39th National Immunization Conference Using Registry Data in Daily Program Operations: The Washington, D.C. Experience Karyn L. Berry, MD, MPH March 23, 2005 39th National Immunization Conference Washington, DC

Washington, DC Overview District of Columbia: “City-state” Self-governing Congressional budget approval & oversight Non-voting congressional representation Overall population: 572,059 residents African-American: 60.0% 343,321 White: 30.8% 176,101 Hispanic 7.9% 44,953 Asian/PI 2.7% 15,537 112,000 (20%) of residents are Children (2002)

DC Immunization Registry Overview 1992 - Began with Immunization 2000 - Linked to DC Birth Registry 2000 - Became internet-based October 2001 - Added Medicaid EPSDT Program “Age-less” System: tracks records birth to death Records accessed more than 2.5 million times since system began tracking in May 1996 Contains 366,479 Individual’s Records 4,015,843 million Immunizations 2,247 exemptions 64,236 histories of Varicella data from March 1, 2005

DC Registry & Daily Work Importance of integrating the Immunization Registry with Immunization Program Functions Cost savings in using data multiple times Decreased staff time in completing assignments Increased unification of program components: Team Approach Guidance for Integrating: Immunization Program Operations Manual (IPOM)

DC Registry & Vaccine Management Capture VFC Eligibility Status for each dose of vaccine Capture VFC PIN of Provider giving vaccine Capture lot number and manufacturer for tracking Project Vaccine Needs Generate Doses Administered Reports by Patient Age for Specific Time Periods by VFC-eligibility

DC Registry & Provider QA Web-based Lists of patients for Reminder (“Due”) Notices and Recall (“Overdue”) Monthly reports to Medicaid, Medicaid MCOs, WIC, Schools… Web-based export of Registry data to CASA Registry reports on immunization levels beyond CASA Other Age Groups: 0-4-year-olds, school-age Track incorrectly administered doses and other vaccine rules (4-day grace period) Display record with vaccine assessment (incorrect doses marked)

DC Immunization Registry Record

DC Registry & Service Delivery Linked to WIC Program WIC Enrollment tracked in Registry (monthly update) Key WIC Sites linked to Registry (view only) Monthly Immunization Level reports generated for each WIC site (17 sites) Monthly reminder/recall lists generated for each site (also available on web) Linked to Child Care and Head Start Programs Enrollment tracked in Registry (yearly update) Immunization level reports and reminder/recall lists for each site (also available on web)

DC Registry & Consumer Information Prints official immunization records for clients Incorporates Broadcast Fax System Send out health alerts/advisories to community providers Send out alerts for upcoming Immunization Clinics

DC Registry & Surveillance Disease investigators access Registry as “Users” over internet Generate individual immunization histories on clients Generate reports on students enrolled in specific school, child-care, Head Start center Track Perinatal Hepatitis B cases Identify vaccine provider if follow-up required Track vaccine lot numbers in case of recall Track vaccine adverse events

DC Registry & Assessment All Assessment activities done solely through Registry Child-care facilities (comprehensive) Head Start facilities (comprehensive) Public, Charter, Parochial, Private Schools (comprehensive) WIC Specific populations (physician/clinic, adults, STD/HIV, corrections) All varicella histories and exemptions (religious and medical) are entered into Registry and counted in Forecasting Algorithm Utilization of Registry for DC Public School Immunization Initiative Monthly and on-line reports of immunization levels Monthly and on-line lists non-compliant students

DC Registry & School: Enrollment ES (101): 39,161 MS (11): 4,638 JHS (9): 5,111 SHS (20): 12,311 Special ed schools (20+): 1,058

School Demographics & Diversity Student population by race/ethnicity: African-Americans: 84.4% Hispanics: 9.4% Whites: 4.6% Asian Americans: 1.6% Other: 0.5% 112 different home languages representing 138 different nationalities 60.8% of DCPS students receive free or reduced price meal support

School Immunization Survey By law- DCPS requires all children (pre-school thru 12th grade) to be immunized Yearly enrollment and immunization check of all students Can be excluded from school Required immunizations: ACIP schedule for: DTaP, polio, HIB, Hepatitis B, MMR, Varicella, Td Doses must be appropriately spaced & given at appropriate ages June 2001: Survey demonstrated 40% compliance with required immunizations for DCPS students Almost 40,000 students required immunizations/data

Immunization Requirements

DC Registry & School: Results Compliance rates increased from 40% at the end of school year SY 2000-01 to greater than 94% by mid SY 2004-05 Improvements in public school immunization compliance were demonstrated equally across the community Current immunization levels (DCPS = 94.38%) place DC in the upper echelon of system compliance nationwide Data is collected, analyzed and reported on in 1 system: The DC Immunization Registry

DC Schools: See the Success!

Key Working Partnerships DC Immunization Program Technical expertise Tool: Registry Data entry, analysis & distribution School Health Services Record collection Contact with school principals & parents DCPS Enrollment data Enforcement of immunization laws DC Medicaid Admin Enrollment data MCO accountability Medicaid MCO’s Member follow-up Provider communication Providers Patient access Implementing ACIP schedule Community partners Outreach & follow-up activities Parents

Value of the DC Registry On-going healthcare tracking system established Reduced over/under immunization due to lost records Improved Provider immunization practices Decreased Provider labor to locate patient records Decreased labor required to assess immunizations and prepare reports (e.g., school forms, HEDIS, surveys, CASA) Improved School immunization rates

Future of the DC Registry Mandatory reporting by Providers Expand system usage to more Providers and Groups Expand linkages with other Systems Child Care WIC Lead Screening

Acknowledgements District of Columbia Department of Health Primary Care Prevention and Planning Administration Maternal and Family Health Administration Health Promotion Administration Children’s Hospital Medical Center Children’s School Services District of Columbia Public Schools DC Medicaid Administration and Managed Care Organizations DC Immunization Coalition World Vision DC Pharmaceutical Companies – Aventis, Merck, GlaxoSmithKline and Wyeth

Contact Information Immunization Program Rosie McLaren, PHA Phone: (202) 576-7130 x24 Email: rosie.mclaren@dc.gov Registry/Tracking System C Thomas, RN Phone: (202) 576-7130 x11 Email: cthomas@trey-industries.com