Paul Melinkovich, MD Toni Lyles, RN Successes Related to Implementation of an Immunization Registry in an Integrated Health System Paul Melinkovich, MD Toni Lyles, RN Anne L. Hammer, RN Arthur J. Davidson, MD Denver Health, Denver, Colorado

Background Denver Health is an integrated health system consisting of a public hospital, public health department, 11 community-based health centers, and 13 school-based health centers. In 1995, Denver Health implemented a computerized immunization registry (ADIOS) linking all sites delivering immunizations. The registry was pre-populated with vaccine histories from patient charges. Vaccine history is added as new patients enter the system and currently administered vaccines are documented in the registry.

Registry Timeline 1995 implemented in Denver Health Public Health Immunization Clinic for all clients 1996-1997 implemented in Denver Community Health Clinics, Inpatient Newborn Nursery, Inpatient Pediatrics for pediatric clients 1998 implemented in Denver School-Based Health Centers 2002 working toward implementation for adult patients in Community Health Clinics

Registry Objectives To track all immunizations given throughout Denver Health facilities and other vaccine history. To periodically assess childhood immunization rates using Clinic Assessment Software Application (CASA). To increase immunization rates and decrease missed opportunities through provider feedback and reminder/recall activities. To create an electronic system that serves as the legal medical record of immunizations delivered at all Denver Health sites. To interface with other regional or state immunization registries

Methods Registry size monitored over time to assess growth. Immunization assessments (CASA) performed quarterly at all primary care sites for 1-year olds and 2-year olds. Immunization coverage rates trended by clinic and aggregate for Community Health Services over time. Performance Improvement support and coaching provided to all clinics to increase immunization coverage rates. Reminder/Recall and clinic specific feedback reports are integral components of Performance Improvement activities.

Methods Quarterly sample of active patients: continuously growing (~1,200 patients in 1995 to ~2,400 patients in 2001) Patients assessed between the ages of 24-35 months of age 4-3-1 coverage = 4DTP, 3Polio, 1MMR by 24 months of age 4-3-1-3-3 coverage = 4DTP, 3Polio, 1MMR, 3Hib, 3HepB by 24 months of age Paper chart audits for CASA coverage were performed in 1995 - 1996 Electronic registry audits for CASA coverage have been performed since 1997

Results Registered patients has grown to >275,000 Registry size (total number of vaccines) has increased 1,197 % over a six-year period Registry size has increased by adding history (1,071%) and by recording vaccine delivered (1,518 %) CASA immunization coverage levels, while consistently improving since implementation of the computerized registry, leveled between 2000 - 2001

Registry Growth - Patients

Registry Growth - Vaccines

Vaccine History

Denver Community Health Clinics CASA coverage

Limitations Current registry used only for assessment of preschool vaccine rates No systematic use of registry for >18 y.o. users Recent vaccine shortages have interfered with efforts to increase up-to-date rates Incomplete documentation of moved or gone elsewhere (MOGE) may impact overall up-to-date rates. Absence of compatible registries in local or state jurisdiction limit information sharing capacities.

Conclusions Use of a computerized immunization registry in an integrated health system setting was successful in improving: vaccine history documentation of vaccine delivery immunization completion rates