1. Contra Costa County Health Services, California1 Implementation of Adult and Adolescent Schedule Contra Costa County Health Services Siu Wing Tong, Ph.D. Information Systems Division

2. Contra Costa County Health Services, California2 What is CCAIR? Contra Costa Automated Immunization Registry is a centralized data repository designed to accept and consolidate all immunization history records from multiple providers Prototype developed in 1995

3. Contra Costa County Health Services, California3 What is CCAIR?, Cont’d CA DHS (partial) funding started in January 1996 Remaining funding picked up by County In-kind supports Piloted in Contra Costa Public Health in 1996

4. Contra Costa County Health Services, California4 What is CCAIR?, Cont’d Selected by CA DHS in 1999 after HumanSoft collapse for replication elsewhere in the state Selected by Nevada State Health Division in 1999

5. Contra Costa County Health Services, California5 What Happened To CCAIR? Turned over a copy of web-enabled source code to CA DHS in 2001 – After the 2 nd IRC held in Little Rock, AK – CA DHS now maintains their CAIR version 3.x

6. Contra Costa County Health Services, California6 What Happened To CCAIR?, Cont’d Contra Costa Health Services retained client/server copy of source code Continue to operate as standalone registry

7. Contra Costa County Health Services, California7 dot-NET Conversion Porting of client-server version to Microsoft dot-NET – Started in November 2001 Finished the first prototype before the 3 rd IRC in PA in October 2002 Prototype presented at 3 rd IRC

8. Contra Costa County Health Services, California8 Scheduling in CCAIR Modeled after ACIP recommendations Table-driven logic for next due date recommendations Validate/invalidate shots given based on minimum age & intervals

9. Contra Costa County Health Services, California9 Scheduling in CCAIR, Cont’d Help text to show ACIP recommendations “WHY button” text to explain CCAIR internal logic

10. Contra Costa County Health Services, California10 Why A&A? CCAIR for children has been in Contra Costa County for years, covering primarily children 0 to 5 years of age Mature and in use since 1996 Desire to expand

11. Contra Costa County Health Services, California11 Why Now? CCAIR is linked into Patient Care Information System, our County’s Electronic Health Record project, which is intended for all ages New vaccines expected for older patients

12. Contra Costa County Health Services, California12 A&A In CCAIR Finished implementation of some adolescent schedule by 1998 – HBV 2-dose formulation – VZV adolescent schedule after age 13 Started selected implementation of a subset of A&A in 2003 after dot-NET rewrite

13. Contra Costa County Health Services, California13 Current Scope Which subset of ACIP A&A schedule for this current first phase – Influenza – 3-dose adolescent DTP (or Td) – Td (Tetanus Diphtheria) boosters – Pneumococcal polysaccharide

14. Contra Costa County Health Services, California14 Goals & Challenges Follow ACIP A&A schedule Select a subset to implement in the initial attempt Maintain current table-driven architecture – Ease of maintenance Leverage existing mechanisms – VZV, HBV-2dose, Rotavirus

15. Contra Costa County Health Services, California15 Goals & Challenges, Cont’d Discover new mechanisms needed – Repeating doses, age dependency, disease dependency, seasonal nature Link up with other tracking systems – Asthma, Prenatal/OB

16. Contra Costa County Health Services, California16 How Does It Work Now? One single table for all schedules of vaccine groups of interest One record for each recommended dose Lots of parameters in each dose record storing min/max age, intervals, conditional skips and many others

17. Contra Costa County Health Services, California17 How Does It Work Now?, Cont’d Match one shot with one schedule record The last unused or unassigned schedule record will be used for calculation of next-due-date recommendation.

18. Contra Costa County Health Services, California18 What’s Needed? Apply new table parameter values Change conditional skip to relative Add new “repeating” parameter Create multiple age ranges of recommendation Add new “seasonal” parameter

19. Contra Costa County Health Services, California19 Our Findings Td 3-dose series – May use existing DTP 5-shot series – Need new skip condition that is relative to a previous dose, not to a particular, fixed dose number – Cannot easily specify the recommended vaccine codes from DTP to Td etc.

20. Contra Costa County Health Services, California20 Our Findings, Cont’d Td Boosters – Need new “repeating” parameter – User may specify a shot as booster shot – Put “repeating” scheduling record (for booster) at the end of the series

21. Contra Costa County Health Services, California21 Our Findings, Cont’d Influenza – Need new “repeating” parameter – Need new “seasonal” parameter To specify the starting of the season – Need two records in schedule table The second one being “repeating”

22. Contra Costa County Health Services, California22 Our Findings, Cont’d Pneumococcal Polysaccharide – Separate group from PNU conjugate – Avoid recommending both PNUps and PNUcon – Disease history or medical conditions To store or not to store

23. Contra Costa County Health Services, California23 Our Experiences More difficult to maintain totally table- driven algorithm Complexity of schedule Dependency on sensitive disease history & medical conditions – How best to obtain information – To store or not to store in registry

24. Contra Costa County Health Services, California24 Contributors Erika H. Jenssen Carol Fitzgerald Ates Temeltas Siu Wing Tong

25. Contra Costa County Health Services, California25 Contact Us Siu Wing Tong, Ph.D. Information Technology Supervisor Contra Costa County Health Services 595 Center Ave, Suite 200 Martinez, CA 94553 swtong@hsd.co.contra-costa.ca.us