Integrating Systems: The Impact on an Immunization Registry The Impact on an Immunization Registry 2002 Immunization Registry Conference Paul Schaeffer, MPA NYC DOHMH (212) Co-Authors: Deborah Walker, Alexandra Ternier (DOHMH) Alexandra Ternier (DOHMH) Alison Chi (MHRA) Alison Chi (MHRA)

Objectives Describe modifications to the Citywide Immunization Registry (CIR) applications due to the implementation of the Master Child Index (MCI) Describe modifications to the Citywide Immunization Registry (CIR) applications due to the implementation of the Master Child Index (MCI) Describe programmatic challenges and solutions Describe programmatic challenges and solutions

Background -MCI The Master Child Index (MCI) is a NYC Child Health Registry that integrates data from: The Master Child Index (MCI) is a NYC Child Health Registry that integrates data from:  Citywide Immunization Registry (CIR)  Lead Quest Registry (LQ) from the Lead Poisoning and Prevention Program  Vital birth records  Additional child health databases (in the future)

Rationale for Integrating the Registries CIR and Lead Quest (LQ) target the same population CIR and Lead Quest (LQ) target the same population CIR and LQ currently separate systems CIR and LQ currently separate systems  Inability to relate data for the same child across the systems  Missed opportunities for children who are under- immunized and at risk for lead poisoning  Lack of access by providers to lead screening information

Background-CIR and LQ CIR contains over 2 million records with over 14 million immunization events CIR contains over 2 million records with over 14 million immunization events LQ contains about 1.7 million children with over 3.9 million blood tests LQ contains about 1.7 million children with over 3.9 million blood tests CIR contains demographics and immunizations of children up to 21 years of age CIR contains demographics and immunizations of children up to 21 years of age LQ contains demographics, lead test results and case management events of children up to 18 years of age LQ contains demographics, lead test results and case management events of children up to 18 years of age

Goals of Integration Centralize access to immunizations and lead tests Centralize access to immunizations and lead tests Improve data quality for both registries Improve data quality for both registries Leverage resources Leverage resources Create a NYC Child Health Registry and a Data Warehouse Create a NYC Child Health Registry and a Data Warehouse Provider access to both immunization and lead screening test information Provider access to both immunization and lead screening test information

Steps to Create MCI Developing Requirements & Specs Developing Requirements & Specs Building MCI Core Services Building MCI Core Services Configuring servers and platforms Configuring servers and platforms Building MCI Administration Tools Building MCI Administration Tools Modifying CIR and LQ Modifying CIR and LQ Data loads into MCI Data loads into MCI Deploying MCI Deploying MCI

Master Child Index MCI Core Services Win 2000 Servers (Geo-Support, MEDD) CIR Database Server (UNIX) LQ Client LQDatabase Server (NT ) CIR Client MCIAdministrationTools (VB Application) MCIDatabase(Oracle) MCI Database Server(Unix) CIRDatabase (Oracle) (Oracle) LQ Database (Microsoft SQL ) CIR Front End Power Builder Application LQ Front End Power Builder Application

CIR Applications Power Builder Front-End Application – CIR search and merge screens Power Builder Front-End Application – CIR search and merge screens Smart Search – Query Tool and recall report generator Smart Search – Query Tool and recall report generator On-Line Registry – Provider Online access On-Line Registry – Provider Online access

Currently searches CIR and displays immunization data Currently searches CIR and displays immunization data Human review - merging Human review - merging Will search CIR(fields not stacked) and display immunization and lead data using MCI Services Human review done in MCI only CIR Front-end Application User screens to search individual children and produce immunization reports – phone calls

Smart Search Query tool that searches, matches, and retrieves CIR records in batch – MCOs, Board of Ed Currently searches CIR for immunization data Currently searches CIR for immunization dataand Produces files for Data Exchange (with MCOs) and Reminder Recall reports on matched kids Produces files for Data Exchange (with MCOs) and Reminder Recall reports on matched kids Will search the CIR for immunization data and Use MCI Services to retrieve lead data on children found in the CIR to generate output files

On-Line Registry Online query tool for providers to access individual CIR records Will search CIR and Display child immunization and lead data using MCI Services Currently searches CIR Currently searches CIRand Displays child immunization data Displays child immunization data

Programmatic Challenges Phase out CIR Front-End application Phase out CIR Front-End application Who will be responsible for merging records – individual programs, or a MCI team? Who will be responsible for merging records – individual programs, or a MCI team? Setting “agreeable” thresholds for merging Setting “agreeable” thresholds for merging

Ownership of data – CIR will now disseminate LQ data Ownership of data – CIR will now disseminate LQ data Fiscal issues between CIR and LQ Fiscal issues between CIR and LQ Joint Project Activities – data dissemination Joint Project Activities – data dissemination MCI System Operations & Maintenance – need to divide responsibilities between MIS, MCI, CIR and LQ staff MCI System Operations & Maintenance – need to divide responsibilities between MIS, MCI, CIR and LQ staff Programmatic Challenges (continued)

Future Plans – Applications Complete modifications to CIR applications to include LQ data Complete modifications to CIR applications to include LQ data Eventually all CIR applications will go against the MCI – full integration Eventually all CIR applications will go against the MCI – full integration Finalize inter-program protocols for De- duplication, address standardization and data dissemination Finalize inter-program protocols for De- duplication, address standardization and data dissemination

Future Plans – CIR and LQ Expand communication between Programs – Weekly Meetings!!!!! Expand communication between Programs – Weekly Meetings!!!!! Cross-training between programs Cross-training between programs Standardize human review Standardize human review Phone calls – providers and parents Phone calls – providers and parents Data Sharing – MCOs, reminder letters, Board of Ed Data Sharing – MCOs, reminder letters, Board of Ed

Future Plans – MCI Expand MCI to include Medicaid Population Expand MCI to include Medicaid Population Begin Data Warehouse Begin Data Warehouse Leverage Resources Leverage Resources Expand partnership between CIR and LQ to include provider education and outreach Expand partnership between CIR and LQ to include provider education and outreach