Proof of Concept: A Critical Milestone on the Road to a New Immunization Information System Jenne McKibben, Oregon ALERT IIS National Immunization Conference Wednesday, April 21, 2010

Background: Oregon’s Immunization Systems ALERT: A statewide IIS since 1995 Lifespan since 2008 100% of public providers and 92% of private providers participate ~4 million demographic records, ~45 million immunization records IRIS: An immunization medical record system in use in most Local Health Departments since 2003 ~1.1 million demographic records, ~12 million immunization records Clients linked with WIC Oregon currently has two immunization systems: <slide content> Both systems were aging, but in the community, both were used heavily and both had many advocates/followers.

Motivation for Change Data was exchanged between the two systems, but synchronization was challenging Both systems were aging Expensive to support and maintain Data needs were growing exponentially Oregon’s population was increasing ALERT was expanding to lifespan ACIP schedule was becoming more complex

The Process of the Search Worked with partners to develop 300+ requirements for new IIS Conducted Request for Information, Market Analysis, Request for Proposal Chose a public domain system as base The Wisconsin Immunization Registry, as modified by New York State Oregon extends our deep appreciation to all the states and organizations who generously shared their requirements, their lessons learned and their challenges

The New ALERT IIS The new system will replace IRIS and the existing ALERT Registry Robust Oracle platform, hosted and supported by Hewlett-Packard Scalable to accommodate growing data needs, and provides emphasis on capacity for bidirectional electronic data exchange/health information exchange

The Contracting Path Broke transition down into two phases: Proof of Concept (POC) Phase 1: period of 3-6 months Contract with HP to set up instance of New York State IIS for Oregon to test Contract signed 2-20-09 System Implementation Phase 2: period of 5 years Contract with HP to construct and host Oregon IIS Contract signed 6-15-09

Reasons for Proof of Concept Offered opportunity to evaluate base system more fully against Oregon requirements Provided go/no go decision point with relatively small initial investment (~$70,000) Oregon team wanted hands-on experience with base system (Read: we have control issues)

Oregon Team POC Responsibilities Ensure staff is available to be trained on the system. Provide training facility and equipment. Review documentation provided by Contractor pertaining to the Proposed WIR. Conduct in-depth analysis of Proposed WIR solution versus the DHS Requirements.

Oregon Team POC Responsibilities Participate in an in-depth analysis, led by Contractor, of Proposed WIR solution versus Base WIR. Manage the Requirements refinement process and conduct requirements review meetings as needed. Review and approve final Deliverables.

HP Team POC Responsibilities Host POC and provide access of the system to DHS Project Team. Train DHS Project Team in operational and technical aspects of system. Provide access to all system documentation. Respond to DHS questions regarding system policies, practices, procedures and operations.

HP Team POC Responsibilities Participate in Requirements analysis meetings with DHS Project Team. Conduct and present to DHS an in-depth analysis of Proposed versus Base WIR. Document findings of these meetings and prepare draft outline of the Proof of Concept Report for review and comment. Prepare a Validated Set of Requirements that shall be managed as a baseline to guide work to be performed in subsequent Project Tasks and Phases.

HP Team POC Responsibilities Conduct a walk-through of the Validated Set of Requirements with appropriate DHS staff. Develop and submit a Proof of Concept Report that confirms that the Contractor’s Solution meets Oregon Requirements. Prepare and submit final Deliverables for approval.

Summary of Phase 1 Deliverables Proof of Concept Report Validated set of requirements Passed Passed with Modification Customization Follow-Up Preliminary Planning Documents System Design Documents

Proof of Concept - Outcomes The vast majority of mandatory requirements passed Some minor modifications were needed Ex: Adding instructions for minimum search criteria, allowing sub-potent dose flagging on historical (as well as administered) shots, etc. Some information led to additional requirements development A few key gaps were identified

Key Gaps re: Oregon Needs Tracking Eligibility by Dose Forecaster Algorithms Statewide Reminder Recall Deducting Inventory via Data Exchange

Outcomes: Launchpad for Phase 2 (Implementation) HP delivered on all written mandatory requirements and agreed to remedy key gaps Based in part on POC outcomes, Oregon decided to choose 18 optional requirements Ex: tracking/monitoring same level of detail, providing evaluation reports, duplicating close date algorithms, providing tools related to test deck and site database, redesigning data entry user interface, etc. Oregon also added 17 additional requirements Ex: prioritization of reported doses (primary vs. secondary sources), reminder recall enhancements, etc.

Outcomes: Staff Acceptance Internal partners gained knowledge about and familiarity with new system Increased confidence Provided assistance with business transition planning Gave visibility into essential training and communication messages

IIS Team Perspective: Proof of Concept Results A very strong system, customized for Oregon Increased customizations = fewer process changes Increased confidence, decreased risk in implementation phase Stonger IIS Team/Vendor Team relationship <mostly>

Why Proof of Concept Works… Vendor Team Perspective Product familiarization occurred prior to delivery teams coming together Developed common understanding of base product Provided platform for discussions

Why Proof of Concept Works… Vendor Team Perspective Provided an opportunity to establish common terminology for discussions Huge impact on requirements gathering Requirements were clearer, more defined early on Moved us further - faster

So – is the process perfect? “It’s like buying a car before you’ve have a chance to fully test-drive it…” - Gregg Russell, Immunization Coordinator, Washington County, Oregon

Next Steps: Implementation User Acceptance Testing: May 15th First Wave Public Site Roll-Out: July 15th Private Site Roll-Out: August, 2010 Schools and Childcare: Fall, 2010 Long Vacations for HP Team and Oregon IIS Team: 2011

Acknowledgements Co-authors Rick Hammontree, IIS Project Manager Mary Beth Kurilo, ALERT Director Katie Reed, HP Project Manager Rick Hammontree, IIS Project Manager ALERT IIS Team HP Development Team

Questions/Discussion?

Contact Information Jenne McKibben, ALERT Training Lead Jenne.McKibben@state.or.us 971-673-0280