Title: New York State Immunization Information System NYSIIS
1 New York State Immunization Information System (NYSIIS) Western New York and Finger Lakes Immunization Coalition Meetings May 21-22 2008 Loretta A. Santilli M.P.H. NYSIIS Project Manager New York State Department of Health 2 Program Objectives
At the conclusion of this program attendees will
Be familiar with the latest general immunization legislative efforts.
Understand why immunization information systems are necessary.
Understand the specific requirements of the NYSDOH system.
Understand the steps to participate in NYSIIS.
Understand the benefits for providers and patients.
3 Immunization Legislative Efforts
Vaccines Containing Mercury
Meningococcal Vaccine for 7th Grade Entry
ACIP recommended vaccines can become school requirements when recommended by commissioner
Minor consent for HPV vaccine
Influenza Vaccine for Health Care Personnel in LTCFs
Lead and NYSIIS
4 Vaccines Containing Mercury
Public Health Law Section 2112
Effective July 1 2008
Prohibits the administration of vaccines containing more than trace amounts of thimerosal a mercury-containing preservative to children less than 3 years of age and women who know they are pregnant.
Definition of Trace
For all vaccines EXCEPT influenza vaccine the term trace means no more than 0.5 micrograms of mercury per 0.5 milliliter dose.
For children under 3 years of age an influenza vaccine may contain no more than 0.625 micrograms of mercury per 0.25 milliliter dose.
For women who know they are pregnant an influenza vaccine may contain no more than 1.25 micrograms of mercury per 0.50 milliliter dose.
5 Pregnant Women
Yearly determination of an adequate influenza vaccine supply for pregnant women
The restriction on the administration of influenza vaccine containing no more than 1.25 micrograms of mercury per 0.5 milliliter dose will not apply to pregnant women unless the Commissioner of Health makes a yearly determination that there is an adequate supply of influenza vaccine that has no more than this amount.
The commissioner may authorize the use of vaccines containing more than the levels described if
it is determined necessary to prevent or respond to an outbreak and there are insufficient amounts of a vaccine containing the lower amounts of mercury.
a vaccine with lower mercury levels is not available for distribution in this state.
If a practice cannot find/obtain appropriate vaccine
In these situations a parent or legal guardian of a child pregnant must provide informed consent.
7 Tdap Booster - Current
Requirement for students born on or after 1/1/94 and entering the 6th grade (or a comparable age level special education program).
Those entering 6th and 7th grades are required to provide proof of a Tdap booster.
If a student has received a Td DT or DTaP vaccination within the last two years the students Tdap vaccination should be deferred (with rare exceptions) until a period of two years has elapsed.
10-year-old students who are entering 6th grade will not be required to receive a Tdap vaccine and will not be excluded from school but they must be flagged tracked and immunized when they turn 11 years old.
8 Tdap Booster - Proposed
Moving requirement to 7th grade
There are 10 year olds in 6th grade that can only receive one of the Tdaps available. A practice may not carry this product.
There is a physical examination already required for 7th grade.
Removes need to track and revaccinate those kids.
Less burdensome to practices and school nurses.
9 Meningococcal Vaccine for 7th Grade Entry - Proposed
ACIP recommendation is for 11 years.
Would be in line with current physical examination requirement and proposed Tdap booster.
Increased risk begins in teen years.
10 College Entry - Proposed
Meningococcal vaccine to be required for college entry
First year students living in dorms at higher risk
Part-time students to be required to comply with college requirements
They sit in same classrooms so risk is there
Less burden for administrators to sort students
Doesnt apply to on-line students
11 ACIP Recommendations Proposed
Would allow commissioner to add ACIP recommended vaccines to school requirements
Sufficient safety studies
12 Consent of Minors - Proposed
Minors can consent to an HPV vaccine
No parental consent required
13 Influenza Vaccine for Health Care Personnel in LTCFs - Proposed
Would require all health care personnel (HCP) in long term care facilities (LTCFs) to get vaccinated yearly against influenza.
Requirement for hospital personnel would be done through regulations since other vaccine requirements are in regulations.
Article 21A has made it law to offer influenza vaccine to HCP in LTCFs and the results have been stable at around 40.
14 Vaccine Financing
2008 budget calls for DOH to conduct a study of the feasibility of developing a universal purchase/distribution vaccine system
Would remove vaccine purchase as a major cash flow issue for many practices.
15 Lead and NYSIIS - Proposed
Inclusion of lead testing results into NYSIIS
16 What is NYSIIS
NYSIIS is the New York State Immunization Information System.
A confidential web-based data system designed to collect and consolidate vaccination information from health care providers located in New York State outside of New York City. (New York City has their own registry - mandatory since 1997).
Voluntary participation by providers since 1994 in regional registries such as HealthyShot and IRIS. Consent to participate was required.
Legislatively mandated provider participation as of January 1 2008 for immunizations given to children less than 19 years of age (including immunization history). No opt-out provision.
Lifespan system (with consent once aged 19 years or older).
17 Why do we need immunization information systems
By the age of two children will need up to 20 vaccines and one in five U.S. children receives at least one unnecessary dose of vaccine.
More than 20 percent of the children in the U.S. have seen more than one health care provider in their first two years resulting in scattered paper medical records.
CDC started the registry initiative in 1995 following the measles outbreak too many kids were not up-to-date.
18 Fiscal Impact
Projected annual cost for nationwide network of IISs for children 0-6 years 100 million
Cost offsets 280 million
168M immunization assessment activities for child care Head Start and school entry
58M manual pulling of records for all children entering Kindergarten
26.5M duplicate immunizations
2M Health Plan Employer Data and Information Set (HEDIS) reports
11.1 National Immunization Survey
Source Immunization Information Systems Committee
on Practice and Ambulatory Medicine.
19 National Picture
Immunization information systems are operational in 46 states.
Healthy People 2010 goal (objective 14.26) is 95 of children from birth through age five with two or more shots in a fully functioning immunization information system.
Making Progress U.S. total 65 (compared to 56 for 2005 and 48 for 2004) Participation is defined as having two or more vaccinations recorded in an immunization information system. 21 (No Transcript) 22 NYSIIS Web-based Application
EDS awarded contract in 2006 to modify Wisconsin Immunization Registry (WIR) for NYS needs.
The Wisconsin application is in use in 12 other projects of which EDS is supporting 7.
User access to NYSIIS is through individual account on the NYSDOH Health Commerce System (secure intranet).
No fee to use NYSIIS.
Cost may be incurred to maintain Internet access.
23 Key Features of NYSIIS
Read/write access for health care providers and their designees.
Read only access for other authorized users (i.e. schools)
Patient level immunization history report.
AAP Health Appraisal form.
Reminder and recall notifications.
Vaccine inventory VFC reports.
Assessment benchmark and ad hoc reports (AFIX).
24 HPN Instructions
All medical professionals (prescribing and non-prescribing) can apply for HPN account access at the following Department of Health web site https//commerce.health.state.ny.us/pub
(note the s after http)
Providers designate an HPN Coordinator to manage the medical practice user accounts including non-medical office staff.
25 Were LIVE!!
NYSIIS officially launched February 25 2008
As of May 14 2008
1157 participating organizations
1618 individual users
Key Message The focus of the first year of implementation (2008) is training data submission and user support NOT compliance/enforcement.
26 Implementation Messages
Providers will be allowed additional time to report patient immunization histories as long as the provider initiates and maintains reporting of active immunizations administered.
Providers are not expected to track immunizations given after 1/1/08 but before their implementation date. The information for such immunizations should be entered at the next immunization visit following the date on which active reporting begins.
27 Implementation Schedule - 2008 28 NYSIIS Training Summary(through May 15 Western NY Region)
110 classroom sessions and 53 webinars held
Additional 55 classroom and 24 webinars scheduled through July 15th (downstate regions)
1100 targeted VFC provider organizations
1180 participants trained
730 via classroom sessions
450 via webinars
Evaluations are overwhelmingly positive
What NYSIIS Users Are Saying
29 But I missed training
Webinars are scheduled continuously and available to anyone statewide.
Register at http//nysdoh.webex.com
Independent learning is available via the user manual available on the DOH website or in the NYSIIS application.
Additional classroom sessions will be scheduled for the Fall of 2008.
One week in each of six regions between mid-September and mid-November.
30 User Group Meetings
Open forum user group meetings will be held in each region the month after implementation to discuss progress.
Very positive feedback!
31 Legacy Data Migration
Migration of previously submitted data from legacy systems (IRIS and HealthyShot) is complete.
Error reports are available upon request for migrated provider data files to determine if patients and/or immunizations were rejected and the reason why.
HealthyShot data migration will continue until the end of September.
As providers transition from HealthyShot to NYSIIS their final files will also be migrated.
32 Electronic Data ExchangeProvider-based
Data export files are being accepted from vendors/providers using electronic billing or EMR systems.
Must follow standard HL-7 or flat file specifications.
Once test file is submitted and verified data exchange can proceed.
33 LIVE Data Exchange Users(as of 5/16/08)
Clinton Essex Monroe Suffolk Counties
Columbia Memorial Hospital
Four Seasons Pediatrics
Hudson Headwaters Health Network
United Medical Associates/United Health Services
Honeoye Valley Family Practice
PerfectCare (8 orgs)
eClinical (10 orgs)
PractiCare (1 org)
Health Systems Technology (1 org)
34 In Progress Data Exchange Users(as of 5/16/08)
Cayuga Medical Center/Northeast Pediatrics/Meditech
St. James Mercy Hospital/Southern Tier/Meditech
East End Pediatrics/Office Practicum
MISYS EMR/Urszula K Rakowska
Physicians Computer Company
Medical Communication Systems
Unity Health NextGen
Dr. Bosco - Portland Peds (Perfectcare)
Plattsburgh Primary Care Pediatrics - Primary Care Health Partners
27 other orgs and/or vendors in progress
35 Electronic Data ExchangeOther Partners
Vital records birth certificate information including immunizations administered at birth will be loaded into NYSIIS.
With legacy data migration complete testing of vitals files is underway.
Will include all births in NYS outside of NYC since 1/1/2004.
Weekly updates planned.
Planning weekly data exchange with NYC based on patient residence.
Other health information system linkages . . .
36 Potential Data Linkages
Newborn Hearing Screening
Newborn Bloodspot Screening
Public Health Emergency Preparedness
SNS inventory management
Countermeasure and response administration (CRA)
Indian Health Services
37 Coming Soon
Data exchange with NYC and bordering states
NJ VT PA
Expanded authorized users
Schools in early adopting areas beginning in June
38 Historical Data Entry Reducing the Burden
Two minimum data fields Date vaccine type
Lot number (if available) is encouraged but not required
Short cut for rapid manual data entry of complete immunization history stay tuned!
Investigate backload of historical info from EMR and/or billing system.
39 Provider Benefits
NYSIIS is not intended to be primarily a system to report data to the state
The true benefit to physicians will be in the information they get out of the system. Without the historical data in the system much of this functionality will be lost.
Tools for managing the complex pediatric vaccine schedule
Patient-specific reminders of vaccine doses recommended due or overdue and invalid doses
Generate reminder/recall notices for patients
Tracking vaccine lot numbers in the event of a recall
Track practice coverage levels
Official immunization records printed for entrance into daycare school camp and college
40 Benefits for Others
For parents and children
Permanent immunization record
Reminders and tracking to keep up-to-date
For public health
Monitor population levels guide interventions
Optimize vaccine management
Minimize vaccine misuse and wastage
41 Cost Savings
Ultimate cost savings when utilizing an IIS
Savings from not having to manually pull a chart for immunization records 14.70 per chart (McKenna 2002)
Downloading information is most cost-effective
0.24 per shot for automated entry vs. 3.24 for manual data entry (Rask 2000)
Increase cost of 0.56 per shot post-implementation with nurses spending 3.4 minutes per shot on registry activities (Glazner 2004)
Source Immunization Information Systems Committee on Practice and Ambulatory Medicine. PEDIATRICS. 2006118(3)1293-95 42 Communications
Partnerships with professional societies
Letters to providers
Dear Doctor letter (Dec 2007)
Dear CEO letter for hospitals (March 2008)
Dear Doctor letter 2 (in approval process)
Websites (NYSDOH and HPN)
Local regional and statewide presentations
Frequently Asked Questions
Public notification campaign
Parent Notification Letter
Parent brochure in development
43 Take Home Points
Get an HPN account for EACH INDIVIDUAL USER
Confirm Internet access available for designated users
Commerce Accounts Management Unit (CAMU) Help Desk
For HPN access or account issues
(866) 529-1890 or hinhpn_at_health.state.ny.u s
NYSIIS Technical Help Desk
For NYSIIS user access or questions on how to use the system
(866) 389-0371 or nysiishelpdesk_at_eds.com
Growing Up Healthy Hotline
For general program or policy questions
(518) 473-4437 or nysiis_at_health.state.ny.u s
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