Integration of the Responder System and the Statewide Immunization Registry Benefits and Steps – A Case Example in Wyoming Presented by Sandra Urbanek Wyoming Dept. of Health with Robert (Buzz) Conn Scientific Technologies Corporation

Immunization Registry/First Responder Integration Background – Wyoming Immunization Registry Decision Factors - PVS to Non-PVS State Benefits - Non-PVS State Steps – Systems Integration and Certification Funding Source/Cost Expectations

Background – Wyoming Immunization Registry Wyoming Demographics Sparsely populated – 500,000 Annual Births – 6,000 Patients in the Immunization Registry – 172,169 Vaccinations in the Immunization Registry – 1,588,730 In spite of low population, technology infrastructure requirements are similar to more populated states

Background – Wyo. Immunization Registry, cont. WY Immunization Registry History Project started in late 1999 with statewide assessment Completely deployed throughout the public health nursing offices Offices now operate as “paperless” immunization programs Immunization Registry technology is a mix of client-server and Web interacting with a common central registry Focus now is on private provider recruitment/deployment

Decision Factors – PVS to NON-PVS State Difficulty in accessing or controlling the smallpox data with PVS. Required dual tracking systems Paper and PVS Burden on public health nursing offices. Difficulty in transferring of reconstituted vaccines from one office to another. Difficulty in reporting preparedness through PVS. Wyoming would be low on CDC’ priority list to furnish support. Wyoming was responsible for user training on PVS

Decision Factors – PVS to NON-PVS State, cont. PVS certificate process created a roadblock for potential post-event mass immunization clinics. Data entry would not be conducted by the staff or on the workstation the certificate was issued. Temporary workers will be utilized. School computer labs would probably be the source of data entry. Need IMMEDIATE set up for a worker and workstation Unable to forecast in advance what workers or workstations would be utilized.

Decision Factors – PVS to NON-PVS State, cont. Smallpox first responder clinics PVS utilized to track 400 first responders WY DOH recognized that local tracking of first responders would provide a better return for data entry efforts expended The WY SIIS was already in use for adult immunizations – flu shots, travel shots, PPD skin tests Decision made to leverage the WY SIIS for first responder tracking

Benefits - Non-PVS State True responder system – not limited to smallpox program Anthrax Influenza SARS Export developed to transfer data back to the Immunization Registry from PVS. Immediate access and control of raw data Data stored on Immunization Registry database Web enabled

Benefits - Non-PVS State, cont. Only need certificate for workstations sending XML update file to PVS. Expanded management reports. Ability to communicate preparedness. Ability to transfer reconstituted vaccine. Public health nursing staff not trained on two different applications Look and feel is the same as the Immunization Registry

Benefits - Non-PVS State, cont. Training and help desk support supplied by vendor. Reminder recall feature in Immunization Registry can be utilized. Patient Immunization Record report in Immunization Registry incorporated into First Responder Leverage the Immunization Registry infrastructure. Use the Immunization Registry servers Immunization Registry IT staff will support First Responder Same database - Full immunization record is accessible (e.g. small pox, Td Adult, PPD skin tests).

Benefits - Non-PVS State, cont. Post-event Mass Immunization Module Web enabled or client application Quick and easy mobilization in the event of an outbreak Streamlined data collection Better tracking and record keeping Records stored on central registry database User friendly, easy to train Ability to use in Influenza clinic Training is kept up through Influenza clinic

Step 1 – Product Acquisition Product acquisition choices Internal development Contracted development Purchase existing application WY DOH elected to purchase existing product Product had history in several other states Fully integrated with the registry product in use Other states using the application had already achieved certification Product had to meet the requirements necessary for the state to become certified

Step 1 – Product Acquisition, cont. For certification, the integrated responder system had to provide new data elements and features such as: PVN Numbers Smallpox/Diluent batch creation Additional patient contact information Occupations Smallpox vaccination history Take responses/re-vaccinations Readiness reports XML formatted export for CDC PVS

Step 2 – Notification to CDC Letter of intent to CDC and the PVS Certification Team to become a non-PVS state. Software vendor name Software name and version Verify software functionality Simple process – work with the assigned TADA representative Enables the PVS Certification Team to schedule the certification activities

Step 3 – System Administrator Training Who/what is certified? Certification applies to the state department of health, not the system Demonstrates the DOH staff competency in the use of the non-PVS system and submission of properly formatted data to the CDC PVS system Obtain PVS User ID and password (Different users from previous PVS users). Certificate for submitting workstations Training (in this case conducted by the system vendor) prepares the DOH staff for the certification activities

Step 4 – Certification Process Conducted by the PVS Certification Team Five scenarios - each must be successfully completed prior to moving to the next one Set of control data supplied by the Cert. Team Scenarios consist of data entry, edits of previously entered data and submission via the XML export file The certification team tests each submission and provides go ahead (or requires problem resolution) for the next scenario Approximately three days required for training and certification

Step 5 – Data Migration Wyoming started as a PVS system user Necessary to import data from PVS to the First Responder/SIIS database CDC Certification Team provides flat-file export Programming effort was required to import the data to the state’s first responder system Approximately 120 hours were required for migration and testing activities

Step 5 – Data Migration, cont. Data Validation Need to create and send an export file from Immunization Registry to PVS PVS Certification Team generated a Discrepancies in Data Comparison Report Data entry errors corrected Program modifications and data reloads required by software vendor Re-submit export file with a letter certifying discrepancies were corrected or noted as not an issue. Certification letter issued by PVS Certification Team

Step 6 – User Training End user training required minimal effort Interface similar to the registry interface Functions similar to the PVS system Approximately 4 hours were required for training

Funding and Cost Expectations Funding – State BT funding was used for product acquisition, certification and training activities In summary, plan for about $70,000

Summary Wyoming has extended the features provided by the PVS system to a state managed system and continues to support the CDC PVS through the enhancement of the statewide immunization registry The state now has a system to track the preparedness of responders for a variety of public health emergencies

For More Information Sandra Urbanek Robert (Buzz) Conn Information Systems Project Manager Wyoming Department of Health (307) 777-3556 surban2@state.wy.us Robert (Buzz) Conn Director of Product Development Scientific Technologies Corporation (602) 241-1502 buzz_conn@stchome.com