Bringin' Them Out of the Woodworks: H1N1 and NYSIIS Participation Loretta A. Santilli, M.P.H Program Manager New York State Immunization Information System (NYSIIS) New York State Department of Health (NYSDOH) (518) 473-2839 las09@health.state.ny.us

Acknowledgements Co-Authors Debra Blog, MD, MPH, Director NYSDOH Bureau of Immunization Katie Reed, MPA, Project Manager HP Enterprise Services, LLC The NYSIIS Team who went “above and beyond” during the H1N1 campaign: Barb, Diane, Jean, Laura, Logan, Lori, Megan, Michael, and Munyaradzi

NYSIIS Public Health Law mandated provider reporting as of January 1, 2008 for immunizations given to children less than 19 years of age (including immunization histories) Info for persons 19 years of age or older can be added with written consent New web-based system serving New York State (outside of New York City) Officially launched February 2008

Key Statistics As of April 1, 2010 NYSIIS contains: 3.1 million patients 35.1 million immunizations 9,100+ individual users 3,100 health care provider organizations 1,450+ schools 78.2 % of NYS children (outside of NYC) less than 6 years of age have 2 or more shots in NYSIIS

How’d We Get Here? We designed a two-year multi-faceted implementation strategy to maximize provider participation. Focused on: Communication and outreach Training and education Technological support

What’s the Problem? At the beginning of year two (2009), we observed our rate of growth slowing slightly. Then, at around 15 months (April 2009), the first cases of the novel H1N1 influenza pandemic emerged. Provider outreach activities were significantly impacted due to redirected team efforts. Concern that provider participation levels (new and existing) would plateau due to increased clinical activities in provider offices. 

How’d We Solve It? Enhanced NYSIIS infrastructure to support H1N1 data collection and reporting Added Countermeasure and Response Administration (CRA) module to track by age groups AND priority groups Added new vaccine codes and established independent H1N1 schedule to assist with tracking second doses Highlighted existing reminder recall features in NYSIIS Encouraged use of existing inventory module for tracking doses wasted, expired, recalled

How’d We Solve It? (2) Integrated NYSIIS into H1N1 vaccine registration process Reminded of PHL requirement for children – incorporated into provider agreement Strongly encouraged for adult providers Pointed directly to NYSIIS training page at end of registration process Linked H1N1 PIN to NYSIIS Org Id for vaccine accountability (doses administered vs. shipped)

How’d We Solve It? (3) Communication Communication!

Results How’d We Do?

Provider Participation in NYSIIS By Month, January 2009 – April 2010 Percent of Known Providers Participating in NYSIIS

NYSIIS and H1N1 From April 1, 2009 to April 1, 2010: 1,212 new organizations and 3,391 new users were added. Including non-traditional participants such as occupational health and Ob-Gyns 993,000 new patients and 12.7 million new immunizations were added. including nearly 1 million doses of H1N1 The percentage of children less than six years of age with two or more immunizations in NYSIIS increased from 56.2 % to 78.2%. 

12/19/2019 Percent of Children Less Than 6 Years of Age with Two or More Shots in NYSIIS* New York State (outside of New York City) 04/01/2010 *New York State Immunization Information System **Based on Claritas population estimates for 2008 (Jan08-Nov08) and 2009 (Jan09-present). Percent Participating**

P.S. - Other Ways NYSIIS Contributed to the H1N1 Response Adverse event monitoring Exchanged info with 3 health plans (Aetna, Cigna, Humana) to compare immunization history to health care utilization data to monitor potential adverse events (miscarriages, GBS). Evaluation project underway Did different vaccination strategies in counties impact H1N1 immunization coverage rates in children?

Conclusion The availability of NYSIIS was critical for providers to track patient immunization and assure vaccine accountability and provides a valuable data set for the public health analyses necessary in responding to an event of this magnitude. “Nothin’ like a good pandemic to bring ‘em outta da woodworks!”

Q & A