Immunization Information SystemsNVAC Progress Report

Alan R. Hinman, MD, MPH

NVAC Subcommittee on

Immunization Coverage

September 26, 2006

1997 NVAC Registry Initiative

• Charged with identifying barriers to developing and implementing immunization registries

• Defining milestones for development and implementation of a comprehensive plan for implementation of universal state-based and community-based immunization registries

1997 NVAC Registry Initiative

• 4 public meetings attended by >400 persons

• Testimony from 104 persons• 20 focus group interviews by CDC• “Development of Community- and State-

Based Immunization Registries” approved by NVAC January 1999

Healthy People 2010 goal

• Increase to 95% to proportion of children <6 years of age who participate in fully operational population-based immunization registries

IIS goals

• Ensure appropriate protections of privacy and confidentiality for individuals and security for information included in the registry

• Ensure participation of all immunization providers and recipients

• Ensure appropriate functioning of registries

• Ensure sustainable funding for registries

2000 NVAC IIS progress report

• Developed late 2000• Approved January 2001

Recommendations - 2000

1. Ensure appropriate protections of privacy and confidentiality for individuals and security for information included in the registry.a. Continue efforts to ensure that all registries implement

policies and procedures that meet minimum specifications for protecting privacy and confidentiality.

b. Monitor implementation of minimum specifications.c. Further explore and develop privacy and confidentiality

guidelines for interstate exchange of information.d. Continue to ensure that privacy and confidentiality

specifications are consistent with evolving HIPAA regulations.

Recommendations - 2000

2. Ensure participation of all immunization providers and recipients.

a. Intensify efforts with major payers and plans to go beyond mere endorsement and obtain commitment to participation.

b. Continue dissemination of information about the utility of registries.

c. Continue demonstration of registries’ decision support functions at the provider level.

d. Additional research on the impact of registry use on workflow in providers’ offices.

e. Additional research on the impact of registry use on parents/families.

Recommendations - 20003. Ensure appropriate functioning of registries.a. Continue advocacy and dissemination of the HL7

standards and the ACIP algorithm (perhaps making them required conditions for continued 317 funding).

b. Finalize and implement approach to certification of registries.

c. Disseminate information about how registries are being used to improve immunization coverage and immunization practices (this also serves as an important means of recruiting providers).

d. Continue to provide technical assistance.e. Assure quality of data in registries.f. Resolve remaining issues on exchange of information

between registries.

Recommendations - 20004. Ensure sustainable funding for registries.a. Continue and increase support for registries through

the 317 program.

b. widely promote use of Medicaid funds for registries and monitor implementation; explore possible use of CHIP/S-CHIP administrative funds.

c. Obtain approval to use VFC operational funds for registries.

d. Intensify discussions with insurers/health plans urging them to provide support for registries (i.e., $5/year/child covered)

Recommendations - 2000

d. Develop a 5-year $60 million/year grant program to support further development and initial operation of registries (this could be handled through a targeted increase in 317 funding). This is justified by the cost-effectiveness of registries.

e. Continue to update and expand studies of costs and benefits of registries

Participation in IIS – 2000 & 2005

2000 2005

Children <6 21% 56%

Public provider sites 38% 75%

Private provider sites 19% 44%

Percentage of children <6 participating in IIS December 31, 2005

   

FIGURE 1. Percentage of children aged < 6 years participating* in a grantee†

immunization information system-- United States and six cities §, 2005

No Report

0-33%

34-66%

67-94%

95-100%Source: CY2005 IISAR

*Participation is defined as a child having two or more vaccinations recorded in an immunization information system.

†Grantees include 50 states, five cities and the District of Columbia, funded under section 317b of the Public Health Service Act.

§Chicago, Illinois (34%-66%); District of Columbia (67%–94%); Houston, Texas (34%–66%); New York City, New York (95%–100%); Philadelphia, Pennsylvania (95%–100%); San Antonio, Texas (67%–94%).

National Coverage: 56%

 

            

            

FIGURE 3. Percentage of private provider sites participating in a grantee†

immunization information system-- United States and six cities §, 2005

No Report

0-33%

34-66%

67-94%

95-100%Source: CY2005 IISAR

†Grantees include 50 states, five cities and the District of Columbia, funded under section 317b of the Public Health Service Act.

§Chicago, Illinois (0%-33%); District of Columbia (95%–100%); Houston, Texas (34%–66%); New York City, New York (67%–94%); Philadelphia, Pennsylvania (95%–100%); San Antonio, Texas (95%–100%).

National Coverage: 44%

$0

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Estimated 317 and VFC Grant Awards for Immunization Information Systems 1995 - 2005

Source: CDC National Center for Immunization and Respiratory Diseases

IIS State Legislation (including Washington DC):

• Authorizes an IIS: 27 states (53%)

• Mandates reporting: 14 states (27%)

• Requires participation (Opt-Out): 44 states and Washington D.C. (86%)

Immunization Information SystemsState Legislation

Source: Survey of State Registry Legislation (updated 11-9-2005)

IIS Capacity to Track Adolescent and Adult Vaccinations

Provisional data from the 2005 Immunization Information System Annual Report indicate that:

• About 21% (12 of 56 grantees) report that they include birth to < 23 years of age in their IIS.

• About 63% (35 of 56 grantees) report that they include all ages in their IISs.

• 4 million births/year (11,000/day)

• Population mobility

• Extra-immunization

• Resources for immunization activities are diminishing

• Few providers use reminder/recall

Immunization Information SystemsWhy they are Still Needed

• Parents and providers over-estimate coverage

• New vaccines keep being added

• Public health emergencies

• As a source of experience for the development of Electronic Medical Records

Immunization Information SystemsWhy they are Still Needed

MCIR ActivityMCIR Activity

3.8 million records

Over 50 million immunizations are stored in MCIR

7,500 user log-ins to MCIR every day

Gogebic

Otonagon

Houghton

Keweenaw

Iron

Baraga

Marquette

Dickinson

Alger

Delta

Menominee

Schoolcraft

Luce

Mackinac

Chippewa

Cheboygan

Presque Isle

Charlevoix

Antrim Otsego

Leelanau

BenzieGrand

TraverseKalkaska Crawford Oscoda Alcona

Manistee Wexford Ogemaw Iosco

Mason Lake Osceola Clare

Gladwin

Arenac

Oceana Newaygo Mecosta IsabellaMidland

Bay

Huron

MuskegonMontcalm Gratiot Saginaw

Tuscola Sanilac

St. Clair

Lapeer

ShiawasseeClintonIonia

Kent

Ottawa

Allegan Barry Eaton Ingham Livingston Oakland

Macomb

VanBuren

Kalamazoo Calhoun Jackson Washtenaw Wayne

Berrien Cass Hillsdale LenaweeMonroe

St. Joseph Branch

Missaukee

Alpena

Roscommon

Emmet

Genesee

Montmorency

January 2001 4:3:1:3:3:0

Detroit

0 - 29%

50 - 59%

60 - 69%

70 - 79%

80 - 89%

30 - 49%

90 - 100%

Current Immunization Profile for 19 - 35 Month Old Children

Based on MCIR Data

Gogebic

Otonagon

Houghton

Keweenaw

Iron

Baraga

Marquette

Dickinson

Alger

Delta

Menominee

Schoolcraft

Luce

Mackinac

Chippewa

Cheboygan

Presque Isle

Charlevoix

Antrim Otsego

Leelanau

BenzieGrand

Traverse KalkaskaCrawford

Oscoda Alcona

Manistee Wexford

OgemawIosco

Mason Lake Osceola Clare

GladwinArenac

Oceana Newaygo Mecosta Isabella Midland Bay

Huron

MuskegonMontcalm Gratiot Saginaw

Tuscola Sanilac

St. Clair

Lapeer

ShiawasseeClintonIonia

Kent

Ottawa

Allegan Barry Eaton Ingham Livingston Oakland

Macomb

VanBuren

Kalamazoo Calhoun Jackson Washtenaw Wayne

Berrien Cass Hillsdale LenaweeMonroe

St. Joseph Branch

Missaukee

Alpena

Roscommon

Emmet

Genesee

Montmorency

4:3:1:3:3:1

Detroit

August 2006

MCIR Immunization Levels for 4:3:1:3:3:1

68

76

71

50

60

70

80

Statewide WIC Health Plan

Health Plan Incentives

• $250.00 up to date 2 year old • $100.00 up to date 2 year old• $30.00 for up to date Medicaid 2 yr. Old• $125.00 for up to date 11 to 13 yr old• Enter historical data for providers• Must participate in MCIR to become a

participating provider

Lead Data Results

• Added a lead pop-up window– Medicaid enrolled– Mapped to HR zip code

• 23% increase March – May of 2004 in lead testing as compared to 2003 data.

• Increased provider participation

Schools and Daycares

5620 Schools

92% enrolled in MCIR

5542 Daycares

81% enrolled in MCIR

• All Assessment activities done solely through Registry

– Child-care facilities (comprehensive)

– Head Start facilities (comprehensive)

– Public, Charter, Parochial, Private Schools (comprehensive)

– Specific populations • Registry Algorithm determines

compliance with childcare and school immunization requirements

– Includes varicella disease history– Includes medical and religious

exemptions to Antigens

DC Registry & Assessment

Newer uses of IIS

• IIS and adolescent/adult immunization• IIS and preparedness• IIS and vaccine shortages• IIS and interoperability with other health

information systems/health information exchanges (HIE)

Proposed NVAC recommendations

1. Ensure appropriate protections of privacy and confidentiality for individuals and security for information included in the registry.

• Continue to ensure that IIS comply with HIPAA and other applicable laws/regulations governing privacy, confidentiality, and security.

• HHS should work with the Department of Education to ensure that FERPA does not impede the sharing of immunization information among schools, healthcare providers, health departments, and IIS.

Proposed NVAC recommendations

2. Ensure participation of all immunization providers and recipients.

• Continue recruiting immunization providers by demonstrating the utility of IIS and minimizing any administrative burden participation may place on providers.

• Pursue partnership opportunities with professional organizations and other key stakeholder groups.

Proposed NVAC recommendations

3. Ensure appropriate functioning of registries.• Finalize and implement the approach to certification

of IIS by promoting third party evaluation of IIS functionality, performance, and data quality assessment.

• Resolve remaining issues on exchange of information between IIS.

• Promote integration of IIS with electronic medical records, other health information systems, and Health Information Exchanges.

Proposed NVAC recommendations

• Promote the expansion and utility of IIS by:– including persons of all ages

– changing the following data variables from optional to required status:

• patient contact information, including address, zip code and phone number

• patient race/ethnicity• patient birth order

Proposed NVAC recommendations

– adding new optional data variables:• historical vaccination flag indicator• VFC eligibility• history of varicella disease indicator• patient status indicators, including active,

inactive, MOGE, and other classifications.

Proposed NVAC recommendations

• Promote the continued development and adoption of a guidebook and best practices for IIS as started by the CDC/NIP and AIRA/MIROW workgroup to adopt uniform operational guidance and quality control procedures that ensure good data quality.

• Promote the central role of IIS in response to pandemic influenza or other public health emergencies.

Proposed NVAC recommendations

• Encourage further evaluation and feasibility studies that use IIS data to support national vaccination coverage data needs.

• Promote enhanced immunization program management by analysis and use IIS data for program evaluation, quality control, and assessment to meet state and local needs (e.g., outbreak control, VFC functions, up-to-date analyses, new vaccine uptake, identifying pockets of need, vaccine management and inventory functions, school assessments).

Proposed NVAC recommendations4. Ensure sustaining funding for registries:• Assure sustaining funding for IIS:

– Continue and increase support for IIS through the 317 program

– Increase use of VFC operational funds– Increase support from CMS– Intensify discussions with insurers/health plans

urging them to provide support for IIS (i.e., $5/year/child covered)

– Develop a 5-year $60 million/year grant program to support further development and initial operation of IIS (this could be handled through a targeted increase in 317 funding).

Proposed NVAC recommendations

– Continue to update and expand studies of costs and benefits of IIS.