2010 AAP National Conference & Exhibition

2012 AAP NCE Selected Short SubjectTracking Immunizations InYour Practice and CommunityStuart T. Weinberg, MD, FAAPVice Chair, AAP Council on Clinical Information Technology (COCIT)

Assistant ProfessorDepartments of Biomedical Informatics and PediatricsVanderbilt University School of Medicinestuart.weinberg@vanderbilt.eduOctober 22, 2012Faculty Disclosure InformationIn the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.

I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentationObjectivesUnderstand how recent efforts to bar-code vaccine products will assist in recording patient information.

Describe how vaccine data is shared through importing from and exporting to existing immunization registries.

Visualize methods to reconcile vaccine data from multiple sources.

Describe examples of practice workflow where vaccine data is compiled and assessed prior to a visit.

Learn about immunization assessment/forecasting web services and the potential role they can play in adding functionality to electronic medical records.

Definition of Biomedical InformaticsThe scientific field that deals with biomedical information, data, and knowledgetheir storage, retrieval and optimal use for problem-solving and decision making. (Shortliffe)The discipline dealing with the structure, organization, utilization, and communication of health-related information.Pertinent to clinical care, research, education, and administration.

5What is Bioinformatics?Bioinformatics is the study of how information is represented and transmitted in biological systems starting at the molecular level--Altman

Medical InformaticsBioinformatics

6Information Technology and InformaticsInformation technology centers on the technical tools hardware and software

Clinical informatics highlights people, process, technology.

There are several peer-reviewed journals AND on Sep 22, 2011, Clinical Informatics became a Board-Certified Medical Subspecialty, sponsored by the American Board of Preventive Medicine.

Vaccine Barcodes What is the Workflow?A CDC 2D Vaccine Barcode Pilot began in August, 2012, involving 10+ States/CDC immunization program grantees, 220 Immunizers (public, private, and commercial), and 1-3 vaccine manufacturers . More info at: www.2dbarcodepilot.com

As of August, 2D barcoded vaccines currently shipping were Menactra, Pediatric DT, and adult HAVRIX.

Future distribution was planned for Adacel, Fluzone, Daptacel, Tenivac, IPOL, and Pentacel.

Barcodes are on the vials, *not* the packages. May have implications for vaccine inventory. Different workflows for practices with and without EHRs?Vaccine Barcodes The Pilot ProcessParticipating manufacturers will place a 2D barcode, containing the vaccine type (GTIN/NDC), the expiration date, and the lot number, onto a vaccine vials primary packaging (label);

Upon vaccine administration, immunizers will scan the vaccine barcodes;

Immunizers electronic medical record system, or other records system, will be automatically populated with the three vaccine data items, and;

Data will be transmitted to the participating grantee immunization information systems (IIS) using the existing transmission method. Data that is transmitted will be used to assess the ability to improve the efficiency of immunization record keeping, as well as the availability and accuracy of immunization information in the IIS.

Source: www.2dbarcodepilot.com/pilot_overview/Immunization RegistriesJuly, 2010: The Task Force on Community Preventive Services recommends immunization information systems on the basis of strong evidence of effectiveness in increasing vaccination rates.

Evidence is considered strong based on the findings from 71 published papers and 123 conference abstracts showing that IIS are directly related to increasing vaccination rates and reducing vaccine-preventable disease.

FOR PROVIDERS:

Communication with immunization registries could provide a more complete vaccination history Access may be an issue. Is it through a portal or is immunization information integrated with your sites existing EHR?Tennessee Immunization Registry OverviewTWIS (Tennessee Web Immunization System) technically refers to the web portal for the SIIS (State Immunization Information System)

Overseen by the Tennessee Immunization Program (TIP), located in the Communicable and Environmental Disease Services (CEDS) section of the Bureau of Health Services in the TN Department of Health.

Medical Director of TIP is Kelly Moore, MD, MPH.

Established in 1994 TN birth certificates automatically uploaded to create a demographic record (low birth weight, preterm births, sealed birth certificates excluded).

State law specifically authorizes voluntary participation by healthcare providers (allows them to share these data with the state)

Opt out provision for parents who notify TDH to remove or block childs record.

TN Registry HL7 Message Exchange StatusAt present, the following methods are available for data exchange with the registry:

- Batch (2,000 messages or less)- Fast Batch (negotiable)- [not real-time]

GSA Contractor is creating a method to convert flat files to HL7 message to assist nontraditional providers who would not have or be expected to have HL7 established (or those who would not benefit from meaningful use, e.g., pharmacists).Current Vanderbilt TN Registry ProcessOvernight, a batch request is electronically sent to the state for all patients scheduled in selected clinics for the next *3* days (whose records have not already been requested). This request is processed by the state and the results are retrieved by Vanderbilt and stored *separately* from Vanderbilts electronic immunization records.

During the day, at 20-minute intervals, small batches of requests (no more than 20) are electronically sent to the state to handle newly-scheduled and walk-in patients. Responses are usually available within 20 minutes by the time the next request is made.

The status of the immunization request from the state is displayed on an electronic outpatient whiteboard for each clinic. [P- pending; n/m no match; D done successfully; H hold on administering vaccines as there are records from the state that do not match any in our system]

Clicking on the status in the whiteboard will display an integrated view of imm records from both Vanderbilts EHR and the state registry.Interfacing with Immunization RegistriesInteroperability and Reuse of Data.

Medical Communication Standards:

--HL7 (Health Level 7)--DICOM (Digital Imaging and Communications in Medicine)--CCD (Continuing Care Documentation)

HITECH was passed by Congress in 2009 to support the adoption and use of Electronic Health Records (EHRs) to achieve significant improvements in care through meaningful use of EHRs by health care providers. Interoperability is a key component of meaningful use.

FOR HOSPITALISTS:

Can external charts be incorporated not only in an electronic form but a *computable* form. Example: Importing lab results not as a PDF but as discrete elements that can be graphed among existing lab work?

Can preparations for transport include a mechanism to generate documents and images that can be electronically sent to the receiving facility?

The Electronic Outpatient WhiteboardDeveloped in-house, initially for Pediatric and Adult Cancer Centers to facilitate workflow and communication. Placed in production Summer, 2005.

Pediatric Primary Care was an early adopter and has used the OPWB since October, 2005.

Apache/MySQL/PHP app which lives within the EMR environment and is integrated w/ other apps

Sep 2012 statistics: ~2,400 users per day across 130+ clinics in the Vanderbilt enterprise, tracking room movements of as many as 5,500+ patients per day.

Vendors Consortium: 18 People From 11 Vendors:Allscripts (2)Athenahealth (2)Cerner Corporation (1) 1 MDe-MDs (2) 1 MDEpic Systems Corporation (1) 1 MDGE Healthcare (1)McKesson (1) 1 MDNextGen (2)OptumInsight (3) 1 MDPhysicians Computer Company (2)Sage Software (1)

CDC Survey Assessing Variability Among Immunization Information System (IIS) Vaccine Forecasting AlgorithmsPresented at the National Immunization Conference, April 21, 2010

9 test cases submitted to 44 of 56 IIS grantees which met forecasting functional standard

Response rate: 36/44

Of the 36 IIS forecasting algorithm tools testing the nine cases, 19 (53%) IIS forecasted the next dose due > 5 days before the minimum age for at least one test case or more.

Objectives - RevisitedUnderstand how recent efforts to bar-code vaccine products will assist in recording patient information.

Describe how vaccine data is shared through importing from and exporting to existing immunization registries.

Visualize methods to reconcile vaccine data from multiple sources.

Describe examples of practice workflow where vaccine data is compiled and assessed prior to a visit.

Learn about immunization assessment/forecasting web services and the potential role they can play in adding functionality to electronic medical records.

Questions?Contact Information:

Stuart T. Weinberg, MD FAAP615-936-4239stuart.weinberg@vanderbilt.edu

http://medschool.vanderbilt.edu/dbmi/people/weinberg