Using Immunization Information Systems to Educate Providers on Safe & Effective Vaccine Administration JoEllen Wolicki BSN, RN Barbara Wolicki BSN, RN Michigan Department of Community Health

Acknowledgements Robert Swanson Patricia Vranesich Terri Adams Bea Salada Stephanie Sanchez Laura Korton Gerry Bragg

Michigan Divided into 45 local health department jurisdictions representing 83 counties Immunization activities with providers are conducted at the local level: VFC management including site visits AFIX Immunization Nurse Education (INE) Physician Peer Education Project on Immunization (PPEPI)

Michigan Care Improvement Registry (MCIR) Statewide registry Repository for immunization information for children and adults Capabilities include: Assessing for needed vaccines based on ACIP recommendations Managing vaccine inventory Determining valid and invalid doses Performing reminder and recall activities Generating AFIX reports

% % % % Gogebic Ontonagon Houghton Keweenaw Iron Baraga Marquette Dickinson Alger Delta Menominee Schoolcraft Luce Mackinac Chippewa Cheboygan Presque Isle Charlevoix Antrim Otsego Leelanau Benzie Grand Traverse Kalkaska Crawford OscodaAlcona ManisteeWexford Ogemaw Iosco MasonLake Osceola Clare Gladwin Arenac Oceana NewaygoMecostaIsabellaMidland Bay Huron Muskegon MontcalmGratiotSaginaw TuscolaSanilac St. Clair Lapeer ShiawasseeClintonIonia Kent Ottawa AlleganBarryEatonInghamLivingstonOakland Macomb Van Buren Kalamazoo CalhounJacksonWashtenawWayne Berrien CassHillsdale Lenawee Monroe St. JosephBranch Missaukee Alpena Roscommon Emmet Genesee Montmorency 4:3:1:3:3:1 Detroit September million records Over 62 million shot records Over 14,000 user logins to MCIR every day 2,500 provider sites submitted data in % of all MDCH web traffic 12-14k reports (PDFs) generated daily Over 24,000 registered users MCIR Facts

Adding Immunizations into MCIR

Immunization History in MCIR

Valid and Invalid Doses The “Y” Button identifies invalid doses due to following administration violations Minimum age Minimum interval “Live-Live Rule”

Managing Inventory Vaccine expiration dates are color coded

Doses Administered Report (DAR) Name of Clinic Reporting Period: 06/01/08-06/30/08 VFC Pin: 840XXX o The DAR identifies the Vaccine Age of the recipients Number of doses given DTaP <1 yr 50 Hep B <1yr 0

Provider Profile Report Dr. B. Better MD Persons at least 19 months but not yet 36 months 4:3:1:3:3:1:3 SUMMARY Number Percent Clients that Meet Above Criteria Clients not Meeting The Above Criteria Total Number of Clients Evaluated

Single Vaccine Profile- Hib Dr. B. Better MD Persons at least 6 months but not yet 12 months with 3 doses of any Hib SUMMARY Number Percent Clients that Meet Above Criteria 3 5 Clients not Meeting The Above Criteria Total Number of Clients Evaluated

MCIR and AFIX AFIX reports are generated directly through the MCIR using registry data by health department staff AFIX reports available include: Basic Overview Report Single Antigen Report Diagnostic Report Missing Immunization and Overdue Report Coming Due Report Invalid Doses List Report Summary Report including Needs 1-visit Last vaccine > 12 months ago Missed Opportunities

How do we use the information from immunization information systems promote safe vaccine administration? ????

Vaccine Administration Errors DARs showed tetanus and diphtheria containing vaccines given outside the licensed age ranges Errors with these vaccines were seen with increasing frequency by local health departments throughout the state

Educational Materials 1 page “Quick Looks” outlining recommended use were developed DTaP Td Tdap DTaP/IPV/Hib DTaP/IPV/HepB DTaP/IPV “Quick Looks” for other vaccines available at michigan.gov/immunize

Education Programs: Look Closely at the Letters VaccinesUse for ages: DTaP6 weeks through 6 years of age Td7 years of age and older TdapBoostrix  10 through 64 years of age Adacel  11 through 64 years of age Pay attention to upper and lower case letters The upper case/capital letters “D” and “P” in DTaP mean there is more vaccine antigen in DTaP (it’s stronger) than in Tdap Order, give, and record the correct vaccine based on the person’s age Refer to Quick Looks to Using DTaP; Tdap; Td

Information Distribution Local health departments network with their providers MDCH electronic newsletters and listservs Education Programs INE PPEPI 8 annual conferences conducted throughout the state State and local coalitions Web sites

MCIR.ORG Educational materials Websites links Timely messages

MCIR Welcome Screen

Looking to the Future Linking to vaccine specific information Identifying doses administered with compromised vaccines Storage and handling errors Administration errors Indicating when a dose of compromised vaccine should be repeated

In Michigan- We think MCIR rules!