1. Bilateral Communication With the New York Citywide Immunization Registry Angel Aponte Computer Specialist (Software) Contact: aaponte@health.nyc.gov

2. Outline New York Citywide Immunization Registry (CIR) introduction Open Source technologies used at CIR CIR electronic data exchange –Immunization reporting –Immunization information sharing –Decision support for immunization schedule Current methods Emerging solutions

3. New York Citywide Immunization Registry Immunization Information System for the New York City area Implemented in 1997 NYC has mandatory reporting of vaccinations of children 0-18 years of age < –Birth to < 8 years old since January 1, 1997 –Birth to < 19 years old since August 18, 2005 Over 3.4 million records with over 36 million immunizations >90% of pediatric providers in NYC participate in CIR Population-based

4. Open Source Technologies Used at CIR Red Hat Enterprise Linux (RHEL) 5 operating system Apache Web Server, Tomcat Application Server, and Axis for Web Services/SOAP/XMLP MySQL database Java, C/C++ (gcc), Python, Perl, Eclipse for development nagios service outage alerting system Security: iptables firewall, nmap port scanner, wireshark packet sniffer

5. CIR Application Logical Architecture

6. Current Methods of Reporting Web File Repository (WFR) for batch electronic submission, data quality feedback, and retrieval Reporting: –Paper: 27,130 forms per month are key entered and an electronic file is created and submitted through WFR –Electronic file: Facilities also perform extracts from their information systems and submit a text file to CIR –Web: Online Registry for additions of current and historical immunizations in real-time

7. CIR Reporting Volume Immunizations added to CIR for children < 8 years

8. Shift to electronic methods of reporting

9. Current Methods of Data Access Batch data exchange interface Online Registry for viewing immunization history and immunization schedule recommendations Issue immunization records in response to requests via phone, fax, mail

10. Current Methods of Data Access FY 2008 Method of access% Online Registry72% Electronic file extract in batch26% Phone, fax, mail2% Total100%

12. Online Registry use: 2004-to date

13. Provide current information to doctors through their healthcare facility’s electronic system Provide decision support services Enable real-time reporting from doctor’s system Can also be used by other CIR partners –New York State –Other immunization registries (e.g. ~47,000 patients < 19 years old with a New Jersey address reported to NYC CIR) –Immunization clinics –Regional Health Information Organizations (RHIOs) Emerging Data Exchange: Real-Time EHR Integration With CIR

14. CIR Web Service Logical Architecture

15. Conclusions CIR is a successful system in NYC that uses Open Source technologies CIR Web application currently provides real-time reporting and access to immunization histories and decision support CIR Web Services will provide these immunization information services to providers with EHRs and other partners Existing batch data exchange mechanisms will be maintained as a fallback solution