Child Health Integration Bob Swanson, MPH Division of Immunization Michigan Department of Community Health Michigan Care Improvement Registry (MCIR)

Michigan Care Improvement Registry Web-based application Populated with electronic birth records (within 2 weeks) Operational with a regional approach Majority of the funding from the Healthy Michigan Fund (tobacco tax) First rolled out in 1998

MCIR Activity  4.7 million records  Over 57 million shot records  35,000 registered users  2,334 provider sites submitted data in 2007

MCIR Regions Provider recruitment Provider training Help desk Advisory boards

MCIR Tools Assessment of patient immunization status at the time of the visit Reminder/Recall Letters Coverage Level Reports High Risk Influenza/Lead Pop-up Lead Results Clinical Record All Hazard Component

Schools and Daycares Utilizing MCIR 4813 Schools 95% enrolled in MCIR 4235 Daycares 89% enrolled in MCIR

Reporting Adverse Events (in development) Integrated VAERS form Auto populates data Transmission to CDC

MCIR Electronic Interface Activity in February ,000 immunizations reported from provider offices 860,000 updates from Medicaid with beneficiary information 200,000 WIC ID updates 10,800 Electronic Birth Records

MCIR Benefits High provider participation (>90%) Supports all programmatic functions of the Immunization program All Hazard tracking capabilities Population based system Reports to demonstrate “pocket of need” Flexibility to allow linkages with other public health systems Infrastructure setup with regional staffing model

Population Based Reporting State Levels County Levels WIC Levels MEDICAID Health Plan Levels Clinic Site Levels School District Levels School Building Levels Migrant Schools Migrant Population

Gogebic Otonagon Houghton Keweenaw Iron Baraga Marquette Dickinson Alger Delta Menominee Schoolcraft Luce Mackinac Chippewa Cheboygan Presque Isle Charlevoix Antrim Otsego Leelanau Benzie Grand Traverse Kalkaska Crawford OscodaAlcona ManisteeWexfordOgemawIosco MasonLakeOsceola Clare Gladwin Arenac OceanaNewaygoMecostaIsabella Midland Bay Huron Muskegon Montcalm GratiotSaginaw Tuscola Sanilac St. Clair Lapeer ShiawasseeClintonIonia Kent Ottawa AlleganBarryEatonIngham LivingstonOakland Macomb Van Buren KalamazooCalhounJacksonWashtenawWayne Berrien CassHillsdale Lenawee Monroe St. JosephBranch Missaukee Alpena Roscommon Emmet Genesee Montmorency January :3:1:3:3:0 Detroit % % % % % % % Current Immunization Profile for Month Old Children Based on MCIR Data Gogebic Otonagon Houghton Keweenaw Iron Baraga Marquette Dickinson Alger Delta Menominee Schoolcraft Luce Mackinac Chippewa Cheboygan Presque Isle Charlevoix Antrim Otsego Leelanau Benzie Grand Traverse Kalkaska Crawford OscodaAlcona ManisteeWexford Ogemaw Iosco MasonLake Osceola Clare Gladwin Arenac Oceana NewaygoMecostaIsabellaMidland Bay Huron Muskegon MontcalmGratiotSaginaw TuscolaSanilac St. Clair Lapeer ShiawasseeClintonIonia Kent Ottawa AlleganBarryEatonInghamLivingstonOakland Macomb Van Buren Kalamazoo CalhounJacksonWashtenawWayne Berrien CassHillsdale Lenawee Monroe St. JosephBranch Missaukee Alpena Roscommon Emmet Genesee Montmorency 4:3:1:3:3:1 Detroit August 2008

Lead Data Results Added a lead pop-up window Medicaid enrolled Mapped to HR zip code 23% increase March – May of 2004 in lead testing as compared to 2003 data. Increased provider participation

Benefits High provider participation (90%) Population based system Reports to demonstrate “pocket of need” Flexibility to allow linkages with other public health systems Infrastructure setup with regional staffing model

Newborn Hearing Planning began in 2004 EHDI program began creating their own Oracle Database Rollout in 2009

EPSDT The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program Requirements Gathering January 2007 Rollout 2009

Newborn Screening Requirements Gathering 2005 System Upgrades to MCIR and NBS Database Rollout 2009

Michigan’s BMI Surveillance Efforts On going discussions to add BMI to the MCIR

Emerging Synergies Immunizations, BMI, Lead, WIC, Medicaid, EPSDT, Newborn Screening, Asthma, Diabetes, Vision Screening, TB, EHDI Public Health Population Based Information Systems Surveillance

Lesson Learned Health Plan Incentives Mandated Reporting Billing Data vs Medical Record Regional Training and Support