1. Integration of the Responder System and the Statewide Immunization Registry
Benefits and Steps – A Case Example in Wyoming
Presented by Sandra Urbanek
Wyoming Dept. of Health
with
Robert (Buzz) Conn
Scientific Technologies Corporation

2. Immunization Registry/First Responder Integration
Background – Wyoming Immunization Registry
Decision Factors - PVS to Non-PVS State
Benefits - Non-PVS State
Steps – Systems Integration and Certification
Funding Source/Cost Expectations

3. Background – Wyoming Immunization Registry
Wyoming Demographics
Sparsely populated – 500,000
Annual Births – 6,000
Patients in the Immunization Registry – 172,169
Vaccinations in the Immunization Registry – 1,588,730
In spite of low population, technology infrastructure requirements are similar to more populated states

4. Background – Wyo. Immunization Registry, cont.
WY Immunization Registry History
Project started in late 1999 with statewide assessment
Completely deployed throughout the public health nursing offices
Offices now operate as “paperless” immunization programs
Immunization Registry technology is a mix of client-server and Web interacting with a common central registry
Focus now is on private provider recruitment/deployment

5. Decision Factors – PVS to NON-PVS State
Difficulty in accessing or controlling the smallpox data with PVS.
Required dual tracking systems
Paper and PVS
Burden on public health nursing offices.
Difficulty in transferring of reconstituted vaccines from one office to another.
Difficulty in reporting preparedness through PVS.
Wyoming would be low on CDC’ priority list to furnish support.
Wyoming was responsible for user training on PVS

6. Decision Factors – PVS to NON-PVS State, cont.
PVS certificate process created a roadblock for potential post-event mass immunization clinics.
Data entry would not be conducted by the staff or on the workstation the certificate was issued.
Temporary workers will be utilized.
School computer labs would probably be the source of data entry.
Need IMMEDIATE set up for a worker and workstation
Unable to forecast in advance what workers or workstations would be utilized.

7. Decision Factors – PVS to NON-PVS State, cont.
Smallpox first responder clinics
PVS utilized to track 400 first responders
WY DOH recognized that local tracking of first responders would provide a better return for data entry efforts expended
The WY SIIS was already in use for adult immunizations – flu shots, travel shots, PPD skin tests
Decision made to leverage the WY SIIS for first responder tracking

8. Benefits - Non-PVS State
True responder system – not limited to smallpox program
Anthrax
Influenza
SARS
Export developed to transfer data back to the Immunization Registry from PVS.
Immediate access and control of raw data
Data stored on Immunization Registry database
Web enabled

9. Benefits - Non-PVS State, cont.
Only need certificate for workstations sending XML update file to PVS.
Expanded management reports.
Ability to communicate preparedness.
Ability to transfer reconstituted vaccine.
Public health nursing staff not trained on two different applications
Look and feel is the same as the Immunization Registry

10. Benefits - Non-PVS State, cont.
Training and help desk support supplied by vendor.
Reminder recall feature in Immunization Registry can be utilized.
Patient Immunization Record report in Immunization Registry incorporated into First Responder
Leverage the Immunization Registry infrastructure.
Use the Immunization Registry servers
Immunization Registry IT staff will support First Responder
Same database - Full immunization record is accessible (e.g. small pox, Td Adult, PPD skin tests).

11. Benefits - Non-PVS State, cont.
Post-event Mass Immunization Module
Web enabled or client application
Quick and easy mobilization in the event of an outbreak
Streamlined data collection
Better tracking and record keeping
Records stored on central registry database
User friendly, easy to train
Ability to use in Influenza clinic
Training is kept up through Influenza clinic

12. Step 1 – Product Acquisition
Product acquisition choices
Internal development
Contracted development
Purchase existing application
WY DOH elected to purchase existing product
Product had history in several other states
Fully integrated with the registry product in use
Other states using the application had already achieved certification
Product had to meet the requirements necessary for the state to become certified

13. Step 1 – Product Acquisition, cont.
For certification, the integrated responder system had to provide new data elements and features such as:
PVN Numbers
Smallpox/Diluent batch creation
Additional patient contact information
Occupations
Smallpox vaccination history
Take responses/re-vaccinations
Readiness reports
XML formatted export for CDC PVS

14. Step 2 – Notification to CDC
Letter of intent to CDC and the PVS Certification Team to become a non-PVS state.
Software vendor name
Software name and version
Verify software functionality
Simple process – work with the assigned TADA representative
Enables the PVS Certification Team to schedule the certification activities

15. Step 3 – System Administrator Training
Who/what is certified?
Certification applies to the state department of health, not the system
Demonstrates the DOH staff competency in the use of the non-PVS system and submission of properly formatted data to the CDC PVS system
Obtain PVS User ID and password (Different users from previous PVS users).
Certificate for submitting workstations
Training (in this case conducted by the system vendor) prepares the DOH staff for the certification activities

16. Step 4 – Certification Process
Conducted by the PVS Certification Team
Five scenarios - each must be successfully completed prior to moving to the next one
Set of control data supplied by the Cert. Team
Scenarios consist of data entry, edits of previously entered data and submission via the XML export file
The certification team tests each submission and provides go ahead (or requires problem resolution) for the next scenario
Approximately three days required for training and certification

17. Step 5 – Data Migration Wyoming started as a PVS system user
Necessary to import data from PVS to the First Responder/SIIS database
CDC Certification Team provides flat-file export
Programming effort was required to import the data to the state’s first responder system
Approximately 120 hours were required for migration and testing activities

18. Step 5 – Data Migration, cont.
Data Validation
Need to create and send an export file from Immunization Registry to PVS
PVS Certification Team generated a Discrepancies in Data Comparison Report
Data entry errors corrected
Program modifications and data reloads required by software vendor
Re-submit export file with a letter certifying discrepancies were corrected or noted as not an issue.
Certification letter issued by PVS Certification Team

19. Step 6 – User Training End user training required minimal effort
Interface similar to the registry interface
Functions similar to the PVS system
Approximately 4 hours were required for training

20. Funding and Cost Expectations
Funding – State BT funding was used for product acquisition, certification and training activities
In summary, plan for about $70,000

21. Summary
Wyoming has extended the features provided by the PVS system to a state managed system and continues to support the CDC PVS through the enhancement of the statewide immunization registry
The state now has a system to track the preparedness of responders for a variety of public health emergencies

22. For More Information Sandra Urbanek Robert (Buzz) Conn
Information Systems Project Manager
Wyoming Department of Health
(307)
Robert (Buzz) Conn
Director of Product Development
Scientific Technologies Corporation
(602)