1. National Immunization Conference March 2006 Integrating Immunization Registries with a Disease Surveillance and Management System Michael L. Popovich 520-202-3333 Michael_popovich@stchome.com

2. Scenario/Use Cases Imagine an electronic disease surveillance system interfaced with the state's life-long immunization registry. –Each time a VPD case occurs, the disease surveillance system automatically queries the immunization registry Imagine an case management system with contact tracing –That, during a measles outbreak, creates a line list of all contacts, checks their measles immunization history automatically, highlighting the contacts on the line list who must be immunized. –Or maps lack of immunity against disease incidence block by block. Imagine an outbreak management system that is capable of querying an immunization system that tracks vaccine inventory, location and demand.

3. Learning Objectives Why share information? What information to share? Examples of what some are doing: state-of-the-art? Requirements The ability to electronic link immunization registries with disease surveillance, reporting, case and outbreak management systems provides decision makers with near- real time information to minimize the impact of VPD and effect outcomes

4. Decision Management Requires Integrated Information From Early Warning to Disease Management

5. Early Warning EW Environment (Syndromic Surveillance) Notification of a possible event –Biosensor –Syndromic Surveillance OTC ER visits Absenteeism Questions? –Source and how it might propagate? Weather, Environment, Population Related? –At risk? Facilities, Population, Animals? Decision Makers Needs? –Rapid impact assessment –Decision support criteria An immunization registry with its robust toolset: forecasting, GIS pocket of need analysis along with the ability to manage vaccine inventories provides decision makers with “Information” which translates to “Knowledge” and thus provides capacity building resources.

6. Value Added Benefit Immunization Registry to Support Early Warning Examples of Immunization function –Risk Assessment Population data –Mitigation Assessment Inventories Staff resources Facility resources

7. Disease Reporting Disease Reporting Environment If VPD –Notification to Immunization staff –Awareness of immunization status to case investigators –Awareness of directly linked population –Awareness of contacts and potential contacts Notification of a VPD to disease investigators triggers the need to investigate. Investigation requires information. Information is available in existing medical records, repositories and through individual interviews. An Immunization registry provides core information to support immunization status of a client/case.

8. Value Added Benefit Immunization Registry to Support Disease Reporting Examples of Immunization Registry Features –Population immunization records –Tools to forecast –Use of maps to identify PON

9. Case and Outbreak Management Case and Outbreak Environment Managing cases and Managing an outbreak –Plan the actions –Monitor the response –Report on progress –Learn for next time –Build capacity Knowing who is under immunized, knowing who is at risk and knowing what supplies are available allows case workers to develop strategies for minimizing the impact of a disease. Minimizing disease impact supports public health’s mission, the economic and political impacts of a community

10. Value Added Benefit Immunization Registry to Support Case and Outbreak Management Examples of Immunization Registry Tools –Reminder recall –Automated assessment tools –GIS Maps to determine at risk –Vaccine availability Right amount at right location

11. A Few Examples: States like WV and ND When VPD event reported through Disease Reporting Automatic query of immunization records Electronic notification of program staff

12. Visions like Canada Public Health “Dashboard” Concept with User Based Role and Integrated Access Case Investigators with Access to Immunization Records Immunization Program Staff with Access to VPD Cases

13. A Strategy for Information Sharing 1.Must satisfy CDC PHIN Standards Security, Electronic Exchange, Vocabulary 2.Must have state program support Communicable Disease Program and Immunization Program 3.Must have state DOH IT support No requirement for an integrated solution –Mix of products is fine No requirement for detailed studies –Models and best practices available No requirement for major new expenditures –Low cost integration efforts Linkages are easy to sustain as the program and IT environments evolve

14. Requirements Example Handout that provides Use Case Requirements for organizations wanting to implement the basic linkages Requirements and Use Case Definitions for Integrating Immunization Registries with Disease Surveillance Systems