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Exchanging Registry Data Across State Lines

Exchanging Registry Data Across State Lines. Seth Foldy, MD MPH State Health Officer/DPH Administrator. ASTHO Immunization Registry Summit Crystal City, VA 8/4/10. Current State. Few state-to-state exchange arrangements No national arrangement Extraordinary example: post-Katrina

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Exchanging Registry Data Across State Lines

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  1. Exchanging Registry DataAcross State Lines Seth Foldy, MD MPH State Health Officer/DPH Administrator ASTHO Immunization Registry Summit Crystal City, VA 8/4/10

  2. Current State • Few state-to-state exchange arrangements • No national arrangement • Extraordinary example: post-Katrina • Louisiana data to other states (AMA) • WI and other data to CDC to share with LA, AL • CDC data requests: (CRA, VacMan, Smallpox event) require unique standards and formats—make work • CDC required objective: “comply with NHIN standards and specifications” Protecting and promoting the health and safety of the people of Wisconsin

  3. New Development-HITECHMeaningful Use • New ONC meaningful use IIS submission standards for providers • Standard - HL7 2.3.1 • Implementation specifications - Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol Implementation Guide Version 2.2 AND/OR • Standard - HL7 2.5.1 • Implementation specifications - HL7 2.5.1 Implementation Guide for Immunization Messaging Release 1.0 • Vocabulary - HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version • A SOCKET, not a PLUG Protecting and promoting the health and safety of the people of Wisconsin

  4. Legal Barriers • IIS data originates from a variety of sources • Different state laws and regs regulate these sources • E.g., restrictions on sharing vital statistics records • THUS: legal barriers must be identified and addressed Protecting and promoting the health and safety of the people of Wisconsin

  5. Why do it? • Out-of-state immunizations accessible to state of residence? • In-state immunizations accessible to out-of-state providers? • Assemble better life history from multiple states of residence/care? • Regional or national Imms performance metrics? • Fail-over for IIS collapse? • Share services (e.g., forecasting; reminder/recall; de-duplication) and reduce redundancy? • ??? Protecting and promoting the health and safety of the people of Wisconsin

  6. Technical Architecture • Decentralized Options • “Push” batch records from one IIS to another • “Pull” batch records from one IIS to another • “Push” individual records from one IIS to another • “Pull” individual records from one IIS to another • “Pull” relevant records from EVERY IIS • Push real-time when record created? • Pull real-time when record needed? • Centralized Option • Create a national database from many IISs • Utilize a single IIS nationwide Protecting and promoting the health and safety of the people of Wisconsin

  7. Issues with Centralized Solutions • Legal authority to store and share data? • Could be a private non-governmental entity • Network and server demands • Needs nation-wide de-duplication • Could replace redundant state/local systems over time Protecting and promoting the health and safety of the people of Wisconsin

  8. Issues with Decentralized Approach • DO NOT want multiple bilateral relationships; multiple (different) data use agreements; multiple interfaces, etc. : HIGH MAINTENANCE • ARCHITECTURE • “Push” or “pull”? “Batch” or “message”? • Need a system for authorization and authenticating participating IISs • Transmission, vocabulary and implementation standards • Record locator service may be needed • Many IISs may need to develop “send” capacity • A nationwide agreement on above items enables a fairly standardized (low-cost) interface and gateway for each IIS Protecting and promoting the health and safety of the people of Wisconsin

  9. Selecting an Architecture • Must meet priority needs • Meet as many other lower priority needs as possible • User acceptability – performance • Technical feasibility • Cost • Legal and aligned to policy Protecting and promoting the health and safety of the people of Wisconsin

  10. Tasks • Why interstate exchange? Use cases • National approach or state-by-state? • Who is in charge and accountable? • Inventory and eliminate legal barriers • Select architecture • Fund and implement central (“core”) services • Fund and implement IIS changes Protecting and promoting the health and safety of the people of Wisconsin

  11. QUESTIONS Protecting and promoting the health and safety of the people of Wisconsin Thanks Tom Maertz, Dan Hopfensperger, Gary Urquart, David Ross

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