The Citywide Immunization Registry Intranet

New York’s
Citywide Immunization Registry
(CIR):
An Introduction to the
CIR and Online Registry
NYC Department of Health & Mental Hygiene
May 2007
Overview of presentation
• Immunization registries
• New York Citywide Immunization Registry (CIR)
• CIR Access
• Online Registry features
2
What are Immunization Registries?
• Databases which contain children’s records with
immunizations administered by providers in a certain
geographical area, usually population-based
• Aggregate immunizations given over different visits and
often by different providers into one record
• Usually maintained by state or local health
departments
• Used by providers as a clinical record aid and for
decision support
• Used by health departments as a public health tool to
aid surveillance and activities, such as emergency
preparedness
How do Registries help improve
immunization coverage & practice?
68.9% coverage rate for 4:3:1:3:3:1 for NYC
Barriers
• 1 in 4 children visit more than 1
provider before the age of 2
• Records can be incomplete or
unavailable
• Missed opportunities, overimmunizing
• Immunization schedule is
complex and often changes
9
9
(NIS Q2/05-Q2/06)
Solutions
9 Make consolidated,
centralized immunization
records available at time
of visit
9 Provide decision support—
recommend when
vaccines are due
Measure vaccination coverage levels
Offer reminder/recall functionality for the providers,
health plans, other agencies
National Immunization Registry
picture
1993:
• CDC provided planning grants to develop
immunization registries in every state.
As of 2005:
• 52 states and cities have registries
• 56% of children < 6 years have 2 or more
immunizations in a registry
• Healthy People 2010 objective: 95%
• NYC CIR is at ~85%
CIR profile
• NYC Health Code requires reporting to CIR by all
immunizing providers:
• 1997: children < 8 years of age
• 2005: children and adolescents < 19 years of age
• > 1,600 pediatric provider facilities and offices
• ~75% report regularly
• Reporting methods: electronic files, paper, on-line
• Birth certificates loaded weekly (~2,400/wk)
• Integrated with Lead Registry
• 3 million children’s records; 28 million immunizations
Number of immunizations added to CIR
for children < 8 years of age
4,097,434
4,000,000
series
pneumo
other
3,500,000
3,000,000
2,500,000
2,396,712
2,311,722
2,271,772
1,926,219
2,042,668
1,869,800
2,000,000
1,438,987
1,322,762
1,500,000
1,000,000
500,000
0
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CIR access for providers and other
agencies
• telephone or fax in a request to CIR:
• CIR staff looks up records and sends via fax to
provider’s office (~2,500 requests/mo.)
• use Online Registry - on your own, 24/7:
• look-up immunization records, report, and view lead
test histories (~45,000 requests/mo.)
• print or fax an official record for provider or public
• print pre-completed WIC, 211S, After-school/Day
camp forms, Day Care
8
CIR collaboration with CMHs and
EHR
~35 Community Health Centers or FQHC groups
Current: Immunization extract file from EPIC,
following CIR UPIF specifications
(electronic batch file reporting)
Plan: Build Real-time, bilateral communication
between CIR and electronic health records
EHRs) – eCW, EPIC, other EHRs
9
CIR as a conduit to report to VAERS
Step1:Choose
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CIR as a conduit to report to VAERS
Step3:
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OnlineRegistry
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CIR role in an emergency: capturing
pandemic flu shots
Tabisisactive
activeonly
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duringan
an
during
emergency
emergency
Internet-accessible registry benefits
• Internet applications provide:
– increased accessibility, 24/7
• easier access for users in networked environments
– almost instant gratification
• requires users to contact CIR for User ID and
Password, but no other set-up necessary
– lower resource utilization
• nothing to set up, therefore no site visit required
13
Online Registry Use: 2002 to date
CIR based DAR went into effect
100,000
90,000
All facilities
Immunizing facilities
Lookups
Imms Inserted
Patients viewed
800
Second VFC letter with #s mailed
First VFC letter mailed
700
80,000
New PCS with VFC and 211S
70,000
500
60,000
40,000
MCI deployment- improved
deduplication algorithm
PCS user interface overhaul
400
facilities
Health code amendment
50,000
30,000
600
300
200
20,000
10,000
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CIR access for parents, legal
guardians and custodians
Short, signed application required to obtain a
record:
• telephone to request a Parent/Guardian
Request for Immunization Record Application
(212-676-2323)
• download application forms from
nyc.gov/health/cir (no Online Registry)
Future Enhancements to Online
Registry
•
Real-time bilateral communication with
provider EHRs
•
Forecast adolescent, adult immunizations
•
Report adverse events to VAERS
•
Capture emergency pandemic flu shots
•
Recall patients not up-to-date
•
Order VFC vaccine, manage inventory
•
Feedback reports: site profiles, reporting
activity, coverage profile
•
“Read-Only” access for non-clinical users
Online Registry
Registry Demo
Demo
Online
www.nyc.gov/health/cir
17
CIR Information Website Homepage:
nyc.gov/health/cir
Log in:
Note:
Note:
Bookmark
Bookmark
thispage
page
this
1
2
3
Patient List (MyList):
Search to retrieve a patient record
Navigation:
Navigation:
Menubar
bar
•• Menu
Tabs
•• Tabs
Instruction
•• Instruction
Tip
•• Tip
Alert
•• Alert
SetUp
Up
•• Set
MyList: Choose a patient on list
Patientlist
listcan
can
Patient
besorted
sortedby:
by:
be
ReviewStatus
Status
••Review
Name
••Name
Gender
••Gender
DOB
••DOB
CIRnumber
number
••CIR
DateLast
Last
••Date
Accessed
Accessed
View Immunization and Lead Test Records:
Immunization
Immunization
Recommendations
Recommendations
Footnotes
Footnotes
Leadtest
test
Lead
recommendation
recommendation
This immunization event occurred prior to the
recommended age or recommended interval for
this dose.
This immunization event occurred less than 30
days after the administration of another live
virus vaccine.
Lead Test Record:
Lead
Lead
Recommendations
Recommendations
basedon
onlatest
latest
based
testresults
results
test
Search for patient:
Requiresmatch
matchon
on
•• Requires
FirstName
Name
••First
LastName
Name
••Last
DOB
••DOB
Gender
••Gender
Oncefound,
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•• Once
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added
Search for patient: Advanced Search…
UseTip
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combinations:
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Call212-676-2323,
212-676-2323,ifif
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customize
Search by other demographics….
Add New Patient…
Required elements:
elements:
Required
FirstName
Name
••First
LastName
Name
••Last
DOB
••DOB
Gender
••Gender
Strongly Recommended:
Recommended:
Strongly
MomDOB
DOB
••Mom
MomFirst
FirstName
Name
••Mom
MomMaiden
MaidenName
Name
••Mom
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or
••Full
Telephone
••Telephone
Customize settings…
Print Reports:
Print Reports: for Provider…
Reports:
Reports:
•Filteredor
or
•Filtered
•Unfiltered
•Unfiltered
Print Reports: for Public…
Fax Reports: for Provider…
Pre-completed Forms:
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Pre-completed Forms: School 211S
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yellow
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highlighted
highlighted
fieldsififneeded
needed
fields
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dataare
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Pre-completed Forms: WIC
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highlighted
fieldsififneeded
needed
fields
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dataare
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completed
completed
Pre-completed Forms:
Day Camps, AfterSchool, Youth Center
Edityellow
yellow
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highlighted
highlighted
fieldsififneeded
needed
fields
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•Immunization
dataare
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Pre-completed Forms:
Day Care Forms: New Admission and Periodic Exam
Edityellow
yellow
••Edit
highlighted
highlighted
fieldsififneeded
needed
fields
•Immunization
•Immunization
dataare
areprepredata
completed
completed
Add Current Immunization: Step 1…
Selectvaccine(s)
vaccine(s)
•• Select
Editdate
dateififneeded
needed
•• Edit
Selectpatient
patientVFC
VFC
•• Select
Eligibility Status
Status
Eligibility
Select Vaccine Type…
CombinationVaccines
Vaccines
•• Combination
shouldonly
onlybe
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should
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Add Current Immunization: Step 2…
Editdate
dateififneeded
needed
•• Edit
Selectififgiven
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•• Select
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lot
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Add Current Immunization: Step 3…
Review
•• Review
Change,cancel
cancelor
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confirm
•• Change,
Add Current Immunization: Action completed…
Add to Immunization History:
Foreach:
each:
For
Enterdate
date
•• Enter
Choosespecific
specificvaccine
vaccine
•• Choose
Selectififgiven
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SetUp
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•• Choose
Confirm
Confirm
Modify History:
Checkthe
theimmunization
immunization
•• Check
eventto
toModify
Modifyor
or
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Delete
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Entercorrections
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chooseDelete
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clickContinue
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button
Confirm
Modify History: Demographics
•Addcurrent
currentpatient
patient
•Add
address
address
•Correctpatient
patient
•Correct
name,DOB
DOBand
and
name,
genderinformation.
information.
gender
•Correctionsare
are
•Corrections
submittedfor
for
submitted
review.
review.
Tools:
Tools:
1.Lead
LeadRisk
RiskAssessment
Assessment
1.
Questionnaire
Questionnaire
2.Legal
LegalRequirements
Requirementsfor
for
2.
HealthCare
CareProviders
Providers
Health
3.Recommended
RecommendedTesting
Testing
3.
Schedulesfor
forChildren
Childrenwith
with
Schedules
ElevatedBlood
BloodLead
LeadLevels
Levels
Elevated
4.Medical
MedicalManagement
ManagementBased
Based
4.
onBlood
BloodLead
LeadLevels
Levels
on
5.Risk
RiskReduction
ReductionEducation
Education-5.
Informationfor
forFamilies
Families
Information
6.Obtain
Obtainbrochures
brochuresand
andother
other
6.
informationby
bycalling
calling212212information
BAN-LEAD(266-5323)
(266-5323)or
orvisit
visit
BAN-LEAD
www.nyc.gov/html/doh/htm
www.nyc.gov/html/doh/htm
l/lead/lead.shtml.
l/lead/lead.shtml.
LOOK for more
PRACTICE TOOLS!
Practice: VFC Doses Administered Report
Enterdate
daterange
range
•• Enter
Selectage
ageranges
ranges
•• Select
Practice: VFC Doses Administered Report
Selectthe
theVFC
VFC
•• Select
andNon-VFC
Non-VFC
and
dosesyou
youwish
wishto
to
doses
includeininthe
the
include
report
report
Vaccines for
Children (VFC)
Doses
Administered
Report
Set Up: Manage Vaccine Lots
Set Up: Manage Vaccine Lots - Add New Lot
•Vaccinelots
lots
•Vaccine
enteredhere
here
entered
appearas
asaa
appear
vaccinelot
lotchoice
choice
vaccine
wherevaccine
vaccine
where
additionsand
and
additions
modifications
modifications
occur.
occur.
Help:
Helpby
byFeature
Feature
•• Help
Helpby
byFAQs
FAQs
•• Help
Contact
•• Contact
Information
Information
Contact Information
Citywide Immunization Registry
NYC Department of Health and Mental Hygiene
General CIR contact information:
Tel: 212-676-2323
Fax: 212-676-2314
nyc.gov/health/cir
57