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A Business Case for Electronic Immunization Registries

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DOD MIL STD 2167/498. DOD MIL STD 499A. DOD MIL STD 1703. Immunization ... DOD MIL STD 881b Work Breakdown Structure. System functions. System performance ... – PowerPoint PPT presentation

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Title: A Business Case for Electronic Immunization Registries


1
A Business Case forElectronic Immunization
Registries
  • University of California, San Diego, CA
  • John Fontanesi, Ph.D.
  • CDC Award U1W/CCU914714-01Award

2
Study Goals
  • Articulate strategic long-term capitalization
    requirements
  • Methodology
  • Develop realistic business case scenarios
  • Develop cost/benefit model
  • Provide cost effectiveness benchmarks

3
Cost Model Requirements
  • Predict registry costs
  • Planning, Development, Maintenance
  • Relate costs to performance requirements
  • CDC 12 core functions, inventory, CASA reports
  • CPU usage, transaction times, administration
  • Identify cost drivers
  • SLOC, population, end-user support

4
Easier Said Than Done
  • Averaging costs of funds spent DOES NOT
  • Adjust for performance
  • CDC core functions
  • Size of registry
  • Technical performance
  • Identify cost drivers
  • Suggest areas for improvement
  • Account for different stages of development

5
Tyranny of the MeanAveraging Costs
6
Parametric Models
  • Examine statistical relationships between
  • Dependent variables
  • Independent variables
  • Preferred method in military and industry
  • Permits benchmarking

7
StandardParametric Cost Models
  • Proprietary
  • REVIC
  • PRICES
  • SASET
  • SEER-SEM
  • SLIM
  • Public
  • COCOMO (87 and II)
  • DOD MIL STD 2167/498
  • DOD MIL STD 499A
  • DOD MIL STD 1703

8
Immunization Registries A Special Case
  • Traditional database applications DO NOT
  • Track independent name changes
  • Track items affected
  • At different times
  • By unrelated organizations
  • Have accurate records of these affects
  • Widely available
  • Constrained by confidentiality

9
DOD MIL STD 881b
Work Breakdown Structure
  • System functions
  • System performance
  • Types of personnel
  • Equipment
  • Administrative and planning tasks
  • Other

10
Parametric Cost Estimating Process
11
Work Breakdown Structure
  • Process tree composed of hardware, software,
    services, and data types
  • Define technical objectives
  • Assign management and technical responsibilities
  • Monitor costs, engineering efforts, schedules,
    and technical objectives

12
WBS Populated with Data Form
  • Basic accounting records
  • Cost reports
  • Historical databases
  • Functional specialist
  • Technical databases
  • Other information systems
  • Contracts
  • Cost proposals

13
Statistical Analysis
  • Standard regression analysis
  • Can use null hypothesis
  • R, R2, F and T statistics appropriate
  • Generates cost-estimating relationship
    (CER)
  • Children 0-6
  • SLOC
  • End-users
  • Core functions

14
Comparison SLOC by Function (MEAN 9)
15
Cost Drivers(Cost Estimating Ratios)
  • Number of end-users
  • Number of functions
  • Population size
  • 5300 per station (3 year life)
  • Linear relationship r.94
  • 8 per SLOC
  • Linear relationship r.83
  • 2.06 per record
  • Curvilinear r.73

16
Do Registries Fit Standard Business I.T.
Models?
  • Rationales for Information Technology Investment
  • Labor savings
  • Improved quality
  • Greater product variety
  • Better customer service
  • Faster response time

17
Background costs
  • Chart pulls cost between 8 and 14
  • Audit costs approximately 60 per chart
  • Non-M.D. staff costs approximately 15 per hour

18
Registry Cost/Benefits
  • 2800 Immunization records printed every 4 hours
  • Negates chart Pulls
  • Savings of 22,400 per 4 hours
  • 2,500-5,000 programming costs
  • Labor savings
  • Improved quality
  • Greater product variety
  • Better customer service
  • Faster response time

19
Registry Cost/Benefits
  • Manual HEDIS Audit gt100K per annum
  • Ad Hoc HEDIS reports - 2.5K to 5K programming
    costs
  • Labor savings
  • Improved quality
  • Greater product variety
  • Better customer service
  • Faster response time

20
Registry Cost/Benefits
  • 250,000 in performance penalties annually
  • 2,500-5,000 programming costs to produce 20
    month old outreach
  • Labor savings
  • Improved quality
  • Greater product variety
  • Better customer service
  • Faster response time

21
Registry Cost/Benefits
  • Increased patient flow from 12 to 15 per hour
  • 30-50 labor cost reduction
  • 1,211,422 shots administered 1/98-10/98
  • Labor savings of 700,000
  • Labor savings
  • Improved quality
  • Greater product variety
  • Better customer service
  • Faster response time

22
Registry Cost/Benefits
  • Improved data QA
  • Switch to Standing Orders
  • Inventory Reports
  • Billing Cross-reference
  • Seasonal Predictions
  • Labor savings
  • Improved quality
  • Greater product variety
  • Better customer service
  • Faster response time

23
Return on Investment
24
Return on Investment (ROI)
25
Operational Cost Modeling
  • Output (Q)
  • Production function (F)
  • Increase in immunized children
  • Computer capital (C)
  • Non-computer capital (K)
  • I.T. staff (S)
  • Other labor/expenses (L)
  • QF(C,K,S,L,I,t,) (1)t

26
Coverage Rates
27
Registry Cost/Benefits
  • Practice Pattern

28
Percent of Shots Missed By Visit Age
29
Registry Cost/Benefits
  • Missed Opportunities

30
Missed Opportunity Rates
31
Encounter Notification
32
Contributing Factors
  • Use of Reminder/Recall Systems
  • Assessment Feedback, Information and Corrective
    Action (AFIX )
  • Readiness to Change
  • Linkage to other Data Sources

33
Contributing Deficiencies
  • Compliance
  • Less than 80 of shots given are entered
  • Data Accuracy
  • Over 15 error rate when completed by clinical
    staff
  • Convenience
  • Data terminals most often placed in billing
    office
  • Stand alone systems
  • Data Availability
  • 50 of 2 year olds have 2 or more providers

34
Cost/Benefit by Function
  • Greatest ROI per man-hours per SLOC
  • Retrieve patient information (54)
  • Print record (124)
  • Coverage level reports (180)
  • HL7 (136)
  • Requiring most man-hours per SLOC
  • Determine immunization needs (550)
  • Determine individuals due/late for immunizations
    (220)

35
Obtained Production Values Q Ratio
36
Major Benefit Activities
  • Improved targeting
  • Rapid response
  • Change in I.T. culture
  • QA activities
  • Practice oversight
  • Review of procedures
  • Improved client relations

37
Lessons Learned
  • To maximize ROI
  • Record prints
  • Accessibility of terminals
  • Workflow dynamics
  • Standard reports
  • VFC
  • Billing
  • HEDIS
  • CASA
  • To maximize immunization rates
  • Provider profiles
  • AFIX
  • QA

38
NEXT STEPS DEVELOPER GUIDELINES and TEMPLATES
  • Performance Planning (PL 103-62)
  • Business Results (PL 100-107)
  • Resource Deployment (PL 101-576)
  • Best in Business standards (executive Order
    12862)
  • Technology Management Reform Act (PL 104-106)

39
NEXT STEPS READINESS FOR CHANGE TEMPLATE
  • Need to identify proposed sites
  • Willingness
  • Capacity
  • Ability to maintain
  • Need to identify appropriate strategies for
    rollout by clinics Readiness For Change
    characteristics

40
NEXT STEPS FEEDBACK
  • Combining with other Data sources to provide
  • Missed Opportunity Feedback
  • Practice Patterns
  • Population Patterns
  • Non-Responders
  • Case Management
  • Geo-demographics
  • Vaccine Safety Studies

41
NEXT STEPS REMINDER/RECALL
  • What are the functions of Reminders?
  • What are the functions of Recalls?
  • Timing?
  • Which methods fits a clinic type?
  • Small vs large practice
  • Community-based clinic
  • Organized vs storefront

42
NEXT STEPS PROVIDER PROMPTS
  • Printing Record at Encounter
  • Flagging Record for Review
  • Immunization Due
  • Contraindications
  • Familial Objection

43
Results
  • Immunization registries can be cost effective
  • 3-year break-even point
  • 5-year ROI of as high as 81
  • Immunization registries CAN improve and maintain
    high coverage rate ONLY if they are made a part
    of an administrative TQM/CQI effort
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