1. MICHIGAN CARE IMPROVEMENT REGISTRY
MCIR ACROSS THE U. P.
Jeanne’ McCoy, Region 6 Coordinator

2. HISTORICALS
1994, Michigan began creating Electronic Birth Certificates (EBCs) for all children born in the state
1996, the Michigan Childhood Immunization Registry (Public Act 540) created
Designed to record childhood immunizations given by private providers in MI
2006, (Public Act 91), MCIR expanded to adults, becoming a lifespan registry
Name changed to Michigan Care Improvement Registry to reflect expansion
(Click) The creation of Electronic Birth Certificates (EBCs) for Michigan’s residents began in (Click) Then in 1996, the Michigan Childhood Immunization Registry was created under Public Act 540. (Click) In the beginning, MCIR was designed for the childhood immunizations for Michigan residents, but (Click) in 2006, MCIR was expanded to a lifespan registry. (Click) The name was then changed to Michigan Care Improvement Registry to reflect that expansion.

3. HISTORICALS
1997, Public Health, Delta and Menominee Counties, received contract for Region 6 for FY 1998
Regional office located in Escanaba, centrally serving the U.P. from within the U.P.
Current staffing, full-time Coordinator, part-time assistant
(Click) PHDM was granted the contract for Region 6 starting in FY 1998, (Click) serving the entire Upper Peninsula from its central location. (Click) We currently have 2 staff, a full-time coordinator and a part-time assistant.

4. THEN… MCIR began as a software program Installed on office computers
Connection problems
Records incomplete
No easy way to track inventory
Resistance to using new technology/software
(Click) When MCIR was first created, it was a software program (Click) that was installed on the computers in the doctors’ offices. (Click)There were connection problems, (Click) the records were, of course, incomplete at this time, (Click) and there was no easy way to track the vaccine inventory. (Click) And as usual, there was resistance to using new technology and software.

5. …AND NOW MCIR web-based through the State portal
Assesses each record; displays due dates for overdue and future vaccinations
All providers access immunization records for patients of all ages
(Click) MCIR is now a web-based database which is accessed through the State’s Single Sign On Portal.
(Click) Each record is assessed and MCIR provides the current immunizations that are due and those that are overdue.
(Click) All types of providers (hospitals, long term care facilities, doctors’ offices) can access the immunization records for their patients, regardless of their age.

6. U.P. NOW! 223 sites across U.P. (and Wisconsin) using MCIR
19 different facility types, including
Pharmacies
Tribal Health Centers
Long Term Care Facilities
Obstetrics and Gynecology
Family Planning Clinics
Internal Medicine
Urgent Care
(Click) There are currently more than 223 active providers sites in the U.P. and Wisconsin (8 sites).
(Click) Some of the 19 different facility types include: (read some from the list) (Click, Click, Click, Click, Click, Click, Click)

7. Number of Sites by County
Here is the breakdown of sites in each county jurisdiction.

8. Number of Sites by District
Jurisdiction
Number of Sites
Chippewa County Health Department 25
Dickinson-Iron District Health Department 37
LMAS District Health Department 24
Marquette County Health Department 32
Public Health, Delta & Menominee Counties 31
Western U.P. Health Department 52
And the number of sites in each LHD jurisdiction.

9. ENHANCEMENTS
2008, Vaccine Inventory Management (VIM) module introduced
VIM allows providers to use MCIR to maintain an electronic inventory that:
Tracks VFC doses received and administered
Increases provider accountability
(Click) In 2008, MCIR introduced the Vaccine Inventory Management module, (Click) giving providers (and VFC) the ability to track the VFC doses received in (Click) and the doses administered to patients. (Click) This made the provider more accountable for the VFC vaccines received under the program.

10. ENHANCEMENTS 2010, E-Ordering module introduced for VFC vaccine
E-Order is an online order system
Local health department electronically reviews and approves orders submitted by provider
Vaccine shipped directly to provider offices
It’s easy!
(Click)The E-Ordering module for VFC vaccines was welcomed in 2010, and is working wonderfully. (Click) E-ordering is much like ordering personal items online, putting your items in a cart, verifying your information, and submitting your order! (Click) The local health department receives the order first, reviews it and approves the orders, forwarding them on to the Michigan Department of Community Health. After their approval, (Click) the vaccine is shipped directly to the provider’s office. The feedback on this module has been very positive. (Click) It really is easy!

11. ENHANCEMENTS
2011, birthing hospitals began training for VFC Universal Hepatitis B ordering and accountability
VIM module used to balance inventory
E-Ordering module used to order vaccine
(Click) In 2011, the birthing hospitals across the State began training with their regional staff for the Universal Hepatitis B on-line ordering. (Click) The balancing and ordering process is almost the same as for the providers offices, except the hospitals are not doing a dose-for-dose accounting. (Click) The same e-ordering module is used to order the HepB vaccine.

12. U.P. Birthing Hospitals Hospital Date Pharmacy Agreement Signed
Date Training Completed
Aspirus Keweenaw Hospital
May 6, 2011
June 2, 2011
Bell Hospital
May 20, 2011
June 13, 2011
Dickinson County Healthcare System
May 5, 2011
August 28, 2011
Aspirus Grand View Hospital
May 12, 2011
June 21, 2011
Marquette General Health System
July 6, 2011
August 25, 2011
Portage Health
OSF St. Francis Hospital
April 28, 2011
May 31, 2011
War Memorial Hospital
September 14, 2011
November 8, 2011
This chart shows the seven birthing hospitals in the U.P. You can see the date the agreement was signed with the Pharmacist at each hospital, and the date the training for the balancing and ordering was completed. As you can see, all hospitals completed their training by therequired deadline, end-of-year 2011.

13. Regional MCIR New staff hired June and August 2010
Redesigned quarterly newsletter produced
Easily accessible through link on MCIR News Screen
Short, easy-to-read articles
MCIR Quiz
Winners
Lorene Maulding, Marquette Medical Center-Gladstone
Sara Henry, OSF Walk-In Clinic
Genevieve Pokley, Marquette General Family Medicine
Reminder and Recall postage reimbursement reinstated FY
MCIR Region 6 has undergone some changes in the last 2 years. (Click) In June 2010 a new Regional Coordinator was hired, and in August of the same year a new Assistant Coordinator. (Click) Starting in the first quarter of FY2011, the Region 6 quarterly newsletter was redesigned, with the first issue published in January (Click) The newsletters are linked through the MCIR News Screen to make it easy for all users to access. (Click) The newsletter is designed to be easy to read and understand so users will be able to read it quickly. (Click) A special feature of the newsletter is the Quiz. (Click) Those who answer all questions correctly are entered into a drawing. (Click) The 3 winners have been:
(Click) Also for FY 2011 the postage reimbursement for the reminder/recall efforts was reinstated.

14. Postage Reimbursement
County Jurisdiction
Reimbursement
October 2010-September 2011
WUPHD-Houghton
$ 1,205.60
WUPHD-Gogebic $
WUPHD-Ontonagon $
PHDM $
Chippewa
$1,385.56
LMAS $
DIDHD-Dickinson $
DIDHD-Iron $
Marquette $
TOTAL
$4,316.42
Here you can see the amount of postage each county or jurisdiction has been reimbursed during FY2011 for their reminder/recall mailings. This reimbursement assists the LHD’s with the mailing costs of these required reports. MCIR has reimbursed more than $4,300.

15. Site of Excellence Awarded quarterly Nominated by LHD
Evaluated by MCIR Regional Coordinator
Evaluation criteria includes:
profile percentage
Significant rate improvement
Consistently balance each month
Adult immunizations
Timeliness of data entry (compliancy rate)
Another special feature that was reinstated for this year was the Site of Excellence Award.(Click) Each quarter the local health department is asked to (Click) nominate one provider site that has met or exceeded the criteria; in other words, they have gone above and beyond the requirements. (Click, Click, Click) A profile report is run, which will show the number of children months of age that have the required doses for their age group. (Click) I look at whether they have had a significant improvement in the rate, (Click) if they have consistently balanced each month with minimal borrowing and (Click) whether they are entering adult immunizations. (Click)The last report I run is the compliance report. This shows the number of days it takes for the provider to enter the shots given in their clinic. I calculate the compliancy rate and that is used in the criteria for the Site of Excellence determination.

16. Site of Excellence Award Recipient Sault Tribe Health Center - Sault
The first site to receive the Site of Excellence Award was the Sault Tribe Health Center, in Sault Ste. Marie. Pictured here are one of the doctors and the nurses that administer the shots and enter them into MCIR.

17. Site of Excellence Award Recipient Bellin Health Family Medical Center - West
Our second award was to the Bellin Health Family Medical Center. At the time they were the West site, but the East and West sites have now combined in their new building. They had a 100% immunization coverage rate ( ) and a 91% compliancy rate. Pictured here are: Jennie Miller, PHDM’s Immunization Coordinator, the doctor, and the nurses responsible for data entry and balancing.

18. Site of Excellence Award Recipient Aspirus Grand View Clinic - Ironwood
Our third award was presented to the Aspirus Grand View Clinic in Ironwood. The site was so excited they called everyone in the clinic down to see the presentation, and put the picture in the local newspaper. That’s what we like to see! Pictured here in the front are the 2 individuals responsible for all data entry and balancing for the clinic (with some of their co-workers in the background).

19. What Else is MCIR Staff Doing?
Activity (Oct 2010-Aug 2011)
Number Completed
Individuals Trained
249
Training Events
118
Record Deduplications
470
Find-A-Child Forms 87
Password Resets
143
Petitions for Modification
348
What else is MCIR staff doing? We keep very busy with things like this! 249 people were trained at 118 different provider sites around the U.P. and Wisconsin. Debbie had 470 records with duplicates that she researched and merged; she processed 348 Petitions for Modification, which involved corrected/changed names, dates of birth, or gender.

20. Training Superior Family Medical Associates
MCIR trainings are held around the Upper Peninsula, from Superior Family Medical Associates in Sault Ste. Marie,

21. Training Lac Vieux Desert Clinic
To Lac Vieux in Watersmeet (Gogebic County),

22. Training MGHS – Family Care Doctors
To Marquette General Health Systems - Family Care Doctors in Marquette. (Click)

23. Display at U.P. Immunization Conference and Kid’s Health Fair, Luce County
As the Regional Coordinator, I am responsible for training providers to use MCIR; but I am also responsible for educating parents on the benefits of MCIR. So in addition to a display at the local Immunization Conference, I share materials with parents at health fairs around the U.P. about immunizations and how MCIR safeguards their records.

24. Anything Else? Initiatives Clean-Up Reports 4313314 Varicella HepB
Run by county
Run regular basis
To find duplicate records
To find incorrect county/state
Increases profile rate
(Click) Debbie runs reports, (Click, Click, Click) called initiatives, for provider offices that gives a list of children who do not meet the minimum requirements listed on the report; (Click, Click)I run county clean-up reports (Click) and examine them to flush out the duplicate records, (Click) and find incorrect address information. (Click) The intent of the clean-up reports is to help increase the profile rate for the county. (Click) These are, at a minimum, run prior to the county’s accreditation.

25. County 4313314 Percentages County April 2011 May 2011 June 2011
July 2011
Alger
67%
68%
71%
74%
Baraga
77%
80%
79%
82%
Chippewa
69%
70%
72%
Delta
76%
78%
Dickinson
Gogebic
73%
Houghton
65%
Iron
Keweenaw
61%
63%
62%
Luce
Mackinac
56%
53%
55%
Marquette
75%
Menominee
Ontonagon
Schoolcraft
Here is the county-wide percentage of children current on their immunizations, months of age. Delta County is currently at 78% (the highest it has ever been); Menominee County is 70%.

26. Regional Comparison State Percentage
June 2011
July 2011
Region 1
68%
69%
Region 2
79%
Region 3
74%
76%
Region 4
72%
Region 5
Region 6
73%
State
71%
In this chart is a comparison of the 6 Regions and the State. Region 6 is at 73%.

27. Wait a Minute!
What is ?
It is a percentage of children aged 19 thru 35 months old that have had a minimum of:
4 doses of DTaP/DT/Td/Tdap
3 doses of IPV
1 dose of MMR
3 doses of HIB
3 doses of HepB
1 dose of Varicella
4 doses of PCV7/13
(Click) I mentioned several times…so what is it? (Click) That number represents the number of children, ages months of age, that are current on their immunizations. You’ve heard that a few times already. (Click) But the numbers represent the doses of each vaccine they should have received by 35 months of age.

28. Thank you!
Contact Information:
Jeanne’ McCoy, Region 6 Coordinator