The Futures Initiative Creating the Future of CDC for the 21st Century Dixie E. Snider, Jr., MD, MPH Assistant Surgeon General Acting Deputy Director for Public Health Science Immunization Registry Conference Atlanta, GA October 29, 2003

President’s Vision for Reforming Government “Government needs to reform its operations- how it goes about its business and how it treats people it serves.” Expanding E-Government part of President’s Management Agenda

CDC’s Futures Initiative A Strategic Direction An opportunity to examine Priorities Systems Practices

Initiative Goals (1) Ensure measurable improvements Address public health challenges Ensure excellence in science and service

Initiative Goals (2) Better serve the public Ensure a state-of-the-art CDC workforce

Future Initiative Themes (1) Be a catalyst for shaping the public health system Respond to our customers needs Expand our public health research capacity Measure results and impact of programs

Future Initiative Themes (2) Communication and Information to become our core business Assess resource and allocations Define our relationships with government partners

Future Initiative Themes (3) Balance integration and coordination Enhance diversity of programs and grants Expand impact on global health issues

Registries Can Support the Futures Initiative

Working from the “outside in” The future of immunization registries follows along the same mechanism as the Futures Initiative in that both are using an “outside-in” approach. In this approach we will interact with our customers, partners, stakeholders, and employees. Right now, with the Futures Initiative we are gathering information to help us set our direction and priorities. In July 2001, NIP committed to the development of the Immunization Registry Strategic Plan. Using the outside- in approach, they invited partners and stakeholders to participate and achieve buy-in to a three-step development process. Today, the Strategic Plan serves as the guiding force for driving the directions of registry activities. So, much like the Future Initiative, the wheels on the future for immunization registries are in motion.

Catalyst for Shaping the Public Health System Improved public health and clinical decision making Serve patients/parents/providers Accountability Immunization registries are tools, we believe, that will ensure continued successful delivery of one of the greatest public health achievements- vaccines. Fully operational and fully populated registries can improve both the public health and clinical decision making process. Functional standards promote accountability as well as providing a level of functionality for registries to achieve. Successfully passing registry certification, although voluntary at this time, can provide a level of confidence for patients, parents, providers, and data exchange entities that the registry data is accurate, complete, timely, secure, private and confidential.

Assess Registry Resources for Future Needs Research Initiatives Cost Study Develop Standards Best Practices We need to develop more evidence-based research and publications. A current NIP initiative is the registry cost study which is a continuation of an earlier study. Collecting registry expenditures for additional years will allow a better understanding of the current funding needs associated with immunization registry development and operations. The evaluation should be available early next year. We must continue to develop standards and best practices. Some initial work has been done as evidenced by the functional standards and the Program Registry Operations Workgroup document; however, more evidence based research needs to occur and be published to demonstrate usefulness of registry data. Standards for data quality should be developed.

Balance Integration and Coordination Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Metabolic and Lead Screening Bioterrorism Medicaid (CMS) Schools, Day care centers Vital Statistics Electronic billing data The message we at CDC have heard is that registries must have value to the provider; it must have value to the end user. These providers say that the registry must be designed appropriately to be useful to all providers, both public and private and that the functionality must allow for expansion into other tracking modalities. Balancing integration and coordination with registry development and operations will continue to be a challenge, but one that some registries have explored. Sharing the strategies that were used, barriers that were overcome, and the lessons learned is valuable information. Your input on what works and what does not work is important.

…working from the “outside in”…. The Immunization Registry Strategic Plan has brought the “outside in” concept to several areas, such as involving key stakeholders in the development of provider participation, education, data quality & use, privacy & confidentiality and integration. Because this plan is based on sound strategic thinking, we are confident that this will help ensure that CDC continues focusing on the public health priorities of America.

There is no use in trying,” said Alice; “one can’t believe impossible things.” “I dare say you haven’t had much practice,” said the Queen. “When I was your age, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast. Lewis Carroll