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
What AIRA does Purpose Collaborate Measurement & Improvement Support Promote the Provide a way to Identify the key Support IIS and development, work aspects of an IIS immunization implementation collaboratively to that can be programs through and develop evaluated and education, interoperability of standards, best measured targeted Immunization practices, Provide technical assistance, and Information strategies and assistance to IIS advocacy Systems provide education programs to foster about IIS improvement
What are Immunization Information Systems (IIS)? Hint – they are immunization registries, but so much more 3
IIS… are confidential, population-based, computerized databases that record all immunization doses Assist with Create clinical comprehensive administered by participating providers to records decision persons residing within a given geopolitical area. support & forecasting Confidential Assist with Generate reminders to disease Population-based ensure on- surveillance & outbreak time Identify pockets of need response vaccinations Exchange data with multiple providers Create Assist with Assist schools & child care providers vaccine consolidated ordering & reports inventory Help improve vaccination rates & management Reduce vaccine-preventable disease 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 Percentage of Percentage of adults <6 participating in an IIS adolescents 11-17 greater than or equal to in the United States - participating in an IIS in 19 years of age 2017 the United States - 2017 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 • 10 th Amendment – states dictate what their system can and cannot do 8
Measurement and Improvement
Value of IIS Measurement and Improvement • Increases IIS function and helps streamline data in/data out operations • 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
2 1 3 Content Area Transport Testing & Discovery Assessment Validation Submission / Acknowledgement Testing & Discovery Assessment Validation Query / Response Testing & Discovery Assessment Validation CDS Testing & Discovery Assessment Data Quality Testing & Discovery
Measurement and Improvement: Validation Validation is a public-facing summary stage to acknowledge IIS that are progressing toward or achieving alignment with community-selected measures.
Great Participation Nationwide WA ME MT ND VT MN OR NH MA ID WI NY SD WY RI MI NYC NYC CT PA NJ IA NE PHIL PHIL NV OH DE IL IN DC UT Connected MD CO WV VA KS MO CA KY NC TN Actively Working OK AZ on Connection AR SC SDIR SDIR NM Guam GA AL MS CNMI TX AK Puerto Rico LA Virgin Islands FL HI
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 45 40 40 40 38 40 37 37 38 36 37 37 37 37 37 36 33 35 35 35 34 34 33 33 33 30 30 30 29 26 27 26 25 25 23 23 21 22 21 20 20 19 17 16 16 15 15 14 12 10 6 5 5 0 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 50 47 47 46 43 45 45 42 44 43 42 40 37 33 35 35 35 32 29 29 30 30 29 26 28 28 25 25 24 22 21 21 20 18 15 15 14 13 12 11 10 6 5 5 4 1 0 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 “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.” Query Response
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? UP-TO-DATE RATE 84% 81.6% 82% A 2016 study in the journal 80% 78% Pediatrics demonstrated an 75.0% 76% increase in up-to-date status 74% 72% and a decrease in missed 70% Prior to Query Post Query opportunities following MISSED OPPORTUNITIES implementation of query 8.8% 10% 8% 6% 4.7% 4% 2% 0% Prior to Query Post Query Stockwell et al., Pediatrics, 2016
Assessment Results: Query and Response 50 44 44 43 45 43 40 39 41 41 41 40 40 38 37 37 37 37 35 35 31 32 28 30 30 30 27 29 29 29 28 27 27 27 24 26 25 25 25 25 24 23 23 21 20 20 19 17 15 15 14 12 11 11 10 10 10 10 9 5 4 4 2 1 0 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
Before CDSi System A ACIP Recommendations System B and Clarifications System C Individual Interpretation System C Recommendation And Implementation System B Recommendation System A Recommendation https://www.cdc.gov/vaccines/programs/iis/cdsi.html
With CDSi Workgroup Interpretation and ACIP Documentation Recommendations CDSi Resources and Clarifications Individual Implementation Consistent System Recommendations https://www.cdc.gov/vaccines/programs/iis/cdsi.html
CDS Measures CDS Concept Supports Accuracy Pediatric Evaluation Status Adolescent Did the dose count? Adult Pediatric Earliest Date Adolescent When could the next dose be given? Adult Pediatric Recommended Date Adolescent When should the next dose be given? Adult
HIMSS/AIRA Collaborative AIRA Measurement and Improvement HIMSS/ AIRA Collaborative HIMSS Immunization Integration Program For more information: ImmunizationCollaborative@himss.org
Goals of the HIMSS/AIRA Collaborative • 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 For more information: ImmunizationCollaborative@himss.org
In Summary 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
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