Integrating Registries and AFIX for Data Quality I’m excited to be here today to tell you the way that Michigan utilizes the registry with our record assessment service to aid providers in their goal at increasing immunization rates. Barbara Day AFIX Assessment Specialist Phone: (313) 378-4533 E-mail: DayBar@Michigan.gov Stephanie Sanchez AFIX Assessment Coordinator Phone: (517) 335-9011 E-mail: Sanchezs@Michigan.gov

How does Michigan integrate AFIX and the Registry (MCIR)?

What is AFIX? AFIX is a quality improvement strategy to raise immunization coverage levels and improve standards of practices. Assessment of immunization coverage of public and private providers, Feedback of diagnostic information to improve service delivery, Incentives to recognize and reward improved performance, and eXchange of information among providers To have an understanding of the way in which we integrate our record assessment service- AFIX (Assessment, Feedback, Incentive and eXchange) and our registry (MCIR) let me tell you briefly about our immunization record assessment service. This is a voluntary service offered to any provider or practice. We use the AFIX methodology for our record assessment. AFIX was developed and endorsed by the Centers for Disease Control and the National Immunization program.

What is MCIR? Michigan Childhood Immunization Registry Michigan’s answer to every immunization question! MCIR is an electronic statewide childhood immunization registry that is accessible by private and public providers. Keywords for discussion: MCIR is legislated Michigan is “opt out” Available for use on the web (internet)

What is MCIR? Over 32 million shot records in the MCIR 2000 users access MCIR everyday 1932 provider offices submitted immunization data in 2002 to MCIR 2.8 Million Child Records Over 32 million shot records in the MCIR

How does Michigan integrate AFIX & MCIR? Conduct chart review at provider office using CASA Perform a quality data comparison (QDC) Information is presented in a feedback meeting to provider and staff Contact provider and set up appointments Chart review Feedback meeting

Chart review at provider office AFIX staff reviews charts of children 19-36 months of age (maximum 200 charts) Name, date of birth, dose dates are entered into CASA Prior to the assessment date the provider pulls specific charts to be available to the assessor for the review. On the day of the chart review the assessor will go to the provider’s office with a laptop which is loaded with the CASA software and input the data necessary for the assessment. The data that we use is the name of the child, the date of birth, and all of the immunization dose dates found in the patient’s chart.

How does Michigan integrate AFIX & MCIR? Conduct chart review at provider office using CASA Perform a quality data comparison (QDC) Information is presented in a feedback meeting to provider and staff Contact provider and set up appointments Chart review Feedback meeting

AFIX staff performs the quality data comparison (QDC) The data abstracted from the patient chart is compared with the data in the Immunization Registry The assessment specialist will review up to 200 charts for a provider. That is over 3000 dose dates that are entered into CASA and then accessed in the MCIR!

AFIX staff performs the quality data comparison (QDC), continued Dose dates added to the registry Dose dates identified in the registry that are not in the patient chart Duplicate dose dates are “de-dupped” Identify discrepancies between dose dates in the MCIR and patient chart This is a time consuming yet extremely beneficial service that we provide for our health care professionals! A “good” practice –one that uses the registry faithfully – may take only one minute per child for the QDC while a practice that uses the registry sporadically may take up to 3 minutes or more per child to perform the QDC. Dose dates that are missing in the MCIR are added at this time Missing dates (from the providers’ charts) are identified and a copy is printed out Duplicate dates are identified and corrected Discrepancies between the dates in the MCIR and the chart are identified so that corrections can be made

This year from January thru September – the specialists have entered over 9000 dose dates into the MCIR. Also, over 12,000 dates have been “found” for providers. This can be a tremendous time saver for practices! Since the providers did not have these dates in their records – these additional doses could have been duplicated at the practice. Imagine how much time would be spent administering these 12,000 doses to children!

The possible errors identified could be due to transcription errors – clearly showing how important documentation is for accurate assessment purposes. They also could have occurred in the billing process or data entry – after all – we are human! The MCIR does not recognize (yet!) that specific types of vaccine are the same – hence the duplicates accepted into the registry. For example – Hep B and the combination Hib-HepB would be considered 2 separate vaccines and both dates would be accepted. With enough information – the specialist can identify the correct dose and delete the duplicate to clarify the data in the registry

What is the benefit of a QDC? Assures that the most accurate immunization information is both in the registry and is given to the provider to add to the patient chart With children as transient as they are these days – moving from provider to provider for immunizations – it is essential that a statewide electronic registry is used and accessed for immunization status. This will help keep our children from being “over” immunized as well as “under” immunized.

During the feedback presentation the provider & staff receives Copy of immunization record from the MCIR with dose dates highlight that were not in the patient chart Because of the extensive QDC that we perform for the office – we are able to supply them with several useful tools to aid in appropriate immunization in their practice. We give them a copy of the immunization dose dates that were found in the MCIR We let them know how many dose dates were added to the MCIR for their patients We give them a list of the children who were assessed as not being “up to date” We also give them a list of children who have records of invalid doses as well as children who are not entered into the MCIR.

During the feedback presentation the provider & staff receives Copy of immunization record from the MCIR with dose dates highlighted that were not in the patient chart Number of immunization dose dates added to the MCIR for the provider List of children not up to date List of children who had received invalid doses Because of the extensive QDC that we perform for the office – we are able to supply them with several useful tools to aid in appropriate immunization in their practice. We give them a copy of the immunization dose dates that were found in the MCIR We let them know how many dose dates were added to the MCIR for their patients We give them a list of the children who were assessed as not being “up to date” We also give them a list of children who have records of invalid doses as well as children who are not entered into the MCIR.

Here is an example of 13 public clinics that have had an AFIX visit this year. Even though these clinics perform an excellent job with their data in the clinic – we demonstrated that by accessing the MCIR they l have a more complete immunization record for their patients.

Benefits of Collaboration of AFIX & MCIR Assures quality of data in the MCIR and in the patient chart Demonstrates how the use of MCIR can increase immunization coverage levels Demonstrates how to prevent the inefficient practice of over immunizing Using the MCIR for every child with a visit saves time for the provider office There are many benefits to collaborating AFIX with MCIR. Discrepancies are clarified – We can demonstrate how immunization coverage levels can be increased We show how MCIR saves time and money for the practice by minimizing the inefficient practice of over immunizing And………

Benefits of Collaboration of AFIX & MCIR Everybody Wins!! Increased awareness of immunization rates Save time and money Accurate data in MCIR and patient chart Everybody wins when utilizing the MCIR in the best possible way! Adding the QDC to our AFIX assessment enhances the amount of information that we can pass on to our providers in the never ending quest for higher immunization rates which means only one thing – Protection for our children!