MICHIGAN CARE IMPROVEMENT REGISTRY MCIR ACROSS THE U. P. Jeanne’ McCoy, Region 6 Coordinator r6mcir_jeanne@phdm.org

HISTORICALS 1994, Michigan began creating Electronic Birth Certificates (EBCs) for all children born in the state 1996, the Michigan Childhood Immunization Registry (Public Act 540) created Designed to record childhood immunizations given by private providers in MI 2006, (Public Act 91), MCIR expanded to adults, becoming a lifespan registry Name changed to Michigan Care Improvement Registry to reflect expansion (Click) The creation of Electronic Birth Certificates (EBCs) for Michigan’s residents began in 1994. (Click) Then in 1996, the Michigan Childhood Immunization Registry was created under Public Act 540. (Click) In the beginning, MCIR was designed for the childhood immunizations for Michigan residents, but (Click) in 2006, MCIR was expanded to a lifespan registry. (Click) The name was then changed to Michigan Care Improvement Registry to reflect that expansion.

HISTORICALS 1997, Public Health, Delta and Menominee Counties, received contract for Region 6 for FY 1998 Regional office located in Escanaba, centrally serving the U.P. from within the U.P. Current staffing, full-time Coordinator, part-time assistant (Click) PHDM was granted the contract for Region 6 starting in FY 1998, (Click) serving the entire Upper Peninsula from its central location. (Click) We currently have 2 staff, a full-time coordinator and a part-time assistant.

THEN… MCIR began as a software program Installed on office computers Connection problems Records incomplete No easy way to track inventory Resistance to using new technology/software (Click) When MCIR was first created, it was a software program (Click) that was installed on the computers in the doctors’ offices. (Click)There were connection problems, (Click) the records were, of course, incomplete at this time, (Click) and there was no easy way to track the vaccine inventory. (Click) And as usual, there was resistance to using new technology and software.

…AND NOW MCIR web-based through the State portal Assesses each record; displays due dates for overdue and future vaccinations All providers access immunization records for patients of all ages (Click) MCIR is now a web-based database which is accessed through the State’s Single Sign On Portal. (Click) Each record is assessed and MCIR provides the current immunizations that are due and those that are overdue. (Click) All types of providers (hospitals, long term care facilities, doctors’ offices) can access the immunization records for their patients, regardless of their age.

U.P. NOW! 223 sites across U.P. (and Wisconsin) using MCIR 19 different facility types, including Pharmacies Tribal Health Centers Long Term Care Facilities Obstetrics and Gynecology Family Planning Clinics Internal Medicine Urgent Care (Click) There are currently more than 223 active providers sites in the U.P. and Wisconsin (8 sites). (Click) Some of the 19 different facility types include: (read some from the list) (Click, Click, Click, Click, Click, Click, Click)

Number of Sites by County Here is the breakdown of sites in each county jurisdiction.

Number of Sites by District Jurisdiction Number of Sites Chippewa County Health Department 25 Dickinson-Iron District Health Department 37 LMAS District Health Department 24 Marquette County Health Department 32 Public Health, Delta & Menominee Counties 31 Western U.P. Health Department 52 And the number of sites in each LHD jurisdiction.

ENHANCEMENTS 2008, Vaccine Inventory Management (VIM) module introduced VIM allows providers to use MCIR to maintain an electronic inventory that: Tracks VFC doses received and administered Increases provider accountability (Click) In 2008, MCIR introduced the Vaccine Inventory Management module, (Click) giving providers (and VFC) the ability to track the VFC doses received in (Click) and the doses administered to patients. (Click) This made the provider more accountable for the VFC vaccines received under the program.

ENHANCEMENTS 2010, E-Ordering module introduced for VFC vaccine E-Order is an online order system Local health department electronically reviews and approves orders submitted by provider Vaccine shipped directly to provider offices It’s easy! (Click)The E-Ordering module for VFC vaccines was welcomed in 2010, and is working wonderfully. (Click) E-ordering is much like ordering personal items online, putting your items in a cart, verifying your information, and submitting your order! (Click) The local health department receives the order first, reviews it and approves the orders, forwarding them on to the Michigan Department of Community Health. After their approval, (Click) the vaccine is shipped directly to the provider’s office. The feedback on this module has been very positive. (Click) It really is easy!

ENHANCEMENTS 2011, birthing hospitals began training for VFC Universal Hepatitis B ordering and accountability VIM module used to balance inventory E-Ordering module used to order vaccine (Click) In 2011, the birthing hospitals across the State began training with their regional staff for the Universal Hepatitis B on-line ordering. (Click) The balancing and ordering process is almost the same as for the providers offices, except the hospitals are not doing a dose-for-dose accounting. (Click) The same e-ordering module is used to order the HepB vaccine.

U.P. Birthing Hospitals Hospital Date Pharmacy Agreement Signed Date Training Completed Aspirus Keweenaw Hospital May 6, 2011 June 2, 2011 Bell Hospital May 20, 2011 June 13, 2011 Dickinson County Healthcare System May 5, 2011 August 28, 2011 Aspirus Grand View Hospital May 12, 2011 June 21, 2011 Marquette General Health System July 6, 2011 August 25, 2011 Portage Health OSF St. Francis Hospital April 28, 2011 May 31, 2011 War Memorial Hospital September 14, 2011 November 8, 2011 This chart shows the seven birthing hospitals in the U.P. You can see the date the agreement was signed with the Pharmacist at each hospital, and the date the training for the balancing and ordering was completed. As you can see, all hospitals completed their training by therequired deadline, end-of-year 2011.

Regional MCIR New staff hired June and August 2010 Redesigned quarterly newsletter produced Easily accessible through link on MCIR News Screen Short, easy-to-read articles MCIR Quiz Winners Lorene Maulding, Marquette Medical Center-Gladstone Sara Henry, OSF Walk-In Clinic Genevieve Pokley, Marquette General Family Medicine Reminder and Recall postage reimbursement reinstated FY2010-11 MCIR Region 6 has undergone some changes in the last 2 years. (Click) In June 2010 a new Regional Coordinator was hired, and in August of the same year a new Assistant Coordinator. (Click) Starting in the first quarter of FY2011, the Region 6 quarterly newsletter was redesigned, with the first issue published in January 2011. (Click) The newsletters are linked through the MCIR News Screen to make it easy for all users to access. (Click) The newsletter is designed to be easy to read and understand so users will be able to read it quickly. (Click) A special feature of the newsletter is the Quiz. (Click) Those who answer all questions correctly are entered into a drawing. (Click) The 3 winners have been: (Click) Also for FY 2011 the postage reimbursement for the reminder/recall efforts was reinstated.

Postage Reimbursement County Jurisdiction Reimbursement October 2010-September 2011 WUPHD-Houghton $ 1,205.60 WUPHD-Gogebic $ 378.40 WUPHD-Ontonagon $ 37.84 PHDM $ 501.60 Chippewa $1,385.56 LMAS $ 136.42 DIDHD-Dickinson $ 213.84 DIDHD-Iron $ 349.36 Marquette $ 107.80 TOTAL $4,316.42 Here you can see the amount of postage each county or jurisdiction has been reimbursed during FY2011 for their reminder/recall mailings. This reimbursement assists the LHD’s with the mailing costs of these required reports. MCIR has reimbursed more than $4,300.

Site of Excellence Awarded quarterly Nominated by LHD Evaluated by MCIR Regional Coordinator Evaluation criteria includes: 4313314 profile percentage Significant rate improvement Consistently balance each month Adult immunizations Timeliness of data entry (compliancy rate) Another special feature that was reinstated for this year was the Site of Excellence Award.(Click) Each quarter the local health department is asked to (Click) nominate one provider site that has met or exceeded the criteria; in other words, they have gone above and beyond the requirements. (Click, Click, Click) A profile report is run, which will show the number of children 19-36 months of age that have the required doses for their age group. (Click) I look at whether they have had a significant improvement in the 4313314 rate, (Click) if they have consistently balanced each month with minimal borrowing and (Click) whether they are entering adult immunizations. (Click)The last report I run is the compliance report. This shows the number of days it takes for the provider to enter the shots given in their clinic. I calculate the compliancy rate and that is used in the criteria for the Site of Excellence determination.

Site of Excellence Award Recipient Sault Tribe Health Center - Sault The first site to receive the Site of Excellence Award was the Sault Tribe Health Center, in Sault Ste. Marie. Pictured here are one of the doctors and the nurses that administer the shots and enter them into MCIR.

Site of Excellence Award Recipient Bellin Health Family Medical Center - West Our second award was to the Bellin Health Family Medical Center. At the time they were the West site, but the East and West sites have now combined in their new building. They had a 100% immunization coverage rate (4313314) and a 91% compliancy rate. Pictured here are: Jennie Miller, PHDM’s Immunization Coordinator, the doctor, and the nurses responsible for data entry and balancing.

Site of Excellence Award Recipient Aspirus Grand View Clinic - Ironwood Our third award was presented to the Aspirus Grand View Clinic in Ironwood. The site was so excited they called everyone in the clinic down to see the presentation, and put the picture in the local newspaper. That’s what we like to see! Pictured here in the front are the 2 individuals responsible for all data entry and balancing for the clinic (with some of their co-workers in the background).

What Else is MCIR Staff Doing? Activity (Oct 2010-Aug 2011) Number Completed Individuals Trained 249 Training Events 118 Record Deduplications 470 Find-A-Child Forms 87 Password Resets 143 Petitions for Modification 348 What else is MCIR staff doing? We keep very busy with things like this! 249 people were trained at 118 different provider sites around the U.P. and Wisconsin. Debbie had 470 records with duplicates that she researched and merged; she processed 348 Petitions for Modification, which involved corrected/changed names, dates of birth, or gender.

Training Superior Family Medical Associates MCIR trainings are held around the Upper Peninsula, from Superior Family Medical Associates in Sault Ste. Marie,

Training Lac Vieux Desert Clinic To Lac Vieux in Watersmeet (Gogebic County),

Training MGHS – Family Care Doctors To Marquette General Health Systems - Family Care Doctors in Marquette. (Click)

Display at U.P. Immunization Conference and Kid’s Health Fair, Luce County As the Regional Coordinator, I am responsible for training providers to use MCIR; but I am also responsible for educating parents on the benefits of MCIR. So in addition to a display at the local Immunization Conference, I share materials with parents at health fairs around the U.P. about immunizations and how MCIR safeguards their records.

Anything Else? Initiatives Clean-Up Reports 4313314 Varicella HepB Run by county Run regular basis To find duplicate records To find incorrect county/state Increases profile rate (Click) Debbie runs reports, (Click, Click, Click) called initiatives, for provider offices that gives a list of children who do not meet the minimum requirements listed on the report; (Click, Click)I run county clean-up reports (Click) and examine them to flush out the duplicate records, (Click) and find incorrect address information. (Click) The intent of the clean-up reports is to help increase the profile rate for the county. (Click) These are, at a minimum, run prior to the county’s accreditation.

County 4313314 Percentages County April 2011 May 2011 June 2011 July 2011 Alger 67% 68% 71% 74% Baraga 77% 80% 79% 82% Chippewa 69% 70% 72% Delta 76% 78% Dickinson Gogebic 73% Houghton 65% Iron Keweenaw 61% 63% 62% Luce Mackinac 56% 53% 55% Marquette 75% Menominee Ontonagon Schoolcraft Here is the county-wide percentage of children current on their immunizations, 19-36 months of age. Delta County is currently at 78% (the highest it has ever been); Menominee County is 70%.

Regional Comparison State Percentage June 2011 July 2011 Region 1 68% 69% Region 2 79% Region 3 74% 76% Region 4 72% Region 5 Region 6 73% State 71% In this chart is a comparison of the 6 Regions and the State. Region 6 is at 73%.

Wait a Minute! What is 4313314? It is a percentage of children aged 19 thru 35 months old that have had a minimum of: 4 doses of DTaP/DT/Td/Tdap 3 doses of IPV 1 dose of MMR 3 doses of HIB 3 doses of HepB 1 dose of Varicella 4 doses of PCV7/13 (Click) I mentioned 4313314 several times…so what is it? (Click) That number represents the number of children, ages 19-36 months of age, that are current on their immunizations. You’ve heard that a few times already. (Click) But the numbers represent the doses of each vaccine they should have received by 35 months of age.

Thank you! Contact Information: Jeanne’ McCoy, Region 6 Coordinator 1-888-217-3905