Implementation of Adult and Adolescent Schedule

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

2. 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 Contra Costa County Health Services, California

3. 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 Contra Costa County Health Services, California

4. 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 Contra Costa County Health Services, California

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

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

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

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

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

10. 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 Contra Costa County Health Services, California

11. 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 Contra Costa County Health Services, California

12. 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 Contra Costa County Health Services, California

13. 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 Contra Costa County Health Services, California

14. 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 Contra Costa County Health Services, California

15. 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 Contra Costa County Health Services, California

16. 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 Contra Costa County Health Services, California

17. 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. Contra Costa County Health Services, California

18. 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 Contra Costa County Health Services, California

19. 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. Contra Costa County Health Services, California

20. 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 Contra Costa County Health Services, California

21. 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” Contra Costa County Health Services, California

22. 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 Contra Costa County Health Services, California

23. 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 Contra Costa County Health Services, California

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

25. 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 Contra Costa County Health Services, California