Registry Support of Immunization Program Activities

1. Registry Support of Immunization ProgramActivities Lance Rodewald, M.D. Director Immunization Services Division, NIP/CDC Bill Brand, M.P.H. Vice-President, American Immunization Registry Association

2. Population Assessment Consumer Information Program Management Provider Quality Assurance Registries Service Delivery Surveillance Vaccine Management Immunization Grantee Requirements Implement required and locally-identified activities in eight core areas:

3. NIP/CDC Support • Immunization Program Operations Manual (IPOM) • Grant guidance on required and recommended activities • “Best practices” for an effective and comprehensive immunization program • Program Consultants in core program areas • Section 317 and VFC funding • Wide range of guidance documents, trainings, print materials, etc.

4. Registries Within Immunization Programs • Unique challenges for fully integrating registries with the rest of an immunization program: • Often separate funding sources • May be organizationally housed in a Medicaid Program or Information Technology unit. • Historically often seen as an experimental and unproven arm of an immunization program.

5. Current Situation • Immunizationregistries are growing in both provider participation levels and in functionality. • 44% of children now participate. • Focus to date has been on technical standards and how a registry supports its external users. • Little is available to guide a registry in supporting other core components of an immunization program. New standards are needed.

6. Potential benefits of new standards • Greater integration and synergy across immunization program staff/teams. • More efficient use of Section 317 and other funds. • More fully functional registry applications. • More integrated, seamless registry support of private providers and local health departments.

7. Registry Support for an Immunization Program – The PROW Project

8. Purpose of the PROW Project • To identify ways registries can effectively and integrally support the other core program components of an immunization program. • To encourage and support adoption of those activities by all registries/ immunization programs.

9. Development of PROW Standards • NIP contracted with the American Immunization Registry Association (AIRA) • AIRA administered a survey of Immunization Program Managers and Registry Managers; conducted focus group with Program Managers. • Convened national work group to draft standards. • Now a collaborative project of AIRA and the Association of Immunization Managers (AIM).

10. Products of PROW • Standards of Excellence in each of six program areas: • Vaccine Management • Provider Quality Assurance • Population Assessment • Consumer Information • Service Delivery • Surveillance • Worksheet for self-assessment and planning.

11. Registry Support of Core Program Components Vaccine Management Provider QA Registries Surveillance Assessment Consumer Information Service Delivery

12. PROW Standards of Excellence • Comparable to Best Practices • Standards as a ceiling to shoot for versus a floor or set of minimum requirements • Concrete and tangible • Organized by Core Program Components • Cross-referenced to recommended activities in the Immunization Program Operations Manual (NIP/CDC)

13. PROW Standards of Excellence • Organized into three levels, from relatively easy to implement to challenging/resource intensive • Useful for: • Identifying enhancements • Upgrading current applications • Developing requirements for a new application or RFP • Seen as an essential companion to minimum registry functions (NVAC), IPOM, and the new certification process.

14. Vaccine Management PROW principle: “Immunization registries provide users with information and functions that support proper storage and handling of vaccines, and internally can support management of the VFC program.”

15. Vaccine Management • Level II: • Support a vaccine inventory feature capable of adjusting doses due to wastage or transfer. • Generate a doses administered or other report(s) to support vaccine accountability activities. • Capture VFC eligibility status and generate annual reports.

16. Vaccine Management • Level III: • Incorporate a feature that alerts users to lots due to expire or already expired. • Incorporate a link to VACMAN for automated ordering as supplies run low. • Incorporate a call-back feature for deferred shots due to shortages.

17. Provider Quality Assurance PROW principle: “By enabling access to complete immunization records, registries support providers in delivering age-appropriate and timely immunizations, and in reducing under- and over-immunization.”

18. Provider Quality Assurance • Level I: • Export to CASA or otherwise use registry data as part of AFIX visits. • Use registry data to highlight general or practice-specific practice issues that can be incorporated into provider trainings, newsletters, or a “tip-of-the-month” web link.

19. Use of an Immunization Registry to Track Hepatitis B Immunization Hep B given 0-56 days after birth Thimerosal 700 and Hep B Hep B given 0-5 days after birth 600 500 T-free widely 400 available—VFC Number of Children 300 T-free available in Hospitals 200 100 0 02 05 08 11 14 17 20 23 28 29 32 35 38 41 44 47 50 01 04 07 10 13 16 19 22 25 28 31 1999 2000 Week Source: Immunization ALERT (Oct 2000) Note: Vital Records reported hospital Hep B1 to ALERT since Nov 1999

20. Provider Quality Assurance • Level II: • Highlight invalid doses when displaying a history. • Use registry data to prioritize AFIX or VFC site visits. • Use the registry to track series completion for children born to surface antigen-positive moms.

21. Provider Quality Assurance • Level III: • Be able to display the reason for an invalid dose. • Include HBV and HBIG data fields in birth records or other mechanisms, and regularly upload to the registry.

22. Inter-relatedness of new standards • Such standards would complement and support existing standards and guidance: • Development of Community- and State-based Immunization Registries (Approved by NVAC, January 1999) • Minimum Functions for Immunization Registries (NIP/CDC, 2001) • Core data set (NIP/CDC, 1995) • Voluntary registry certification (pending approval)

23. What’s next for PROW? • Disseminate Standards of Excellence • Peer learning/mentoring group • Best practices resource kit • Continual revising and growing of the Standards based on their use and the growing maturity of registries. • Potential role for NVAC

24. Proposed Resolution The NVAC believes the growing maturity of immunization registries means they can play a greater and more integral role within an immunization program. In particular, NVAC believes registries can provide important support to other core program components, such as assessment, vaccine management, and provider quality assurance. Further, the NVAC believes the CDC should continue working with others to identify and disseminate best practices for registry support of an immunization program, such as those found in the Programmatic Registry Operations Workgroup Standards of Excellence.

25. For more information… www.immregistries.org or Bill Brand Minnesota Department of Health bill.brand@health.state.mn.us