Immunization Information Systems (IIS) with EHRs to Reduce Burden - - PowerPoint PPT Presentation

IIS Measurement and Improvement: Connecting Immunization Information Systems (IIS) with EHRs to Reduce Burden and Improve Care

HIMSS Spring I&HIE Community Roundtable April 10, 2019

Purpose Promote the development, implementation and interoperability of Immunization Information Systems Collaborate Provide a way to work collaboratively to develop standards, best practices, strategies and provide education about IIS Measurement & Improvement Identify the key aspects of an IIS that can be evaluated and measured Provide technical assistance to IIS programs to foster improvement Support Support IIS and immunization programs through education, targeted assistance, and advocacy

What AIRA does

What are Immunization Information Systems (IIS)?

Hint – they are immunization registries, but so much more

3

Assist with vaccine

• rdering &

inventory management

Create consolidated reports

Create comprehensive records

Generate reminders to ensure on- time vaccinations Assist with disease surveillance &

• utbreak

response

Confidential Population-based Identify pockets of need Assist schools & child care providers Help improve vaccination rates & Reduce vaccine-preventable disease

are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

Assist with clinical decision support & forecasting

Exchange data with multiple providers

IIS…

4

Where are IIS located?

All but one state operate an IIS IIS are also in:

• New York City
• Philadelphia
• San Antonio
• Washington D.C.
• San Diego
• Imperial County
• San Joaquin County (RIDE)
• American Samoa
• Guam
• Marshall Islands
• Micronesia
• North Mariana Islands
• Palau
• Puerto Rico
• U.S. Virgin Islands

5

IIS…Capture the vaccination status of the population

Percentage of children <6 participating in an IIS in the United States - 2017 Percentage of adolescents 11-17 participating in an IIS in the United States - 2017 Percentage of adults greater than or equal to 19 years of age participating in an IIS in the United States - 2017

IISAR https://www.cdc.gov/vaccines/programs/iis/annual-report-iisar/rates-maps-table.html

Maturity

• Each system operates independently
• Newest IIS is planning to launch in late 2019
• Oldest have been in existence for 30+ years

7

Why isn’t there a national registry?

• 1993: Congress rejected national IIS provisions in the

Comprehensive Child Health Immunization Act

• As introduced, it would have created a national immunization

registry

• Derailed amid a firestorm of political protest
• 10th Amendment – states dictate what their system can and

cannot do

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Measurement and Improvement

Value of IIS Measurement and Improvement

• Increases IIS function and helps streamline data in/data out
• perations
• Providers/end users can trust the data they use for clinical

decision support

• Public and private health partners (Medicaid, Accountable

Care Organizations, EHR hubs, etc.) can be confident in data used population-based assessment

• M&I helps the IIS community prioritize and accelerate

essential improvements together

Content Area

Transport Submission / Acknowledgement Query / Response CDS Data Quality

Testing & Discovery Assessment Validation Testing & Discovery Assessment Validation Testing & Discovery Assessment Validation Testing & Discovery Assessment Testing & Discovery

1 2 3

Validation is a public-facing summary stage to acknowledge IIS that are progressing toward or achieving alignment with community-selected measures.

Measurement and Improvement: Validation

SDIR MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI NYC PHIL SDIR NYC PHIL DC

Guam CNMI Puerto Rico Virgin Islands

Connected Actively Working

• n Connection

Great Participation Nationwide

Aggregate Analysis Reporting Tool (AART)

• AIRA Developed Measurement

Tool

• Testing is performed on a

regular basis

• Each IIS has a Dashboard of

their individual results

• Quarterly National Aggregate

Reports are developed and published

Nationwide Validation Reports – Now Available

• Gradations of “validated with

minor differences” and “major differences” to better demonstrate incremental progress.

• Quarterly identified maps with

gradations and footnotes that clarify policy differences.

Assessment Results: Transport

21 26 30 33 36 37 37 40 40 38 40 19 23 27 30 34 33 33 37 37 35 37 17 21 26 29 33 35 34 37 37 36 38 5 6 12 14 15 16 16 20 22 23 25 5 10 15 20 25 30 35 40 45 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 Q1 2018 Q2 2018 Q3 2018 Q4 2018 Q1 2019 CDC WSDLs Assessed Connectivity Test Submit Single Message Security Fault

Assessment Results: Submission and Acknowledgement

26 29 33 29 42 46 47 43 47 18 21 25 22 29 32 35 30 35 1 4 5 6 12 11 14 13 15 21 24 28 28 37 43 45 42 44 5 10 15 20 25 30 35 40 45 50 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1 Measured VXU Pass Average ACK Pass Average Timeliness Pass Average

Query and Response – Huge Value

Query Response

“The Minnesota IIS saves us time. With the click of a button, we can compare the EHR and IIS records. We rely on the Minnesota IIS to make sure that our immunizations are given correctly.”

Drilling Down on EHR-IIS Query – Why Is It Important?

• EHR-IIS query is available in the majority of IIS jurisdictions

nationwide

• Results demonstrate progress toward standardization and

adoption of query

• Coupled with EHR adoption of certified technology, this will

speed up onboarding and interoperability substantially

“Our best defense against missed immunization opportunities is the ability to

conduct an Immunization Query. Our bi-directional interface with our state immunization database has put accurate immunization history and the current CDC recommendations based on that history at our clinicians fingertips.”

Drilling Down on EHR-IIS Query – Why Is It Important?

A 2016 study in the journal Pediatrics demonstrated an increase in up-to-date status and a decrease in missed

• pportunities following

implementation of query

Stockwell et al., Pediatrics, 2016

75.0% 81.6% 70% 72% 74% 76% 78% 80% 82% 84% Prior to Query Post Query

UP-TO-DATE RATE

8.8% 4.7% 0% 2% 4% 6% 8% 10% Prior to Query Post Query

MISSED OPPORTUNITIES

Assessment Results: Query and Response

24 27 31 28 39 43 44 40 44 21 23 27 25 37 41 41 37 43 10 11 14 15 26 29 30 27 35 1 2 4 4 10 10 11 9 12 17 19 25 23 27 29 30 29 32 20 25 28 24 37 41 38 37 40 5 10 15 20 25 30 35 40 45 50 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1 Measured Query Support Pass Average MU3 Query Support Pass Average RSP Conformance Pass Average Core Data Elements Pass Average Timeliness Pass Average

Clinical Decision Support

ACIP Recommendations and Clarifications

System A System B System C System C Recommendation System B Recommendation System A Recommendation

Individual Interpretation And Implementation

Before CDSi

https://www.cdc.gov/vaccines/programs/iis/cdsi.html

With CDSi

ACIP Recommendations and Clarifications Individual Implementation CDSi Resources Consistent System Recommendations Workgroup Interpretation and Documentation

https://www.cdc.gov/vaccines/programs/iis/cdsi.html

CDS Measures

CDS Concept Supports Accuracy Evaluation Status

Did the dose count?

Pediatric Adolescent Adult Earliest Date

When could the next dose be given?

Pediatric Adolescent Adult Recommended Date

When should the next dose be given?

Pediatric Adolescent Adult

HIMSS/AIRA Collaborative

AIRA Measurement and Improvement HIMSS Immunization Integration Program

HIMSS/ AIRA Collaborative

For more information: ImmunizationCollaborative@himss.org

• Improve immunization management, workflow, standards,

usability and data sharing practices

• Harmonize communications to achieve structured data

sharing to support clinical care and public health

• Enable collaboration between organizations that can

implement necessary changes (in EHRs or IIS, and/or in the standards that support them)

• Build on the work of the HIMSS Immunization Integration

Program

Goals of the HIMSS/AIRA Collaborative

For more information: ImmunizationCollaborative@himss.org

Standardization activities have directly improved interoperability with EHRs and IIS, as well as improved the quality of data within IIS This has strengthened IIS as important analytic tools that support a wealth of population health needs Providers can access these data seamlessly through EHR query at the point of care, supporting clinical decisions, ensuring appropriate immunization, and lowering burden

In Summary

• Thank you to:
• The AIRA Measurement for Assessment and Certification Advisory

Workgroup (MACAW) Members for their work in recommending concepts and measures

• The AIRA Board of Directors for approval of measures and oversight
• f the process
• All IIS and EHRs for doing the hard work to

implement and improve interoperability and functionality

Acknowledgements

Thank You!

Eric Larson elarson@immregistries.org HIMSS/AIRA Collaborative ImmunizationCollaborative@himss.org www.immregistries.org