AIRA SnapShots -- April 2005

AIRA President's Report
National Immunization Conference (NIC 2005) Highlights
AIRA Activities at the NIC
Connecting for Children's Health
Research and Evaluation Workgroup Formed
Upcoming Conferences

Click here for file (.doc).

President's Report

This important issue of SnapShots captures highlights from the registry sessions at the recent National Immunization Conference. Having a track (plenary sessions and workshops) dedicated to immunization registries was particularly important this year given CDC’s decision not to have an annual Immunization Registry Conference. Naturally, every approach has its tradeoffs and many conference participants felt the content this year was not as in-depth or as varied as past NICs and so could not due justice to the ever expanding scope and growing complexity of issues facing immunization information systems.

To help address the information needs of the registry community, AIRA is planning to partner with the Public Health Informatics Institute (PHII) to submit a funding proposal for an annual conference devoted to immunization registries and child health information system integration. We anticipate that the National Immunization Program will co-sponsor this conference and other organizations such as CMS and the Public Health Data Standards Consortium will join us as conference endorsers. The conference, if funded, will occur in fall of 2006, and bring back the in-depth coverage and sharing of issues and solutions that made the Immunization Registry Conference so valuable.

This is just one more way that AIRA is working hard to meet the needs of its members and the registry community at large. If you have not already joined AIRA, please consider joining now and being part of a knowledgeable and committed group of immunization registry professionals.

2005 National Immunization Conference Highlights

The 2005 National Immunization Conference held in Washington, DC followed a topic track system. For each track there were two plenary sessions and 10 workshops. The tracks in this year’s conference were Adult Immunization, Epidemiology, Health Communications, Immunization Registries, Programmatic and Vaccine Safety. In addition there were three plenary sessions for all tracks.

For those of you who were not able to make it to Washington, DC, or if you attended but were not able to make it to all the sessions, following are summaries of some of the different plenary sessions and workshops specifically within the Immunization Registries track. Additionally you will find highlights from sessions outside the Immunization Registries Track that were relevant. Remember, NIP has posted the agenda on their web site with links to the presentations and recordings of these presentations. This is a great resource: http://cdc.confex.com/cdc/nic2005/techprogram/meeting_nic2005.htm.

A-5: Registries as Assessment Tools to Improve AFIX Efficiency
Both presentations discussed how the use of immunization registry data in CASA had overall positive results on the AFIX process. They presented on how the process of working together helped to save time and ultimately assisted in the program effectiveness by increasing rates.

Immunization Registry Track Plenary Session - Immunization Information Systems and Clinical Interoperability
Amy Zimmerman of the Rhode Island Department of Health discussed “Creating Synergy: Clinical Care and Immunizations.” Rhode Island has been working on the implementation of a RHIO, a community based organization designed to share health information. The participants include health care providers as well as insurers and consumers. The project has been funded to include a master patient index that will allow access to records in childhood health, pharmacy, laboratory, hospital and ambulatory care databases across the state. Immunization Information Systems can bring experience and knowledge to the process and can help overcome many of the same issues that we have faced: – “you can build it, but they might not use it” – ease of use, web-based applications, the affect on current work flow, compatibility with current systems, etc.

Julie A. Boom, M.D. of the Houston/Harris County Immunization Registry, spoke on “Applying Registry Data in the Clinic Setting: Advancing Electronic Medical Records.” Many different EMRs are in use in the Houston and Harris County, TX area and there are two different immunization registries. In the process of merging the two IIS databases the region decided to take a look at fragmented records in the context of improving patient care.
Their findings since joining the two databases:
* Over-immunization was a problem – they have experienced a savings of $140,000 in cost of vaccine to date.
* Regional CASA provider recall rate has increased from 64% to 85%.
* 2440 duplicated medical records have been merged.

C-5: Managing Vaccination Catch-Up Due to Shortages with Immunization Registries
Both presentations were able to show how the registry data was utilized in managing the catch up process as well as measuring effectiveness of the recall process. See also J-5.

D-3: How to Think Like a (Social) Marketer
James B. Bender, MHS, CHES, was the sole presenter for this workshop. In this session, Mr. Bender gave an overview of social marketing principles and walked the audience through an example of a social marketing campaign – Florida’s TRUTH campaign to reduce teen smoking.

The key points from his presentation were:
Know exactly who your audience is and look at things from their point of view.
Identify the competition for your desired behavior – what would our audience rather do than what we’re asking them to do, and how do we make “our” behavior more appealing than what they’re doing now?
Focus on the greatest opportunity for affecting change, rather than on the greatest need.

The presentation slides have been posted on the web at http://www.izcoalitionsta.org/pdf/tlm.05%20b_w.pdf.

D-5: Developing Information Systems to Meet Immunization Program Core Functions
The session began with an overview of the software development process and the various roles public health and the developer play in the development and maintenance of an information system. The second presenter discussed how data from the Immunization Registry provided valuable information to many of the different departments within the Bureau of Immunizations, such as VFC, Assessment, Perinatal Hep B, and the Medical Provider Liaison.

E-5: Integration of Clinical and Management Systems for Immunization Registries
The session started with discussion of the how Imperial County Health Department (CA) evolved from the traditional silo environment, which was a result of the lack of system integration and very time consuming, to using an incremental approach where they were able to tie all their systems together, to meet the needs of the community better. The next presentation discussed the impact of providers moving to EMR and EHR systems. The need for creating interfaces with EMRs has become important in helping to decrease much of the duplicate work. The bulk of the bridging is done through billing interfaces, however, it can also be done through EMRs by creating HL7 interfaces, as well as VXU, and VXR.

Programmatic Plenary: The Programmatic Challenges of Implementing New Vaccines
In the third discussion around introducing new vaccines, Peter Szilagyi of the University of Rochester discussed how new vaccines are introduced at the provider level. He illustrated how the process should happen in the clinical setting by describing the environment, potential barriers and solutions. It was easy for those of us in the IR world to see where Immunization Registries can have a big impact in overcoming barriers in these environments. Although the speaker did not specifically mention IRs in all the scenarios, this presentation provided further illustration for the need of IRs in the practice setting.

F-5: Linking an Immunization Information System to Vaccine for Children Program Operations
The first presenter shared how including VFC specific enhancements into its immunization registry application increased usage of the registry by its VFC providers. The second presentation discussed many of the aspects of implementing VFC accountability features in a registry, such as the challenges faced getting the providers to use them.

G-5: Registry Partnerships: Collaboration Improves Outcomes
New Jersey conducted a pilot project, Quality Improvement Initiative, to test a process for integrating their IIS into the immunization administration process. A team of physicians, nurses, front office and administrative staff were pulled together at the participating provider offices to address the work flow enhancements and outcome measurements. The group has shared best practices and developed a comprehensive set of change concepts. Additionally, other sites have asked to become a part of the group. The second presentation discussed how multiple states are now using the software application developed for Wisconsin. They have formed a users group to share updates and enhancements and to discuss next steps. This collaboration enhanced the design and development process and positively impacted the cost to each state and the time needed for development.

Immunization Registry Track Plenary Session: Immunization Info Systems & Immunization Program Integration
Robert Swanson, Michigan Dept of Community Health, presented “Toward an Integrated Immunization Program: Using Immunization Information System Data, Features, and Functions to Drive Immunization Program Activities.” His presentation was an overview and history of MCIR, which started collecting data in 1997. Mr. Swanson presented on how the registry helps drive decision making. He also discussed how VFC providers report doses administered through the registry allowing DOH to manage the VFC program through the registry.

Karyn Berry, MD, MPH, of Washington, DC, presented on “Using Registry Data in Daily Program Operations.” She began with an overview and history of Washington, DC’s registry, which started in 1992. She then illustrated how the registry is used in many day to day operations such as vaccine management, provider QA, service delivery, consumer information (immunization information), childcare, WIC, Headstart, and school assessments, demographics, and immunization surveys.

J-5: Measuring Physician Compliance to Pneuumococcal Conjugate Vaccine Recommendations with Immunization Registries
Two presentations were given on research conducted using immunization registry data to determine if there were changes to the administration of vaccines at a time of shortage and how the shortage specifically impacted High Risk children. Both presentations illustrated what could be learned about immunization coverage during a shortage from the data provided from a registry. It was determined that: registry data is a good method for tracking trends as well as tracking children who need to be caught up when a shortage is over; how the data was able to provide information about the recommendations incorporation into the practice setting; and how High Risk children were being impacted.
See also C-5.

K-5: Data Standards: Meeting the Demand for High Quality Data
The presentation from New York City discussed the evolution of data exchange since they started collecting data. As a mandated registry they have always had to provide a variety of reporting options to their participants. They illustrated how the rise in EMRs and EHRs correlates to an increased awareness on all sides of the value of better data exchange, driving the desire for real time and potential two way exchange between other health care systems and the registry. The final presentation focused on the evaluation of the deduplication process and the different methods for evaluating a deduplication algorithm.

L-5: School and Registry Partnerships – How and Why
Presentations were made about the value to the community of partnerships between registries and schools. The first presentation centered around incorporating a registry within the school environment on a pilot basis. This was considered positive by the schools. The second focused on the use of school immunization data in the registry.

Submitted by Amanda Bryant, Tina Kubasiak Katie Reed and Cheryl Stevens

AIRA Activities at the NIC

AIRA was very active at this year’s NIC. In addition to the many AIRA members that presented at workshops and plenaries, AIRA committees presented three posters:

Provider Participation: Turning Barriers into Solutions
Produced by AIRA’s Provider Participation Committee, this poster presented preliminary findings of the survey we conducted last fall to identify significant barriers to provider participation in immunization registries and successful strategies for overcoming them.
Increasing Health Plan and Private Provider Participation in Registries
A collaborative effort of AIRA and Every Child by Two (ECBT), this poster highlighted the resources used to encourage data exchange between managed care organizations and immunization information systems.
Developing Recommendations for Vaccine Adverse Events Reporting via Immunization Information Systems: A Business Modeling Approach
This poster resulted from the work of the Vaccine Safety and Registry Community (VASREC) Workgroup in developing optional best practice guidelines for reporting adverse events to the VAERS System from registries.

The following AIRA committees and workgroups took the opportunity to meet face-to-face in a series of ad hoc meetings held during the conference:

AIRA Board
PROW Team
IIS Research and Evaluation Workgroup
Emergency Preparedness and Response Committee
Data Exchange Standards Committee/Workgroups
Urban/Cities Registries Committee

AIRA once again had an exhibit booth at the conference. AIRA literature was available as were demos of the AIRA web site. And the Citywide Immunization Registry of New York City gave demos of their web-based application. This was a great opportunity for AIRA to engage with conference attendees eager to learn about immunization information systems.

Connecting for Children's Health

The first meeting of Connections, a community of practice supported by HRSA/MCHB, was convened by the Public Health Informatics Institute in March. Launched in fall 2004, Connections assists state and local public health agencies to improve the health of children through the provision of accurate, timely, and comprehensive information, and to strengthen the medical home.

The meeting brought together over 40 state and local health department members, Institute staff, and HRSA/MCHB supporters to get to know each other, further their collaboration on information systems integration issues, share best practices/lessons learned to address the issues, and design the format of Connections for the next year.

Dave Ross, director of the Public Health Informatics Institute, introduced keynote speaker Dale Nordenberg, who serves as Associate Director and Chief Information Officer at the National Center for Infectious Diseases at CDC, and works with David Brailer in the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services. In this role, Nordenberg coordinates the public and private sector interoperable health information system initiatives working to improve child health. For more information, visit http://www.hhs.gov/healthit.

Connections members discussed their possible role in the national effort to develop interoperable systems to serve child health. As representatives of public health departments, they offer a significant range of experiences, relationships, and existing information systems that can advance the goals of interoperability.

Building on the excitement generated from the keynote discussion, Connections members identified several areas of promise for ongoing collaboration, including developing resources and tools, actively sharing lessons learned, encouraging more peer-to-peer meetings, and informing the national level about state and local health department activities.

Before the meeting adjourned, participants created a matrix of next steps and action items for the Connections community of practice to tackle over the next year. These ideas will be honed and the ones perceived as potentially producing the most value to the larger public health community will be further developed.

For more information on Connections, contact Lorrie Alvin (lalvin@phii.org)at the Public Health Informatics Institute.

Submitted by Terry Hastings, PHII

Research and Evaluation Workgroup Formed

AIRA, in partnership with the Immunization Registry Support Branch at the CDC, has formed a workgroup of partner organizations to discuss the moving forward of an IIS Research and Evaluation agenda. The first step of this partnership is the development of a survey tool and process to help solicit feedback from representatives of the stakeholder community on this agenda. The goal is to help identify areas of interest and help facilitate the collection and dissemination of information in these key areas. Look to future issues of SnapShots for updates on this activity.

Submitted by Katie Reed, Co-Chair Education Committee

Upcoming Conferences

Public Health Information Network Conference
Tuesday, May 10 to Thursday, May 12
http://www.cdc.gov/phin

Connecting Communities for Better Health Learning Forum and Exhibition
Wednesday, May 25 to Thursday, May 26
www.ccbhconference.org

America’s Health Insurance Plans’ (AHIP) Institute (annual conference)
Wednesday, June 08 to Friday, June 10
http://www.ahip.org/links/institute2005

National Association of School Nurses (NASN) Conference
Thursday, June 30 to Sunday, July 03
http://www.nasn.org/conference/conference.htm