1. 1 Empowering Regional Registries: Lessons From California Central Valley Immunization Information System San Joaquin Valley Health Consortium California DHS Immunization Branch HLN Consulting, LLC

2. 2 Empowering Regional Registries NIC Presentation Outline March 18, 2003 1. The California Challenge 2. Solution: Partners & Strategies 3. Outcomes: A Progress Report 4. Current Events & Future Plans

3. 3 California Challenge: Home to 12% of the United States Total Population: 40 Million Half of all Californians were born outside of the state. Source: Census 2000 California Profile

4. 4 California Challenge: Demographics of our children Numbers in 000’s. Source: USA Census 2000 Age RangeAll RacesLatinoAsian African American 0-42,4871,188 (48%) 222 (9%) 160 (6%) 0-179,2504,050 (44%) 888 (10%) 654 (7%)

5. 5 California Challenge: Large and mobile population Births July 2001- June 2002 Interstate Migration Internat’l Migration Net Pop. Growth 530,000 (13% of all USA births) -109,000 (2 nd only to NY) 327,000 (23% of all USA) 518,000 (17% of all USA) Proportion Served by a Regional IZR 86%91%

6. 6 California Challenge: IZ rate ranked 34 th (of 51) in 2001 Age 19-35 months with 4:3:1:3:3 series. YearAll RacesLatinoAsian African American 2000- 2001 74%*73%81%N/A 1998- 1999 72%69%73%61% *Equal to national average. Other state rates range from 82% in RI to 63% in NM.

7. 7 Registry I.S. Mini-History 1998: “Guidelines for Local Registry Developers” published by Statewide Immunization Information System, Div. of Communicable Disease Control, DHS. 1999: “California SIIS Software Evaluation” picks Contra Costa County (in-house) registry software as best design from among nine systems in use in CA. 2000: Efforts to form new multi-county IZR regions. 2001: HLN Consulting hired by Central Valley IIS to develop web registry, based on Contra Costa’s PC software, and to be made available to other registries. 2002: CAIR web application is implemented by five regional California immunization registries.

8. 8 Multi-Regional Registry Tools implementation goals Support local immunization outreach Share public health information between public & private health providers Improve and standardize the computer systems used by registries Establish infrastructure for statewide hub

9. 9 2002 Registry I.S. Environment History of false starts Complex disclosure regulations surrounding vital statistics and public health data. Culture of county-lead public health 24 counties, 2 million children under 6 More than 500,000 legacy patient records

10. 10 IZR Map 2002 CAIR Users Shots For Tots Region Bay Area Region Central Valley Region Central Coast Region Los Angeles Region Butte County Del Norte County

11. 11 Source State of California, Department of Finance, Interim County Population Projections. California, June 2001. CA Pop Growth 2000-2020

12. 12 Outcomes March 2003 Seven registries running CAIR software * 63% of births occur in a CAIR region Sharing of expertise and work outputs Ongoing co-ordination of enhancements Increasing private provider participation

13. 13 Sponsorship Public-Private-NGO partnership Funded by State and Federal Sources Administered by Mary Wallace, Director, San Joaquin Valley Health Consortium Managed by Ayesha Gill, Ph.D., Director, CA DHS Immunization Branch SIIS Developed by HLN Consulting, LLC

14. 14 Project Charter software requirements Intuitive high-speed web application Compatible with legacy client/server data Compatible with HIPAA recommendations Conform with disclosure regulations Minimize “total cost of ownership”

15. 15 Software Development multiple jurisdictions Continuous stakeholder involvement Weekly conference calls Continuous rapid development Full visibility of process and product Rapid-response prototyping

16. 16 Project Management Rolling Wave project planning Continuous analysis, prototyping & testing. Rolling Wave Project Planning is a phased iterative approach to project development, applicable to new product development, information systems and other technical development environments. It is an excellent formal project development approach for inventive work. When done well, it balances structured process with flexibility. It is appropriate for project life cycle models/ methods that allow incremental development (spiral, evolutionary prototyping, etc.).” Gregory D. Githens, PMP, Proceedings of the 29th Annual PMI 1998 Symposium.

17. 17 Tactical Analysis ingredients for success Participant activism: testing, outreach Common goal: dedication to outcomes Perseverance and persnickityness Availability of expert counsel Web-based communication tools

18. 18 Regional Representatives at the Center

19. 19 Scope Management: “All the requirements, and nothing more” Sponsors define core deliverables Representatives define interface Representatives prioritize enhancements Developers produce technical requirements Change Control by consensus of users

20. 20 Communication Is The Key location doesn’t matter Project web page with detailed minutes Discussion board with Q & A, Issue Tracking Web conferencing for prototyping On-site training & networking consultations Twice-yearly conferences hosted by CA DHS

21. 21 CAIR Development Web Page

22. 22 HLN’s Issue Tracking Web Site

23. 23 Q&A: Mailing List Web Archives

24. 24 Hummingbird BI/Query for ad-hoc queries & reporting

25. 25 Information Security & HIPAA recommendations Logging of patient disclosures Logging of patient viewing and editing Masking of confidential data fields Enforcement of 128-bit SSL encryption Strong passwords, web session timeouts

26. 26 Key Features CAIR registry system Access-level hierarchy for user accounts Context-sensitive online user manual Optional inventory management subsystem Optional TB test tracking subsystem Custom CASA data export Custom reminder/recall mailings

27. 27 CAIR Patient History Page

28. 28 School Immunization Report

29. 29 Status Report March 2003 Seven registries running CAIR software Regional customization of interface Sharing of expertise and work outputs Ongoing co-ordination of enhancements Increasing private provider participation

30. 30 Planning for 2003 HL7 data exchange Integration with county birth records PVS compliant smallpox tracking Other bio-terrorism enhancements More operational reports and conveniences

31. 31 Empowering Regional Registries contact information Joshua Frost, Project Manager Joshua@hln.com, (916) 454-4394 Joshua@hln.com John Schaaf, Software Specialist JSchaaf@dhs.ca.gov, (510) 540-2208 JSchaaf@dhs.ca.gov