Registry Support of Registry Support of Immunization ProgramImmunization Program

ActivitiesActivitiesLance Rodewald, M.D.

Director

Immunization Services Division, NIP/CDC

Bill Brand, M.P.H.

Vice-President, American Immunization Registry Association

Immunization Grantee Requirements

• Population Assessment• Consumer Information• Program Management• Provider Quality

Assurance

• Registries • Service Delivery• Surveillance• Vaccine Management

Implement required and locally-identified

activities in eight core areas:

NIP/CDC Support

• Immunization Program Operations Manual (IPOM) – Grant guidance on required and recommended

activities – “Best practices” for an effective and

comprehensive immunization program

• Program Consultants in core program areas• Section 317 and VFC funding • Wide range of guidance documents,

trainings, print materials, etc.

Registries Within Immunization Programs

• Unique challenges for fully integrating registries with the rest of an immunization program:– Often separate funding sources– May be organizationally housed in a Medicaid

Program or Information Technology unit.– Historically often seen as an experimental and

unproven arm of an immunization program.

• Immunization registries are growing in both provider participation levels and in functionality.

• 44% of children now participate.• Focus to date has been on technical

standards and how a registry supports its external users.

• Little is available to guide a registry in supporting other core components of an immunization program. New standards are needed.

Current Situation

Potential benefits of new standards

• Greater integration and synergy across immunization program staff/teams.

• More efficient use of Section 317 and other funds.

• More fully functional registry applications.• More integrated, seamless registry support

of private providers and local health departments.

Registry Support for an Immunization Program –

The PROW Project

Purpose of the PROW Project

• To identify ways registries can effectively and integrally support the other core program components of an immunization program.

• To encourage and support adoption of those activities by all registries/ immunization programs.

Development of PROW Standards

• NIP contracted with the American Immunization Registry Association (AIRA)

• AIRA administered a survey of Immunization Program Managers and Registry Managers; conducted focus group with Program Managers.

• Convened national work group to draft standards.

• Now a collaborative project of AIRA and the Association of Immunization Managers (AIM).

Products of PROW

• Standards of Excellence in each of six program areas:– Vaccine Management– Provider Quality Assurance– Population Assessment– Consumer Information– Service Delivery– Surveillance

• Worksheet for self-assessment and planning.

Registries

Provider QA Vaccine Management

Assessment

Surveillance

Consumer Information

Service Delivery

Registry Support of Core Program Components

PROW Standards of Excellence

• Comparable to Best Practices• Standards as a ceiling to shoot for versus a

floor or set of minimum requirements• Concrete and tangible• Organized by Core Program Components• Cross-referenced to recommended activities

in the Immunization Program Operations Manual (NIP/CDC)

PROW Standards of Excellence

• Organized into three levels, from relatively easy to implement to challenging/resource intensive

• Useful for:– Identifying enhancements– Upgrading current applications – Developing requirements for a new

application or RFP

• Seen as an essential companion to minimum registry functions (NVAC), IPOM, and the new certification process.

Vaccine Management

PROW principle:

“Immunization registries provide users with information and functions that support proper storage and handling of vaccines, and internally can support management of the VFC program.”

Vaccine Management

• Level II:• Support a vaccine inventory feature capable

of adjusting doses due to wastage or transfer.

• Generate a doses administered or other report(s) to support vaccine accountability activities.

• Capture VFC eligibility status and generate annual reports.

Vaccine Management

• Level III:• Incorporate a feature that alerts users to lots

due to expire or already expired.• Incorporate a link to VACMAN for

automated ordering as supplies run low.• Incorporate a call-back feature for deferred

shots due to shortages.

Provider Quality Assurance

PROW principle:

“By enabling access to complete immunization records, registries support providers in delivering age-appropriate and timely immunizations, and in reducing under- and over-immunization.”

Provider Quality Assurance

• Level I:• Export to CASA or otherwise use registry

data as part of AFIX visits.• Use registry data to highlight general or

practice-specific practice issues that can be incorporated into provider trainings, newsletters, or a “tip-of-the-month” web link.

Note: Vital Records reported hospital Hep B1 to ALERT since Nov 1999

Source: Immunization ALERT (Oct 2000)

0

100

200

300

400

500

600

700

02 05 08 11 14 17 20 23 28 29 32 35 38 41 44 47 50 01 04 07 10 13 16 19 22 25 28 31

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Hep B given 0-56 days after birth

Hep B given 0-5 days after birth

Thimerosaland Hep B

T-free availablein Hospitals

T-free widelyavailable—VFC

Week1999 2000

Use of an Immunization Registry to Track Hepatitis B Immunization

Provider Quality Assurance

• Level II:• Highlight invalid doses when displaying a

history.• Use registry data to prioritize AFIX or VFC

site visits.• Use the registry to track series completion

for children born to surface antigen-positive moms.

Provider Quality Assurance

• Level III:• Be able to display the reason for an invalid

dose.• Include HBV and HBIG data fields in birth

records or other mechanisms, and regularly upload to the registry.

Inter-relatedness of new standards

• Such standards would complement and support existing standards and guidance:– Development of Community- and State-based

Immunization Registries (Approved by NVAC, January 1999)

– Minimum Functions for Immunization Registries (NIP/CDC, 2001)

– Core data set (NIP/CDC, 1995)– Voluntary registry certification (pending

approval)

What’s next for PROW?

• Disseminate Standards of Excellence • Peer learning/mentoring group • Best practices resource kit• Continual revising and growing of the

Standards based on their use and the growing maturity of registries.

• Potential role for NVAC

Proposed Resolution

The NVAC believes the growing maturity of immunization registries means they can play a greater and more integral role within an immunization program. In particular, NVAC believes registries can provide important support to other core program components, such as assessment, vaccine management, and provider quality assurance. Further, the NVAC believes the CDC should continue working with others to identify and disseminate best practices for registry support of an immunization program, such as those found in the Programmatic Registry Operations Workgroup Standards of Excellence.

For more information…

www.immregistries.orgoror

Bill BrandBill Brand

Minnesota Department of HealthMinnesota Department of Health

bill.brand@health.state.mn.usbill.brand@health.state.mn.us