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Key Steps To Implementing a New Physician into the Regional Registry
IRIS Immunization Registry Information Source K. Sutliff / B. Daish
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Basic Background Began deployment of IRIS in 1997
Saturation of initial seven counties over past five years First stage relatively easy UHPCC contacts & programs within targeted counties We began the deployment of the IRIS program at the county level following advisory board recommendations. We began with the Consortium’s county of residence (Warren) and continued with the remaining six counties the Consortium has affiliations with. Fist stage fairly easy due to UHPCC’s existing contacts and programs throughout the counties targeted. Our county representatives discussed the project at IAP meetings and were able to help and advise.
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Counties Participating
CLINTON Counties Participating in IRIS FRANKLIN STLAWRENCE ESSEX JEFFERSON HAMILTON LEWIS WARREN OSWEGO ORLEANS HERKIMER NIAGARA ONEIDA WASHINGTON MONROE WAYNE FULTON SARATOGA GENESEE ONONDAGA MONTGOMERY ONTARIO MADISON ERIE SCHENECTADY WYOMING CAYUGA LIVINGSTON YATES SENECA CORTLAND RENSSELAER OTSEGO ALBANY SCHOHARIE TOMPKINS CHENANGO SCHUYLER CHAUTAUQUA CATTARAUGUS ALLEGANY GREENE COLUMBIA STEUBEN TIOGA DELAWARE CHEMUNG BROOME The yellow areas show our initial deployment area. ULSTER DUTCHESS SULLIVAN IRIS PUTNAM ORANGE WESTCHESTER ROCKLAND SUFFOLK NASSAU NEW YORK CITY
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Objectives 100% participation in counties serviced
Supply a sound software package Transmit data to regional & state servers Address office day-to-day needs Regional goal is to have 100% participation in each of the counties serviced, but that could be difficult, since participating in the registry is not mandatory. That’s why it is important that we offer a software package that would not only transmit data to the registry, but also streamline there day-to-day activities.
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What’s Next?
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Identify Non-Participating Physicians
NYS DOH assistance Establish contacts through VFC listings County assistance County personnel provide contacts through PBII studies Networking – physicians/practice personnel Yellow Pages - let your fingers do the walking And how do we do this? We establish contacts through Vaccine For Children listings provided by DOH County personnel share leads resulting from PBII (Provider Based Immunization Initiative) studies. We then contact any leads we have received from the latest participants. And, of course, there are the yellow pages.
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Presentation & Demonstration
Show reporting capabilities Simplicity of software (it’s user friendly) Patient consent forms Office visits Kindergarten Round-up HepB clinics We present the reports available with IRIS. A few of them are recall listing, outreach letter, patient immunization history, patient immunization list. Demonstration of software and the ease of using the program. Explain about mandatory consent forms and collection of these forms. Parents/guardians are requested to sign consent form to enable participation in the registry. They can be collected on routine office visits, kindergarten round-up or vaccination clinics.
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Presentation & Demonstration
Explanation of benefits Patient records are accurate, complete and easily accessible Data used for medical reviews, daycare, camps & school requests Vaccine Management Eliminate patient discomfort Generate reports Reduced paperwork – recording immunizations in registry makes it easier to print a patient report for school, camp or travel purposes. Medical Reviews pertaining to CASA, daycare, camps and school requests. Vaccine Management – to eliminate waste Eliminate patient discomfort by having updated immunization records, therefore, not giving vaccinations that are not needed. (Navy nurse realizing that this will not be nationwide for a while, but if this will lesson the amount of times a child is “pricked” with a needle, she’s all for it). Generate reports – eight reports available, one of which is exporting to CASA
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Presentation & Demonstration
Assessment of infrastructure Hardware / Software Workflow process / logistics VPN – Virtual Private Network Confidentiality & Consents Participation Agreement We find out if the software will be installed on a stand-alone PC or a network. How much hard drive space is on the PC or server? What is the operating system i.e. Windows98, WindowsNT? How many PC’s will be pointing to this database (network). We find out the workflow process of the office and where the PC’s are located. We sometimes make suggestions on how they can streamline there daily tasks i.e. daily logs. Data is transmitted to regional registry through VPN using Internet connectivity (Road Runner, Adelphia or other Internet Service Provider) Confidentiality – Non-consented patient information is not transmitted to the registry, but remains in facility database. Consented data is transmitted. Agreement – signed by Director or Administrator of facility. Agreement to adhere to the conditions stated. It doesn’t always run that smoothly, though. Sometimes there are some barriers… ISP – Internet Service Provider
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Barriers Resistance to change Failure to recognize benefits
Participation not mandatory No Internet access for registry connectivity We find that quite a few sites are resistant to anything different. They have run their office a certain way for years, they think it works and they don’t want anyone coming in changing anything. They also think that it will be more work for them. They also fail to recognize the benefit of the program. Streamlining office tasks, reports at the click of a button, not having to pull charts! We’ve also run into practices that feel if it’s not mandatory “why bother?”. They’ll wait until it is.
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Implementation Install and test software Staff training
Data entry and retrieval Daily immunization logs Populate with historical data Support!!Support!!Support!! Install and test to make sure everything is up to par – right down to the passwords working. Training for data entry and how to retrieve data for reports. Historical data goes back 6 years (1996). Data downloads are done where databases are compatible. Support – We stress the importance of calling when assistance is needed for technical or data entry issues. We also supply a training manual that can be referred to when needed. We try to keep an open line of communication.
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Finally… Drum roll, please…
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Go Live!
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But, wait… look at the results
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Counties Participating
in IRIS CLINTON FRANKLIN STLAWRENCE ESSEX JEFFERSON HAMILTON LEWIS WARREN OSWEGO ORLEANS HERKIMER NIAGARA ONEIDA WASHINGTON MONROE WAYNE FULTON SARATOGA GENESEE ONONDAGA MONTGOMERY ONTARIO MADISON SCHENECTADY ERIE WYOMING CAYUGA LIVINGSTON YATES SENECA CORTLAND RENSSELAER OTSEGO ALBANY SCHOHARIE TOMPKINS CHENANGO SCHUYLER CHAUTAUQUA CATTARAUGUS ALLEGANY GREENE COLUMBIA STEUBEN TIOGA DELAWARE CHEMUNG BROOME We have expanded into nine additional counties with a grand total of 16 participating counties. Our original counties continue to send data. And while we have only implemented IRIS on the county level with the newer counties, we have begun our marketing effort in the private sectors with some success. Only one county is pending right now, but with some assistance from DOH, we have no doubt they will be signing up soon – how could they not? ULSTER DUTCHESS SULLIVAN IRIS PUTNAM ORANGE Agreement pending WESTCHESTER ROCKLAND SUFFOLK Private sector only NASSAU NEW YORK CITY
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Conclusion IRIS will continue working to obtain the 100% market penetration in each participating county and will pass data to the state and regional servers in a consistent, secure and reliable manner.
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