1. Streamlining Vaccine Ordering and Improving VFC Accountability
Roles and Challenges with Registries
Thomas Maerz
Wisconsin Department of Health & Family Services
Wisconsin Immunization Registry (WIR)
Emily Peterson-Stauffer
Minnesota Department of Health
Minnesota Immunization Information Connection (MIIC)

2. Session Objectives
Challenges of having providers consistently record VFC eligibility in a registry.
How linking with Medicaid eligibility data can support VFC tracking and reporting.
How registries can alert clinics to inventory that is running low or about to expire and can automate re-ordering.
How use of a registry’s decision support feature prevents inappropriate and wasted doses.

3. Main Points
There is a growing need for improved accountability in the VFC program. Registries can play a role in meeting that need.
Getting maximum value of your registry means exploring how you can more closely link it to VACMAN/vaccine ordering and accountability.
Just because we build it, doesn’t mean they will come. Providers often use a registry on their own terms, regardless of how we intend they use it.
It is not known how the growing use of EMRs will affect VFC eligibility reporting to a registry but it will likely impact how data gets to the registry.

4. The potential…
Registries provide users with information and functions that support proper storage and handling of vaccines, and can internally support management of the VFC program.
PROW Principle for Vaccine Management
The PROW Standards of Excellence provide some concrete examples of how registries can support an immunization project’s
vaccine management responsibilities. This is the principle from the PROW document. Let’s look at the some actual Standards of Excellence.

5. Registry Support of Vaccine Management
Provide users information on vaccine storage and handling.
Support a vaccine inventory feature capable of adjusting doses due to wastage or transfer.
Generate a doses administered or other report(s) to support vaccine accountability efforts.
Capture VFC eligibility status and generate annual provider profiles.
Incorporate an alert feature for lots due to expire or running low.
Incorporate a link for automated ordering as inventory runs low.

6. Challenges
Not all providers want to use a vaccine inventory or VFC eligibility tracking feature or are willing to take time to enter such information.
May send batch data from practice management system or EMR to avoid double data entry; use registry for look-up only.
May have their own systems in place.
May not want clinical staff doing data entry.
Both WIR and MIIC registry systems allow providers to enter inventory into the application, and are able to denote if the vaccine lots were publicly-funded or privately purchased.
These systems may or may not have the features your registry has or track the data you need.
Additionally, once an inventory immunization is entered through the user interface, the dose is automatically deducted from the correct vaccine lot.
This provides a number of reporting capabilities.

7. Where to collect eligibility?
The top screen shot is from WIR’s Add Immunization screen, where they require that all shots drawn from inventory must have the VFC category selected.
Drawback: Does not enable providers to indicate eligibility on shots given historically or those not drawn from inventory.
2. The bottom shot is from MIIC’s Client Information page, where VFC eligibility is a required field for new clients entered via the user interface.
Drawback: This is not stored at immunization level and doesn’t apply to new clients entered through batch data loads.
3. Challenges for both MN and WI: Collecting VFC eligibility through batch data loads and associating with the correct immunization dates.

8. Challenges (cont.)
Front line clinical staff don’t always know or ask about VFC eligibility.
Often handled as part of back office billing functions.
Clinics may have one inventory and use a replacement system for reconciling VFC versus privately-purchased vaccine.
Such replacement schemes are likely not supported by a registry’s inventory module.

9. Linking with Medicaid data
WIR loads Medicaid claims and encounter data weekly.
Automatically assigns or updates the eligibility code to indicate “Medical Assistance.”
MIIC just starting to upload Medicaid data on a quarterly basis.
Since our eligibility codes don’t get updated automatically, we can update each client based on date of immunization.

10. Vaccine management and ordering features in a registry
The Wisconsin Experience

11. When an organization is enrolled in the VFC program, their Medicaid ID number must be entered in WIR before they can order vaccine.

12. A site with the exact name as the organization must be created for ordering to take place. This site must contain a contact person as well as a address for shipping.

13. Organization can set inventory expiration and low-level defaults.

14. A user selects the Create Order button from the Manage Orders screen to begin the order process. The user can then specify the number of doses and/or pre-filled syringes they wish to order. They may also order VIS sheets and Varicella vaccine from this screen.

15. A VFC program coordinator at the state goes through pending orders daily and either fills them, places them on back-order or can deny the order.

16. Packing lists and labels are available for printing for all filled orders on the Shipping Documents screen. One of these two items must at least be viewed before orders can be shipped. Once the orders are shipped the order status is changed to “Shipped” and the state can no longer edit the order.

17. After the state has shipped the order within WIR, the pharmacist or inventory coordinator will receive a transfer notification each time they log in until the order is accepted.

18. The user would then accept the order and post it to one of its sites.

19. The VFC report details the number of clients that were vaccinated by an organization for each eligibility type for a specified date range.

20. The Transaction Summary report provides vaccine dose details.

21. The Vaccine Usage report provides vaccine disbursement details.

22. Ad hoc reports can be generated
This is an ad hoc report that MDH is able to generate for providers who then can verify the VFC eligibility status of their clients.

23. Next Step: Interface with Vacman
Use SDN Server with Digital Certificates
Implement PHIN MS as Transport
Use ANSI approved data standard (HL7)
All 3 of these elements are part of WIR’s functional real-time HL7 Interface.
A number of registries are exploring and even developing a closer linkage between their registry and VACMAN, used for ordering VFC vaccine from the feds. While the current VACMAN system is cumbersome and inefficient in many respects, CDC is proposing a new architecture for VACMAN that will be a significant improvement, and also create opportunities for greater linage with registries.
This proposal features secure digital networks and certificates, relying on PHIN-MS as the transport mechanism, and using HL7. CDC sees a couple of possible models for immunization projects to use in a VACMAN-registry linkage, both acceptable in terms of meeting required and optional functionality.

24. Conclusions
We can build information systems to meet federal and state needs, but that doesn’t mean providers will use them as we intend.
Registries have limited ability to require use of features intended to improve vaccine accountability and VFC eligibility tracking.
Finding the “win-win” is challenging in today’s tight health care environment.

25. Questions? Thomas Maerz WIR Project Manager 608-261-6755
Emily Peterson-Stauffer
MIIC Project Manager