Bilateral Communication With the New York Citywide Immunization

Registry

Angel Aponte

Computer Specialist (Software)

Contact: aaponte@health.nyc.gov

Outline• New York Citywide Immunization Registry (CIR)

introduction

• Open Source technologies used at CIR

• CIR electronic data exchange– Immunization reporting

– Immunization information sharing

– Decision support for immunization schedule

• Current methods

• Emerging solutions

New YorkCitywide Immunization Registry

• Immunization Information System for the New York City area

• Implemented in 1997• NYC has mandatory reporting of vaccinations of

children 0-18 years of age– Birth to < < 8 years old since January 1, 1997– Birth to < 19 years old since August 18, 2005

• Over 3.4 million records with over 36 million immunizations

• >90% of pediatric providers in NYC participate in CIR• Population-based

Open Source TechnologiesUsed at CIR

• Red Hat Enterprise Linux (RHEL) 5 operating system• Apache Web Server, Tomcat Application Server, and

Axis for Web Services/SOAP/XMLP• MySQL database• Java, C/C++ (gcc), Python, Perl, Eclipse for

development• nagios service outage alerting system• Security: iptables firewall, nmap port scanner,

wireshark packet sniffer

CIR ApplicationLogical Architecture

Current Methods of Reporting• Web File Repository (WFR) for batch electronic

submission, data quality feedback, and retrieval

• Reporting:

– Paper: 27,130 forms per month are key entered and an electronic file is created and submitted through WFR

– Electronic file: Facilities also perform extracts from their information systems and submit a text file to CIR

– Web: Online Registry for additions of current and historical immunizations in real-time

CIR Reporting VolumeImmunizations added to CIR for children < 8 years

4,067,281

2,311,722

1,438,9871,322,762

1,869,8001,926,219

2,042,6682,271,772

2,396,712

4,097,434

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

series pneumo other

Shift to electronic methods of reporting

Current Methods of Data Access

• Batch data exchange interface

• Online Registry for viewing immunization history and immunization schedule recommendations

• Issue immunization records in response to requests via phone, fax, mail

Current Methods of Data AccessFY 2008

Method of access %

Online Registry 72%

Electronic file extract in batch 26%

Phone, fax, mail 2%

Total 100%

Online Registry use: 2004-to date

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000110,000120,000130,000140,000150,000160,000170,000180,000190,000200,000210,000220,000230,000240,000250,000

Jan-04

Mar-04

May-04

Jul-04

Sep-04

Nov-04

Jan-05

Mar-05

May-05

Jul-05

Sep-05

Nov-05

Jan-06

Mar-06

May-06

Jul-06

Sep-06

Nov-06

Jan-07

Mar-07

May-07

Jul-07

Sep-07

Nov-07

Jan-08

Mar-08

May-08

Jul-08

Sep-08

0

200

400

600

800

1,000

facilities

All facilities

Immunizing facilities

Lookups

Imms Inserted

Patients viewed

Health code amendment

CIR based DAR went into effect

new OR w add Patient feature

• Provide current information to doctors through their healthcare facility’s electronic system

• Provide decision support services• Enable real-time reporting from doctor’s system• Can also be used by other CIR partners

– New York State– Other immunization registries (e.g. ~47,000 patients

< 19 years old with a New Jersey address reported to NYC CIR)

– Immunization clinics– Regional Health Information Organizations (RHIOs)

Emerging Data Exchange:Real-Time EHR Integration With CIR

CIR Web ServiceLogical Architecture

Conclusions• CIR is a successful system in NYC that uses

Open Source technologies• CIR Web application currently provides

real-time reporting and access to immunization histories and decision support

• CIR Web Services will provide these immunization information services to providers with EHRs and other partners

• Existing batch data exchange mechanisms will be maintained as a fallback solution