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IIS Measurement and Improvement: Connecting Immunization Information

Systems (IIS) with EHRs to Reduce Burden and Improve Care

HIMSS Spring I&HIE Community RoundtableApril 10, 2019

Purpose

Promote the development,

implementation and

interoperability of Immunization Information

Systems

Collaborate

Provide a way to work

collaboratively to develop

standards, best practices,

strategies and provide education

about IIS

Measurement & Improvement

Identify the key aspects of an IIS

that can be evaluated and

measuredProvide technical assistance to IIS

programs to foster improvement

Support

Support IIS and immunization

programs through education, targeted

assistance, and advocacy

What AIRA does

What are Immunization Information Systems (IIS)?Hint – they are immunization registries, but so much more

3

Assist with vaccine

ordering & inventory

management

Create consolidated

reports

Create comprehensive

records

Generate reminders to ensure on-

time vaccinations

Assist with disease

surveillance & outbreak response

Confidential

Population-based

Identify pockets of need

Assist schools & child care providers

Help improve vaccination rates &Reduce vaccine-preventable disease

are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

Assist with clinical

decision support &

forecasting

Exchange data with multiple providers

IIS…

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 <6 participating in an IIS in the United States -2017

Percentage of adolescents 11-17 participating in an IIS in the United States - 2017

Percentage of adults greater than or equal to 19 years of age 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

• 10th 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

Content Area

Transport

Submission / Acknowledgement

Query / Response

CDS

Data Quality

Testing & Discovery Assessment Validation

Testing & Discovery Assessment Validation

Testing & Discovery Assessment Validation

Testing & Discovery Assessment

Testing & Discovery

1 2 3

Validation is a public-facing summary stage to acknowledge IIS that are progressing toward or achieving

alignment with community-selected measures.

Measurement and Improvement: Validation

SDIR

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MD

DE

NJ

CTRI

MA

ME

VT

NH

AK

HI

NYC

PHIL

SDIR

NYC

PHIL

DC

Guam

CNMI

Puerto Rico

Virgin Islands

Connected

Actively Working

on Connection

Great Participation Nationwide

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

21

26

30

33

3637 37

40 4038

40

19

23

27

30

3433 33

37 3735

37

17

21

26

29

3335

34

37 3736

38

56

1214

1516 16

2022

2325

0

5

10

15

20

25

30

35

40

45

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

26

29

33

29

42

46 47

43

47

1821

25

22

29

3235

30

35

1

4 5 6

12 11

1413

15

21

24

28 28

37

4345

4244

0

5

10

15

20

25

30

35

40

45

50

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

Query

Response

“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.”

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?

A 2016 study in the journal Pediatrics demonstrated an increase in up-to-date statusand a decrease in missed opportunities following implementation of query

Stockwell et al., Pediatrics, 2016

75.0%

81.6%

70%

72%

74%

76%

78%

80%

82%

84%

Prior to Query Post Query

UP-TO-DATE RATE

8.8%

4.7%

0%

2%

4%

6%

8%

10%

Prior to Query Post Query

MISSED

OPPORTUNITIES

Assessment Results: Query and Response

24

27

31

28

39

43 44

40

44

2123

2725

37

41 41

37

43

10 11

14 15

26

29 30

27

35

12

4 4

10 10 119

12

1719

2523

2729 30 29

32

20

25

28

24

37

41

38 37

40

0

5

10

15

20

25

30

35

40

45

50

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

ACIP Recommendations and Clarifications

System A

System B

System C

System C Recommendation

System B Recommendation

System A Recommendation

Individual Interpretation And Implementation

Before CDSi

https://www.cdc.gov/vaccines/programs/iis/cdsi.html

With CDSi

ACIP Recommendations and Clarifications

Individual Implementation

CDSi Resources

Consistent System Recommendations

WorkgroupInterpretation and Documentation

https://www.cdc.gov/vaccines/programs/iis/cdsi.html

CDS Measures

CDS Concept Supports Accuracy

Evaluation StatusDid the dose count?

PediatricAdolescent

Adult

Earliest DateWhen could the next dose be given?

PediatricAdolescent

Adult

Recommended DateWhen should the next dose be given?

PediatricAdolescent

Adult

HIMSS/AIRA Collaborative

AIRA Measurement

and Improvement

HIMSS Immunization

Integration Program

HIMSS/ AIRA Collaborative

For more information:ImmunizationCollaborative@himss.org

• 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

Goals of the HIMSS/AIRA Collaborative

For more information:ImmunizationCollaborative@himss.org

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

In Summary

• Thank you to:• The AIRA Measurement for Assessment and Certification Advisory

Workgroup (MACAW) Members for their work in recommending concepts and measures

• The AIRA Board of Directors for approval of measures and oversight of the process

• All IIS and EHRs for doing the hard work to implement and improve interoperability and functionality

Acknowledgements

Thank You!

Eric Larson

elarson@immregistries.org

HIMSS/AIRA Collaborative

ImmunizationCollaborative@himss.org

www.immregistries.org