Courtesy of the Rosebud Sioux Tribe

Exchanging data between RPMS and State Immunization Information Systems (SIIS)

Amy Groom MPHIHS Immunization Program Manager/CDC Public Health Advisor

IHS Division of Epidemiology and Disease PreventionCDC NCIRD Immunization Services Division/Program Operations Branch

What’s an Immunization Information System ?

• Also known as Immunization Registries, State Immunization Information Systems (SIIS) are confidential, population-based, computerized information systems

• They collect vaccination data about all children within a geographic area (usually statewide)

• Some registries also collect vaccine data for adults.

What are the functions of a SIIS?

• Consolidates vaccination records from multiple providers into one central record

• Grants providers access to the consolidated record

• Provides forecasting for immunizations that are due

• Generates Reminder/Recall letters• Tracks inventory• Monitors immunization coverage

SIIS vs. RPMS• IHS , many tribal and urban Indian facilities, and

state of Alaska PHNs already have a system for immunization tracking through RPMS– Provides many of the same functions as a SIIS

• Main difference between SIIS and RPMS – RPMS data are stored only at the local facility and are not

shared with providers outside that facility – SIIS consolidates records from all providers into 1 record

that can be accessed by all providers

• To include RPMS data in SIIS, and SIIS data in RPMS, sites would need to do double data entry– Enter immunizations given into RPMS and the SIIS– Log into the SIIS to view immunizations given at other

facilities– Enter those shots given elsewhere into RPMS

The RPMS Data Exchange Initiative

GOAL: An electronic two-way exchange of immunization data between RPMS and SIIS

Am I allowed to share patient immunization data with a SIIS?

• Yes. Sharing of data with an SIIS is permissible under HIPAA.– Under HIPAA, data can be released without individual

patient consent for “public health activities and purposes”• SIIS is responsible for developing and implementing

procedures for providing access• Users must sign an agreement and follow strict

confidentiality and security policies. • Protection of SIIS data is managed through state

privacy, confidentiality, and security laws and through compliance with federal privacy rules and regulations.

RPMS Data Exchange Software

• IHS contracted to develop software– Part of the RPMS system, called BYIM– Built to CDC standards– Software extracts data from RPMS and

exports to the SIIS and – Imports data from the SIIS back to RPMS– Process can be automated using HL7

communications bridge– Automation saves personnel time and

provides continuity to interface

Immunization Data Exchange Software BYIM 1.01

• BYIM v 2.0 scheduled to be released in fall 2008

• Currently operational in:– AZ, WA, CA, WY, MN, WI, OR, UT

• Interest expressed: – AK, ME, NY, OK, SD

Data Exchanged• Exports data on patients 0 – 18 yrs

– Version 2.0 will allow sites to send data on adults as well

• Entire immunization history every time• The SIIS matches and merges RPMS data

with data in the SIIS• If the SIIS has immunizations for a patient

that the RPMS file did not contain, this information is sent back to the RPMS

Data Exchange Process

Site A

Site B

State Registry

Interface Success - Arizona• Data exchange currently underway at

16 of the 22 IHS and tribal sites• Total number of records received by

Arizona IIS (ASIIS) from IHS/Tribal sites = 2.5 million

• Initial exports from 6 IHS facilities to ASIIS– 1,128,380 shots for 87,737 people – New to ASIIS: 920,602 shots, 37,932 people

• Export from ASIIS to IHS facilities– New to IHS: 490,449 shots

Example: One Child’s Immunization History

1. 08/24/88 DTP 2. 11/29/88 DTP 3. 03/07/89 DTP 4. 11/17/89 DTP 5. 12/30/91 DTaP6. 03/19/92 DTaP7. 05/27/92 DTaP8. 10/13/92 DTP 9. 02/10/93 DTaP10. 12/07/95 DTaP

1. 04/18/01 Td-ADULT 2. 09/10/03 Td-ADULT

1. 08/24/88 OPV 2. 11/29/88 OPV 3. 03/07/89 OPV 4. 11/17/89 OPV 5. 12/30/91 OPV 6. 03/19/92 OPV 7. 05/27/92 OPV 8. 10/13/92 OPV 9. 02/10/93 OPV 10. 12/07/95 OPV

1. 12/30/91 HIBTITER 2. 03/19/92 PEDVAXHIB 3. 11/18/92 PEDVAXHIB

1. 09/12/97 HEP B PED 2. 02/17/98 HEP B PED 3. 03/30/98 *HEP B PED 4. 02/26/01 HEP B5. 03/28/01 HEP B 6. 08/13/03 HEP B

1. 11/17/89 MMR 2. 10/13/92 MMR 3. 02/10/93 MMR 4. 12/07/95 MMR |

1. 11/13/00 HEP A 2PED 2. 02/26/01 HEP A 3. 06/01/01 HEP A 2PED 4. 08/13/03 HEP A

Data Exchange between RPMS and SIIS will . . .

• Improve immunization services for children– IHS, tribal and other health care providers

• Improve ability to monitor immunization coverage for children

• Conserve resources

IHS Support for Immunization Data Exchange

• IHS Immunization Registry Coordinator: Cecile Towncecile.town@ihs.gov505-248-4233

• IHS Help Desk Contact Information: • Toll Free:1-888-830-7280• Email: support@ihs.gov

Gerri Yett, RN, MSN, CHESDeputy Immunization Program Manager

Alaska’s Immunization Information System

AAlaskalaska’’s Immunization s Immunization Information System Information System

MCH/Immunization Conference Sept. 22-23, 2008 MCH/Immunization Conference MCH/Immunization Conference Sept. 22Sept. 22--23, 2008 23, 2008

Immunization Needs Assessment/Feasibility Study – 2004/2005Immunization Needs Assessment/Feasibility Study – 2004/2005

Request for Proposal developed

Contract awarded July 2007

Alaska Regulations

7 AAC 27.892The department shall use identifiable health information collected and maintained by the department under AS 18.05 or AS 18.15 to accomplish the essential public health services and functions for which the information was originally acquired. These uses include(1) Maintaining lists and registries of immunizations…

Excerpts: MOA – Sharing Protected Health Information (Adopted June 2008)

• ANTHC is in the process of replacing MFI with a more modern system that will support exchange of health care information with electronic health record systems other than RPMS.

• ANTHC and the Department agree that this exchange of Protected Health Information is permissible under HIPAA and state law, and desire to memorialize their understanding in this Agreement.

• Integrated Health Record. The delivery of effective health services in Alaska to an individual is best facilitated by a comprehensive health record. It is the express purpose of the Department and ANTHC to continue to work toward this goal and to continue to promote uses and disclosures for the purposes set forth in this Agreement.

• Public Health Settings First (June-Oct)– RPMS interface– Tribal corporations & PHN

• Private Sector (beginning in Oct)– Focus on highest volume providers first

• Phased-in Functionality (Oct-Dec)– Core functionality first– Peripheral modules / complex functionality follows

Peripheral Modules

• Vaccine Ordering Management System

• School Nurse

• Perinatal Hepatitis B

• Mass Immunization

• Provider Tracking

Optional:• Preparedness-related

- PanFlu Aggregate Reporting- Automated Transmission to CDC/CRA

Why use VacTrAK?

• Consolidated record

• Standard vaccination schedule

• Tools (Reminder/Recall, CoCASA, PON, vaccine inventory, etc)

• Real-time information & alerts

• Leads to:– Improved patient care– Higher immunization rates (potentially)

How do I use VacTrAK?Depends on:• Size/volume• Infrastructure sophistication• Clinic workflow

Methods:• Direct data entry• Batch file (uni- or bi-directional)• “Real time” interface• Hybrid

Implementation in RPMS sites • Each tribal facility should identify IT and Program

(clinical) staff responsible for implementation process

• Download latest version of BYIM software (includes process for access and download of HL7 bridge software)

• Install Alaska specific BYIM patch (allows for exchange of IZ records for all ages)

• Contact Immunization Program to coordinate user access and training plans

STC Existing Interfaces (private sector)

• Allscripts Touchworks – Healthmatics (coming soon)• Cerner Power Chart Office• Companion Technologies• eClinical Works• Medcomsoft• Medical Informatics Engineering (IN)• Next Gen• Epic Systems• GE Healthcare – Titan release winter ’08 registry ready• Practice Partners• MARS• Nightingale• Amazing Charts• Encounter Pro• eMD• Medical Office Online

User Roles/PrivilegesWhat a user sees depends on:• User type• Level of organization

Private fields include:• Name• Address• DOB• SSN• Phone• Chart number• Email• Adverse reaction (flag)

Training Plan

• “Train the Trainer” Model

• State, PHN, & Private Sector trainers

• RPMS Training– Depends on final VacTrAK / RPMS

interface

• VacTrAK User Group

• Ongoing training

• School Nurse Module implementation

• Additional modules

• Coverage assessments

• Vaccine Management

• VacTrAK User Group

• Ongoing training

• School Nurse Module implementation

• Additional modules

• Coverage assessments

• Vaccine Management

Don’t just grin and bear it …DonDon’’t just grin and bear it t just grin and bear it ……

Invitation to jump in & use the system!

Jump in and use the system!Jump in and use the system!Jump in and use the system!

Contact Us

Alaska Immunization Program 269-8000

VacTrAK Helpline1-866-702-8725

269-0312

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