clinic does not support, then please let us know.)

To access the reports, start by choosing the Reports tab. Then under the Reports Folders header, select the Inca Clinic - Medical Configuration folder, and click Go! (or you can scroll down to see these folders).

When you click Go!, you get the list of medical configuration reports:

Choose a report, for example:

The reports currently produced are documented here.

You can use the Export Details link to export the report to Excel; you may find this easier to use for some types of data.