VacTrAK Alaska Immunization Information System - ANTHC

Courtesy of the Rosebud Sioux TribeExchanging data between RPMS and StateImmunization Information Systems (SIIS)Amy Groom MPHIHS Immunization Program Manager/CDC Public Health AdvisorIHS Division of Epidemiology and Disease PreventionCDC NCIRD Immunization Services Division/Program Operations Branch

What’s an Immunization Information System ?• Also known as ImmunizationRegistries, State ImmunizationInformation Systems (SIIS) areconfidential, population-based,computerized information systems• They collect vaccination data about allchildren within a geographic area(usually statewide)• Some registries also collect vaccinedata for adults.

SIIS vs. RPMS• IHS , many tribal and urban Indian facilities, andstate of Alaska PHNs already have a system forimmunization 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 notshared with providers outside that facility– SIIS consolidates records from all providers into 1 recordthat can be accessed by all providers• To include RPMS data in SIIS, and SIIS data inRPMS, 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 otherfacilities– Enter those shots given elsewhere into RPMS

The RPMS Data ExchangeInitiativeGOAL: An electronic two-way exchangeof immunization data between RPMSand SIIS

Am I allowed to share patientimmunization data with a SIIS?• Yes. Sharing of data with an SIIS is permissibleunder HIPAA.– Under HIPAA, data can be released without individualpatient consent for “public health activities and purposes”• SIIS is responsible for developing and implementingprocedures for providing access• Users must sign an agreement and follow strictconfidentiality and security policies.• Protection of SIIS data is managed through stateprivacy, confidentiality, and security laws andthrough compliance with federal privacy rules andregulations.

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 andexports to the SIIS and– Imports data from the SIIS back to RPMS– Process can be automated using HL7communications bridge– Automation saves personnel time andprovides continuity to interface

Immunization Data Exchange SoftwareBYIM 1.01• BYIM v 2.0 scheduled to be released infall 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 adultsas well• Entire immunization history every time• The SIIS matches and merges RPMS datawith data in the SIIS• If the SIIS has immunizations for a patientthat the RPMS file did not contain, thisinformation is sent back to the RPMS

Data Exchange ProcessSite ASite BStateRegistry

Interface Success - Arizona• Data exchange currently underway at16 of the 22 IHS and tribal sites• Total number of records received byArizona IIS (ASIIS) from IHS/Tribal sites= 2.5 million• Initial exports from 6 IHS facilities toASIIS– 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 ImmunizationHistory1. 08/24/88 DTP2. 11/29/88 DTP3. 03/07/89 DTP4. 11/17/89 DTP5. 12/30/91 DTaP6. 03/19/92 DTaP7. 05/27/92 DTaP8. 10/13/92 DTP9. 02/10/93 DTaP10. 12/07/95 DTaP1. 04/18/01 Td-ADULT2. 09/10/03 Td-ADULT1. 08/24/88 OPV2. 11/29/88 OPV3. 03/07/89 OPV4. 11/17/89 OPV5. 12/30/91 OPV6. 03/19/92 OPV7. 05/27/92 OPV8. 10/13/92 OPV9. 02/10/93 OPV10. 12/07/95 OPV1. 12/30/91 HIBTITER2. 03/19/92 PEDVAXHIB3. 11/18/92 PEDVAXHIB1. 09/12/97 HEP B PED2. 02/17/98 HEP B PED3. 03/30/98 *HEP B PED4. 02/26/01 HEP B5. 03/28/01 HEP B6. 08/13/03 HEP B1. 11/17/89 MMR2. 10/13/92 MMR3. 02/10/93 MMR4. 12/07/95 MMR |1. 11/13/00 HEP A 2PED2. 02/26/01 HEP A3. 06/01/01 HEP A 2PED4. 08/13/03 HEP A

Data Exchange between RPMS andSIIS will . . .• Improve immunization services forchildren– IHS, tribal and other health care providers• Improve ability to monitorimmunization 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

Alaska’s s ImmunizationInformation SystemMCH/Immunization ConferenceSept. 22-23, 23, 2008Gerri Yett, RN, MSN, CHESDeputy Immunization Program Manager

Immunization Needs Assessment/Feasibility Study – 2004/2005

Request for Proposal developedContract awarded July 2007

Alaska Regulations7 AAC 27.892The department shall use identifiable healthinformation collected and maintained by thedepartment under AS 18.05 or AS 18.15 to accomplishthe essential public health services and functions forwhich the information was originally acquired. Theseuses include(1) Maintaining lists and registries of immunizations…

Excerpts: MOA – Sharing ProtectedHealth Information (Adopted June 2008)• ANTHC is in the process of replacing MFI with a moremodern system that will support exchange of health careinformation with electronic health record systems otherthan RPMS.• ANTHC and the Department agree that this exchange ofProtected Health Information is permissible under HIPAAand state law, and desire to memorialize theirunderstanding in this Agreement.• Integrated Health Record. The delivery of effective healthservices in Alaska to an individual is best facilitated by acomprehensive health record. It is the express purposeof the Department and ANTHC to continue to work towardthis goal and to continue to promote uses anddisclosures 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 TrackingOptional:• 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 workflowMethods:• 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 implementationprocess• Download latest version of BYIM software(includes process for access and download of HL7bridge software)• Install Alaska specific BYIM patch(allows for exchange of IZ records for all ages)• Contact Immunization Program to coordinate useraccess 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 organizationPrivate 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 / RPMSinterface

• VacTrAK User Group• Ongoing training• School Nurse Moduleimplementation• Additional modules• Coverage assessments• Vaccine Management

Don’t t just grin and bear it …

Invitation to jump in & use theJump in and use the system!system!

Contact UsAlaska Immunization Program269-8000VacTrAK Helpline1-866-702-8725269-0312

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