1. Success: Immunization Delivery Enhancement Through Private Investment in a Public Electronic Registry Utah’s USIIS - IHC Partnership Tamara Lewis, MD, MPA, MPH Intermountain Health Care (801) 442-3946 cotlewis@ihc.com

2. IHC - T. Lewis, MD2 About Intermountain Health Care Charitable, nonprofit health care organization Serving Utah and Idaho Integrated system –21 hospitals –44 Ped and FP clinics –202,000 children covered Highly “wired” (EMR)

3. IHC - T. Lewis, MD3 Barriers to Immunization Multiple site of care Missed opportunities Documentation/charting Keeping current with recommendations Need for reminders Time Determining immunization status Creating standard reports for various customers Determining immunization rates

4. IHC - T. Lewis, MD4 Addressing Challenges Lowest immunization rate in country Every Child by Two Task Force Rate increase only 2-3% per year Registry and IT data entry had the potential to break down the barriers in each category

5. IHC - T. Lewis, MD5 What is WebKIDS? A repository of immunization data for children in the state of Utah housed at the department of health (USIIS) Linked to immunization providers through Web- based technology It provides: –complete, accurate, real-time immunization data –forecasting –efficient reporting capacity

6. IHC - T. Lewis, MD6 Multiple Sites of Care Problem: –Full record not present when child seen WebKIDS solutions –Birth record from hospital entered through birth record system at Utah Department of Health –Other delivery sites all linked 50/50 Local Health Department Clinics 7/10 Health Plans, 162/250 Private Provider Clinics Care A Van 2 School Districts

7. IHC - T. Lewis, MD7 Missed Opportunities Problem –Children are seen in the clinic for reasons other than a preventive care visit and their immunizations are overlooked WebKIDS solution –“Forecast” report shows status - Printed for each child up to date, due or overdue –Easy look-up of other family members

8. IHC - T. Lewis, MD8 Documentation/Charting Problem –Documentation required 4-6 separate duplicate entries to chart a given immunization WebKIDS solutions –Document once and print all reports –Inventory tracking is automatic due to decrementing function

9. IHC - T. Lewis, MD9 Keeping Current with Recommendations Problem: –ACIP recommendations change every 6-12 months –Clinic can be following outdated recommendations WebKIDS solutions –Computer logic automatically updated with CDC guidelines by contracted firm –Communication less fragmented - but is it faster?

10. IHC - T. Lewis, MD10 Need for Reminders Problem –No efficient method for identifying patients not up to date with immunizations WebKIDS solutions –State, Schools, Clinic or IHC Quality Improvement department can run off lists of children not up to date and can contact them for recall

11. IHC - T. Lewis, MD11 Time Problem –Reports all had to be filled out by hand using billing databases or by going through patient charts WebKIDS solutions - TIME SAVING –One time data entry –Easily accessed printable standard reports (Immunization history, School entry, VFC, CASA, Detailed charting report) –HEDIS ® look-up function

12. IHC - T. Lewis, MD12 Provider Efficiency Workflow time study ProcessPre- Post-Time Saved Determine status 1:38 0:10 1:28 Re-create individual record10:02 1:29 8:33 Create school report 5:54 2:22 3:25 Vaccine administration11:21 8:04 3:17 (Note: VFC report - saves approx. 6 hours per quarter)

13. IHC - T. Lewis, MD13 Top Selling Points - End User Complete, accurate data Decision support (Forecast) Ease of data entry and reports Batch printing Process change - All visits not just sick visits

14. IHC - T. Lewis, MD14 Managed Care Benefits Increase in HEDIS® rates Increased efficiency of HEDIS auditors Improved provider satisfaction –Through improved administration, documentation, and reporting workflow Ability to transfer data within HIPAA regs Enhanced relationship with state leadership Ability to direct product to meet specific structural needs

15. IHC - T. Lewis, MD15 Rate of Children Fully Immunized by 2 Years of Age - Combo 1

16. IHC - T. Lewis, MD16 Increased Immunization Rates at IHC (1999 – 2000) The most dramatic one-year increase to date HEDIS measurement for commercial members increased from 64.7% to 76.2% –Absolute increase of 11.5 percentage points HEDIS measurement for Medicaid members increased from 66.4% to 76.9% –Absolute increase of 10.5 percentage points

17. IHC - T. Lewis, MD17 Public Health Benefits Doubled funds for system development Data load to system (10 years of past data) Information systems expertise and integration –Application testing and user sites Credibility - image of registry as valid source of information Political will to proceed Influence to attract partners

18. IHC - T. Lewis, MD18 Critical Success Factors User driven (feedback loops) –Oversight Committee –Users Group Faces and names at the clinics - Support No state mandate to report to system –“We will not mandate inefficient business practices”

19. IHC - T. Lewis, MD19 Can it Work in Your Area? Universal truths –HEDIS rates and NCQA accreditation are highly important –Employer groups are asking for better preventive services - marketing –Can’t transfer data between systems without using state health department as the intermediary - HIPAA –It is difficult to convince clinicians to adopt a new practice pattern without an automated system that increases efficiency

20. IHC - T. Lewis, MD20 End User Concerns Accuracy - Duplicate records Speed Ease of data entry Support services (24/7 with quick fixes)

21. IHC - T. Lewis, MD21 Partner Concerns Long term viability of product –Ongoing financial commitment from partners –Capacity of state to support increased volumes –Ability of the state to move with the speed and agility of a private vendor Ability for any IT system to change quickly enough to meet market demands (i.e. version releases)

22. IHC - T. Lewis, MD22 Future Directions Expand USIIS for adult immunization registry –(Smallpox) Expand USIIS as registry for other pediatric data –Metabolic screening –Newborn hearing screening

23. IHC - T. Lewis, MD23 Conclusions Registries improve immunization rates by removing barriers Registries can improve provider efficiency Partnerships with public health allow managed care access to important data The key to success is provider acceptance Managed care can be an important partner for resources and designing practical application

24. IHC - T. Lewis, MD24 Take Home Message: “The KEY to success is End User acceptance.” –The expectations of the customer must be met and exceeded, and the immunization providers are the customers who will dismantle your process if their needs are not met.