California Automated Immunization Registry CASA Audit Process San Luis Obispo County Public Health Clinics Karen Turner, Regional Registry Coordinator, California’s Central Coast Immunization Registry

Presentation Scope This 10-minute presentation will show the steps I use to run CASA audits on specific San Luis Obispo County Public Health Clinics using the CAIR 2.33 product. I will not be showing how to use the template import process, which is a one-time requirement. The CAIR Application has an export function specifically designed to prepare registry information so it may be imported into the CDC CASA application. In California County immunization programs are required to submit annual CASA reports to the California Department of Health Services Immunization Branch. Two years ago my Department of Health Services field Representative asked us to start conducting quarterly CASA audits in an attempt to raise the immunization levels of children 24–35 months of age in San Luis Obispo County.

Overview Entire export process takes me less than five minutes per clinic. CAIR facilitates painless quarterly “pre-CASA” audits. Down load Import Edit CASA Report template The quarterly pre-CASA audits allow us to establish baseline immunization rates, monitor changes in rates overtime, and identify areas for improving vaccination coverage. Reminder Valid doses recall

Step One Main Menu: select “CASA extract” This is just a screen shot of the CAIR main menu. From here you would go to reports and then select CASA extract.

Step Two Provider Provider Group Provider ID Jurisdiction This is a screen shot of the top part of the CAIR CASA export page. This page allows you to make choices about the information that will be sent to CASA. CASA obtains CAIR data by reading the data from a file that has been created by the CAIR Export Page. The first choices you make are in the the provider information section. The Group field is always fixed and can’t be changed. ID refers to the provider ID and is where you can pick the specific clinic you want from a drop down list. Jurisdiction refers to the appropriate county or city you are in. This is also a drop-down list.

Step Three Patient Info DOB Start DOB End Op. Code County Zip codes Race Language Status The patient parameters narrow the scope of the export file to a set of specific patient-related parameters.

Step Four Export Settings Maximum Export Records Export File Documenta tion File Overwrite Files File Format Gzip export file CAIR can contain records of a large population of patients, and the size of an export file can be either very large or very small. Using the Maximum Export Records drop down menu you can limit the size of the export file. Document file - The files are given a default name. You can use that name or type in your own name. The file format button is very important. The Vac Row Format for exporting data to CASA is the recommended format to use. It will create a smaller file than the Vac List Format. The file will be more compact and easier to parse. In my county I do not use the Gzip feature. If you check this box the files will be compressed.

Step Five Vaccine Dose Inclusion Counting Visits Protected Data Fields All doses - Date order All doses – Valid first Valid doses only Counting Visits Within Selection Exclude Single- Visit Patients Protected Data Fields Dose Inclusion: You can chose to export all vaccine doses in date order, all vaccine doses with the valid ones first or only valid doses . In San Luis Obispo I export only Valid doses. Counting Visits: In San Luis Obispo we exclude single visit patients. We have determined that our single visit only patients are probably receiving their other vaccinations somewhere else. Protected Data Field: I chose to include protected data. This data includes the patient’s name, sex, medical record number, address, and phone. I do this because I like to send out the recall letters that the CASA program can generate. It should be noted that only power users and local administrators can export private data.

Step Six Create and save the file Click on create export file button When you have finished entering the patient list criteria and you click on the Create Export file button you create a file that will be saved on the CAIR server for 28 days. After 28 days this file is deleted.

Step Seven Accessing the Export File Click on the Go To CASA Export File List Button This slide is an example of a newly created CASA export file list. You get to this list by clicking on a button that says “Go To CASA Export File List.”

Step Eight down load The file download button allows you to specify where you want your export file saved to.

Step Nine Name the file I usually rename my export files and save them into my “CASAtemp” folder on the C drive of my computer. I try and use a name that I will remember instead of the “default” name the CAIR program gives the file.

Step Ten Importing the file Time to Use CASA Software WIN CASA stands for Clinic Assessment Software Application. It is a menu-driven relational database developed by the National Immunization Program, Centers for Disease Control and Prevention (CDC), and used as an assessment tool for immunization clinics and providers. Now is the time to import your CAIR data into CASA. Two files have been created for the import purposes. They are VAC Row and VAC List. Choose the Vac Row Format. Again, we use this file because it is the recommended format for exporting data to CASA.

Step Eleven Importing into CASA After clicking on the template you want to use, you will be asked which file you want to use. Once you click the appropriate file you will then taken to the Assessment Site Download Screen.

Step Twelve WinCASA’s Assessment Site Download Screen is a “fill in the blank” screen. This is the same screen you would fill in anytime you create a new clinic site in CASA.

Step Thirteen Report Options You are now ready to run any of the reports CASA has to offer. In San Luis Obispo County I run reports which allows me to check on missed opportunities and gives me a list of children who will be up-to-date with one additional visit. I use the Recall Reminder in CASA and send out letters to those children who need them.

Step Fourteen Printing CASA Reports This slide shows a CASA Summary Report. In 1999 this clinic has an up-to-date rate of 54.66%. In 2002 this clinic had an up-to-date rate of 85.33%. We hope to see this trend continue in the 2003 final report. Currently this clinic is at 79.17% and we still have several months left to follow these children.

CASA Assessment from CAIR Extract: Grover Beach Public Health 1998 - 2002 In San Luis Obispo County I began doing quarterly CASA assessments in 2002. You can see what a great improvement this clinic made from prior years. In the past it took me two or three full days to input all of the CASA information into the software. With the CAIR program I can now run a report and have an export file into CASA within minutes.

Summary Using CASA on a quarterly basis has increased our county public health clinics up-to-date CASA rates. Having the CAIR automated CASA product export makes doing the quarterly CASA assessments effortless.

For More Information: Karen Turner Regional Immunization Registry Coordinator For the Central Coast Immunization Registry(CCIR) Kturner@co.slo.ca.us 805-237-3105