READINESS OF PUBLIC HEALTH INFORMATION SYSTEMS TO SUPPORT MEANINGFUL USE OF ELECTRONIC HEALTH RECORD SYSTEMS THROUGH HEALTH INFORMATION EXCHANGES Immunization Information Systems (IIS) PHDSC 2009 Annual Business Meeting November 12, 2009 National Center for Health Statistics, Hyattsville, MD Susan M. Salkowitz

Overview Immunization Information Systems (IIS) are confidential, population-based, computerized information systems that attempt to collect vaccination data about all children within a geographic area. IIS are an important tool to increase and sustain high vaccination coverage by consolidating vaccination records of children from multiple providers generating reminder and recall vaccination notices for each child providing official vaccination forms and vaccination coverage assessments

IIS Characteristics Standards-based NVAC approved functional standards HL7 standards for exchange and interoperability NVAC approved PROW standards of excellence Infrastructure CDC- 317 funding State and local AIRA, AIM Policies and Rules Privacy and Security Data sharing Data Quality

IIS Characteristics- Opportunities ARRA and HITECH Regional Extension Centers IIS and Meaningful Use Health Reform Patient Centered Medical Home Initiatives- Pay 4 Performance, HEDIS Disease Management Comparative Effectiveness Performance Improvement

Improve quality, safety, efficiency & reduce health disparities Eligible Providers and Hospitals 2013 Objectives Use clinical decision support at the point of care (e.g., reminders, alerts) IIS- Recommendations algorithm of ACIP vaccines for children and adults A feature in IIS available at point of service and/or prospectively or retrospectively against data base Can be individual or population-based assessments Is delivered as a web service in Service Oriented Architecture in some IIS

Eligible Providers Health Outcomes Policy-Care Goals 2011 Objectives Provide patients with an electronic copy of their health information (including lab results, problem list, medication lists, allergies) upon request IIS- Provide patients/parents with immunization history Creates “official” record or can be included within a PHR Can be accessed electronically (in some states)

Official Form Example from Florida Shots IIS You already know Florida SHOTS saves you time when you search, certify, and print 680s electronically. But did you know that the registry provides the only electronic D.H. Form 680 authorized by Florida law?* Use Florida SHOTS as your one-stop resource for your practice’s electronic immunization data. Link your software to the registry through data upload and automatically import shot records and vaccination histories to Florida SHOTS. Then make sure when it’s time to print you use a state- issued D.H. Form 680—the only blue form accepted statewide for entry to school and other childcare programs. Your patients will thank you! * Legal Authority: Sections , , , Florida Statutes; rules 64D-3.046, 65C , Florida Administrative Code D C This form is electronically signed and accepted directly by schools

Eligible Providers Health Outcomes Policy-Care Goals 2011 Measures % of all patients with access to personal health information electronically 2013 Objectives Access to all patients to PHR populated in real time with patient data 2013 Measures % of all patients to PHR populated in real time with EHR data

IIS Health Outcomes Policy-Care Goals 2011 Measures % of all patients with access to complete immunization history information electronically 2013 Objectives Access to all patients to PHR populated in real time with immunization history information 2013 Measures % of all patients to PHR populated in real time with EHR data including immunization history

Improve Population and Public Health- Communication with PH Agencies Eligible Providers and Hospitals 2011 Objectives Capability to submit electronic data to immunization registries and actual submission where required and accepted Measures Report up-to-date status for childhood immunizations IIS working to achieve standards-based bi-directional electronic exchange of immunization data with providers and hospitals Public health role to recruit providers, support the timely and accurate submission of data, provide tools for quality assessment, reminder/recall and coordination with other related public health programs

Number of EHR's [excl. EHR vendors] providing immunization data directly to your IIS through an electronic interface, 2008 (CDC Presentation New Orleans, )

Improve Population and Public Health- Communication with PH Agencies Eligible Providers and Hospitals 2013 Objectives Receive immunization histories and recommendations from IIS 2013 Measures % of patients for whom an immunization need and status has been completed during the visit IIS algorithm to assess immunization history and determine coverage status accessed via IIS or called as IIS web service Public health role to use IIS to publish immunization coverage and perform interventions for pockets of need Public Health role to monitor VFC providers for coverage, vaccine storage and use using IIS tools. (AFIX visits)

Improve Population and Public Health- Communication with PH Agencies H1N1 Activities- Use of IIS infrastructure report and track use of H1N1 vaccines- By type- nasal or injected Quickly enroll new providers Recall children requiring second shot Utilize mass vaccination event features (PODS) Report use to CDC via CRA-IIS interface Manage vaccine ordering, distribution, inventory Record and report adverse events Post marketing surveillance (PRISM) with health plans

Ensure Adequate Privacy & Security for Personal Health Information Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law. All IIS have strong security, privacy and confidentiality standards and provider agreements IIS manage opt out provisions where applicable under state law; many allow the record to be reviewed by public health but not other providers Creation of IOA for interstate IIS data exchange

Meaningful Use Challenges for IIS While all states except NH have an IIS, the degree of maturity, population and functionality differs widely. Funding support by CDC-NCIRD focuses IIS purpose on public health immunization program support- often a tension with state directions on other program integration, and HIEs. Many IIS have no additional state funding. Preventive health services such as immunizations heavily promoted by health reform, particularly in chronic disease management. Chronic disease programs often don’t communicate with immunization program in health departments. IIS original focus on children 6 and under now becoming a tool for all ages, but adolescent and adult have fewer records. (Adult has no recommended IIS target for HP2020)

Immunization Information Systems Age Groups Participating in an IIS Source: 2007 Immunization Information System Annual Report Participation of U.S. children < 6 years in an IIS with 2 or more immunizations. 21% 75%(18 million children < 6 years) Participation of U.S. children months in an IIS with 2 or more immunizations. - 71% (4.0 million children months) Participation of U.S. adolescents years in an IIS with 2 or more immunizations. - 65% (23 million adolescents years) Participation of U.S. adults >19 years in an IIS with 1 or more immunizations. - 24% (54 million adults>19 years) (CDC Presentation New Orleans, )

FIGURE 2. Percentage of children aged < 6 years participating in a grantee immunization information system -- United States, six cities §, and eight Territories †, 2008 (CDC Presentation New Orleans, ) § Chicago, IL (34%-66%); District of Columbia (95%–100%); Houston, TX (34%–66%); New York City, NY (95%–100%); Philadelphia, PA (95%–100%); San Antonio, TX (67%–94%). † American Samoa (No Report); Marshall Islands (67%-94%); Federated States of Micronesia (95% - 100%); Guam (No Report); N. Mariana Islands (No Report); Palau (No Report); Puerto Rico (67%-94%); Virgin Islands (No Report). No Report In Transition* 0-33% 34-66% 67-94% % National Coverage: 75% (excluding Territories) Source: CY2008 IISAR * In transition is defined as a grantee implementing a new IIS product.