1. Vermont Department of Health M. Bridget Ahrens, MPH March 8, 2007 National Immunization Conference

2. Vermont Department of Health 2 Vermont Immunization Registry Team and Partners  Sarah Earley, Health Services Trainer  Maura Crandall, AFIX Coordinator  Colleen Carroll, Administrative Assistant  Katie Reed, Partners in Health Systems  Vermont Immunization Registry Users

3. Vermont Department of Health 3 Outline  Why Vermont?  Our basic Data Quality Process  Data Quality Tool  What We Saw  Patterns of Errors  So Now We Know the Errors – What’s next?  What We Learned

4. Vermont Department of Health 4 54% of VT children under 7 in IMR 27% of VT children under 18 in IMR

5. Vermont Department of Health 5  All records loaded via manual data entry.

6. Vermont Department of Health 6 Data Warehouse IMR Registat Plus Reports Quality Control instills trust and value in the registry and the data from it.

7. Vermont Department of Health 7 Identification of the Issues

8. Vermont Department of Health 8 Identification of the Duplicate Patients

9. Vermont Department of Health 9 What We Saw: Duplicate Patients  Identified 127 potential duplicates  Evenly distributed among practices

10. Vermont Department of Health 10 What were the Patterns of Error?  Names involved most often hyphenated  Some inversions of first and last name

11. Vermont Department of Health 11 KEY: Go Back to the Source

12. Vermont Department of Health 12 What We Learned: Duplicate Patients  User Issues Some users using Search shortcuts  Application Issues Few constraints on searches Name search issues with character marks

13. Vermont Department of Health 13 Identification of Duplicate Immunizations

14. Vermont Department of Health 14 What We Saw: Duplicate Immunizations  728,780 immunizations recorded  3,900 (0.5%) of these were duplicates  Concentration of errors higher in certain practices.

15. Vermont Department of Health 15 What were the Patterns of Error?  Both specific and NOS formulation recorded for same shot. Hib PRP-t and Hib NOS  Both combo shot and components of combo shot recorded. DTaP-HepB-IPV and DTaP and HepB and IPV

16. Vermont Department of Health 16 What We Learned: Duplicate Immunizations  User Issues Many users unfamiliar with vaccine antigen descriptions, route of administration, and manufacturer names.  Process Issues Forms not current, encouraged duplicate entry  Application Issues No constraints on entering duplicate shots

17. Vermont Department of Health 17 Approaching the Users You’re Messing Us Up! I Can Save You Some Work!

18. Vermont Department of Health 18 Identify the Process Causing Issues  Who is using the Registry?  What is the source of the data being entered?  Can you show me how you use the Registry?

19. Vermont Department of Health 19 Who is using the system?

20. Vermont Department of Health 20 User Level Issues  Clerical staff not familiar with: Vaccine nomenclature Manufacturer names Route of administration  Solution: The Cheat Sheet

21. Vermont Department of Health 21 Support Material

22. Vermont Department of Health 22 What is the Data Source like?

23. Vermont Department of Health 23 Source Level Issues  Standard form keeps changing.  No standard nomenclature.  New vaccines added before forms get updated.  Solution: Coaching. Encourage nurse level use.

24. Vermont Department of Health 24 How to Fix the Problems  Teamwork! Examine QC data for patterns of errors. Go to the SOURCE – look for processes that cause errors. Show users how to FIX problems. Where possible, provide support in fixing problems. Add checks to the Application to prevent problems.

25. Vermont Department of Health 25 Thank you for your interest and support!