Presented by: Rebecca Coyle MSEd.

AIRA Executive Director

A Summary of the Methods, Successes and Challenges of Pharmacy-IIS Interfaces

What is AIRA• AIRA is viewed by its members as the

centralized core of activity for IIS development, standardization, and best practices

• Provides knowledge sharing opportunities and capacity building activities

• Promotes, advocates for, develops, and disseminates IIS data exchange standards consistent with national standards that increase the visibility of IIS as public health best practice models for interoperable and integrated health management systems

Percentage of children aged <6 years participating* in an Immunization Information System (IIS) – United States, five cities+, and the District of Columbia, 2012

* Participation is defined as having two or more vaccinations recorded in the IIS+Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas.

National child participation: 86%

Percentage of adolescents aged 11 through 17 years participating* in an Immunization Information System (IIS) – United States, five cities+, and the District of Columbia, 2012

* Participation is defined as having two or more vaccinations administered during adolescence recorded in the IIS+Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas.

National adolescent participation: 54%

Percentage of adults aged ≥19 years participating* in an Immunization Information System (IIS) – United States, five cities+, and the District of Columbia, 2012

* Participation is defined as having one or more vaccinations administered during adulthood recorded in the IIS+Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas.

National adult participation: 25%

Methods

Survey Purpose• Examine what is being done to connect IIS

and Pharmacies and how it is being done. • Which pharmacies are providing

immunizations • Which pharmacies are reporting vaccinations

administered to the IIS, and Of those reporting, what is the nature and quality of

the data being received • Capture the successes and challenges of the

pharmacy-IIS reporting relationship and • What efforts are being made to increase the

number of pharmacies reporting to the IIS

Pharmacy Interview Purpose• Gain a better understanding of the

chain’s corporate approach to vaccination and reporting

• Provide balance and validation of responses captured during the IIS Survey phase

Map of IIS Survey Responses

Major Findings

• Of the state and project areas responding to the survey (n=45) Pharmacies are allowed to provide

vaccinations in 42 (93%) of the project areas.

Pharmacies report doses administered to IIS in 36 (80%) jurisdictions and are required to report in 22 (49%).

• Pharmacists will generally administer whatever vaccinations they are allowed to administer in accordance with individual state laws

Types of Vaccinations Reported by Frequency

Most Common Data Submission Methods & Frequency• Flat files loaded manually (26%), • HL7 batch (25%) and • Manual data entry (23%)

• For Electronic Interfaces: Weekly data feeds (42%) Daily feeds (28%)

Reporting Methods by Frequency

Reporting (cont.)

• For pharmacies reporting electronically (n = 64), a multi-site feed including all sites/clinics in the jurisdiction was by far the most common practice (83%).

• For manual submissions (n=22), data entry is almost always performed at the individual site/clinic level (82%).

Most Common Transport Methods• FTP/SFTP (47%) • SOAP over HTTP(s) (24%)

Success

IIS Pharmacy

Partnerships with the pharmacy community is critical when recruiting & interfacing with new pharmacy partners

Significant increase in adult immunization records

Improved quality of adult data

The improvement of overall patient care

Role of pharmacies in the patient care continuum

System improvements

Challenges – IIS Perspective• Data quality issues• Lack of unique patient identifiers• Variations in patient’s name• Lack of patient address• Inability to collect required data

elements• Inability to generate a file format

supported by the IIS

Challenges – Pharmacy Perspective• Restrictions on the type of files that IIS

are willing or able to accept (e.g. pharmacy can generate a flat file but state requires HL7 or vice versa)

• Limited staffing resources and infrastructure on the IIS side can lead to a lengthy onboarding process

• State variations in the IIS specifications• IIS consent requirements mandated

through state/local law

Recommendations1. Evaluate IIS reporting

specifications/recommendations on a more global scale to standardize the reporting process for external partners that span multiple states/jurisdictions (specifically required fields, reporting methods supported, reporting timelines).

2. Assemble partners with the ability to influence public health policy and pharmacy vaccination practice to recommend standardization in laws defining pharmacy vaccination programs, mandatory reporting requirements, and consent/disclosure limitations.

Recommendations (cont.)3. IIS should work with pharmacy reporting

partners to identify alternative reporting options and/or establish feasible transition plans and timelines to facilitate reporting until pharmacy systems can report in the IIS’s preferred reporting method. All efforts should be made to avoid requiring pharmacies to perform unnecessary duplicate data entry.

4. IIS not capable of supporting the most current HL7 2.5 specification should establish timelines for implementing the new standards and communicate those timelines to the more advanced pharmacy partners.

Recommendations (cont.)5. Consider moving to NDC as the

standard for vaccine type and manufacturer reporting, or enhance IIS to support NDC in addition to CPT/CVX codes.

6. Include pharmacy partners in immunization and IIS related meetings and educational opportunities whenever appropriate.

Recommendations (cont.)7. Leverage partnerships to increase the

number of Pharmacy-IIS interfaces, evolve reporting processes and improve patient care.

8. Consider future study opportunities to evaluate pharmacy data quality when compared to other provider submissions, investigate possibility of getting pharmacy data through a centralized billing system, and assess the feasibility of pharmacies incorporating review of records in the IIS into the routine vaccination workflow.

AIRA Website Resources

www.immregistries.org

Danielle Reader-JolleyParticipating Immunization Information Systems

CVSKroger Rite Aid

Safeway Surescripts

Walgreens

Type of Data Exchange

Transport Modes by Frequency