New York State Immunization Information System NYSIIS

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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
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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.

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Immunization Legislative Efforts

• Vaccines Containing Mercury
• Tdap Booster
• Meningococcal Vaccine for 7th Grade Entry
• College 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
• Vaccine Financing
• Lead and NYSIIS

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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.

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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.

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Exceptions

• 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.

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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.

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Tdap Booster - Proposed

• Moving requirement to 7th grade
• Rationale
• 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.

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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.

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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

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ACIP Recommendations Proposed

• Would allow commissioner to add ACIP recommended
  vaccines to school requirements
• Certain caveats
• Adequate supply
• Sufficient safety studies

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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.

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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.

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Lead and NYSIIS - Proposed

• Inclusion of lead testing results into NYSIIS

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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).

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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.

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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.
• PEDIATRICS. 2006118(3)1293-95.

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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.

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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.
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(No Transcript)
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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.

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Key Features of NYSIIS

• Read/write access for health care providers and
  their designees.
• Read only access for other authorized users (i.e.
  schools)
• Deduplication algorithm.
• Recommendation scheduler.
• Patient level immunization history report.
• AAP Health Appraisal form.
• Reminder and recall notifications.
• Vaccine inventory VFC reports.
• Assessment benchmark and ad hoc reports (AFIX).

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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.

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Were LIVE!!

• NYSIIS officially launched February 25 2008
• As of May 14 2008
• 891520 patients
• 11162542 immunizations
• 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.

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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.

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Implementation Schedule - 2008
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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

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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.

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User Group Meetings

• Open forum user group meetings will be held in
  each region the month after implementation to
  discuss progress.
• Very positive feedback!

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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.

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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.

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LIVE Data Exchange Users(as of 5/16/08)

• In-House (12)
• Clinton Essex Monroe Suffolk Counties
• Columbia Memorial Hospital
• Four Seasons Pediatrics
• Hudson Headwaters Health Network
• United Medical Associates/United Health Services
• Dr. Rabadi
• Honeoye Valley Family Practice
• Slocum-Dickson
• Dr. Feinstein

• Vendors (5)
• PerfectCare (8 orgs)
• eClinical (10 orgs)
• PractiCare (1 org)
• Health Systems Technology (1 org)
• MEDENT

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In Progress Data Exchange Users(as of 5/16/08)

• Testing (13)
• eMDs
• 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
• Northeast Health
• Unity Health NextGen
• Pondview Pediatrics
• Dr. Bosco - Portland Peds (Perfectcare)
• Plattsburgh Primary Care Pediatrics - Primary
  Care Health Partners
• Thompson Health/Meditech/LSS
• 27 other orgs and/or vendors in progress

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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 . . .

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Potential Data Linkages

• Lead Screening
• Newborn Hearing Screening
• Newborn Bloodspot Screening
• Public Health Emergency Preparedness
• SNS inventory management
• Countermeasure and response administration (CRA)
• BMI/Obesity
• Health Plans
• Medicaid Medicare
• Indian Health Services
• Congenital Malformations

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Coming Soon

• Data exchange with NYC and bordering states
• NJ VT PA
• Application enhancements
• Householding
• NYSIIS Lite
• GIS
• Expanded authorized users
• Schools in early adopting areas beginning in June
  
• WIC clinics

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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.

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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

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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

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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
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Communications

• NYSIIS News
• 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 FAQs
• Parent brochure in development

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Take Home Points

• Get an HPN account for EACH INDIVIDUAL USER
• Confirm Internet access available for
  designated users
• Monitor NYSDOH communications regarding NYSIIS
  implementation
• Investigate specs for data upload process from
  billing or EMR system
• Register for formal training (when available)
  or complete independently
• Submit final HealthyShot file (if applicable)
• Begin actively reporting to NYSIIS

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Additional Information

• Websites
• NYSIIS on the Health Commerce System (Health
  Provider Network - HPN)
• https//commerce.health.state.ny.us/hpn/bcdc/immun
  ization/nysiis.html
• NYSIIS on NYSDOH Public Web Site
• http//www.nyhealth.gov/prevention/immunization/in
  formation_system/

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Help Desks

• Commerce Accounts Management Unit (CAMU) Help
  Desk
• For HPN access or account issues
• [phone] or hinhpn_at_health.state.ny.u
  s
• NYSIIS Technical Help Desk
• For NYSIIS user access or questions on how to use
  the system
• [phone] or nysiishelpdesk_at_eds.com
• Growing Up Healthy Hotline
• For parents/public
• 1-800-522-5006
• NYSIIS staff
• For general program or policy questions
• [phone] or nysiis_at_health.state.ny.u
  s