Immunization Information Systems 101: Immunization Information Systems 101:

What Every Program Manager Should KnowWhat Every Program Manager Should Know

Immunization Information Systems 101

Need For This ModuleNeed For This Module

Educate new immunization and IIS staffEducate new immunization and IIS staff

Provide an introductory IIS education Provide an introductory IIS education resourceresource

Educate partners, providers, and Educate partners, providers, and stakeholdersstakeholders

Learning ObjectivesLearning Objectives

Describe what immunization information systems (IIS) areDescribe what immunization information systems (IIS) are

Describe the benefits of IISDescribe the benefits of IIS

Describe the basic functions of IISDescribe the basic functions of IIS

Describe how IIS can be used to support immunization and Describe how IIS can be used to support immunization and other partner program activitiesother partner program activities

Continuing Education Continuing Education CreditCredit

Continuing education credit is available only through Continuing education credit is available only through the CDC/ATSDR Training and Continuing Education the CDC/ATSDR Training and Continuing Education Online System at www.cdc.gov/TCEOnline/.Online System at www.cdc.gov/TCEOnline/.

You must have a verification code specific to this You must have a verification code specific to this program to apply for CE credit. The code will be program to apply for CE credit. The code will be revealed during the course of the program. CE credit revealed during the course of the program. CE credit for this activity will expire on July 18, 2011.for this activity will expire on July 18, 2011.

Financial Interest Financial Interest DisclosureDisclosure

CDC, our planners, and our presenters CDC, our planners, and our presenters wish to disclose they have no financial wish to disclose they have no financial interests or other relationships with the interests or other relationships with the manufacturers of commercial products, manufacturers of commercial products, suppliers of commercial services, or suppliers of commercial services, or commercial supporters.commercial supporters.

Unlabeled/Unlicensed Unlabeled/Unlicensed Use DisclosureUse Disclosure

Presentations will not include any Presentations will not include any discussion of the unlabeled use of a discussion of the unlabeled use of a product or a product under product or a product under investigational use.investigational use.

IIS 101 TopicsIIS 101 Topics

What are IIS?What are IIS? IIS BenefitsIIS Benefits Laws, Policies and Laws, Policies and

IISIIS History of IISHistory of IIS Participation in IISParticipation in IIS How IIS WorkHow IIS Work Guiding Documents Guiding Documents

for IISfor IIS

IIS Functional IIS Functional StandardsStandards

IIS Data UseIIS Data Use IIS LinkagesIIS Linkages Future of IISFuture of IIS Additional Additional

ResourcesResources

What are IIS?What are IIS?

What are Immunization What are Immunization Information Systems (IIS)?Information Systems (IIS)?

IIS are electronic information systems designed to IIS are electronic information systems designed to capture and manage data specifically related to capture and manage data specifically related to immunization. They:immunization. They:

–are population-based systems.are population-based systems.–are computerized, primarily web-based systems.are computerized, primarily web-based systems.–ensure confidentiality, privacy, and security of personal data.ensure confidentiality, privacy, and security of personal data.–are a collect and consolidate vaccination-related data from are a collect and consolidate vaccination-related data from multiple healthcare providers.multiple healthcare providers.–generate reminder and recall notices.generate reminder and recall notices.–assess vaccination coverage.assess vaccination coverage.–can capture vaccination-related data on children, adolescents can capture vaccination-related data on children, adolescents and adults.and adults.

Other IIS CapabilitiesOther IIS Capabilities

Integrate with other electronic health information Integrate with other electronic health information systemssystems

Vaccine management at the provider and Vaccine management at the provider and immunization program levelsimmunization program levels

Forecast next appropriate vaccination(s) due, Forecast next appropriate vaccination(s) due, specific to each patient specific to each patient

Emergency preparedness & pandemic influenza Emergency preparedness & pandemic influenza planningplanning

IIS Funding SourcesIIS Funding SourcesSection 317 Section 317 Vaccines for Children (VFC)Vaccines for Children (VFC)Private sources: private foundations, Private sources: private foundations, health plans, service clubs health plans, service clubs State/local funds: immunization State/local funds: immunization coalitions, state legislature, and State coalitions, state legislature, and State Tobacco Dollars Tobacco Dollars Centers for Medicare & Medicaid ServicesCenters for Medicare & Medicaid Services

IIS StakeholdersIIS StakeholdersPublic health and government agenciesPublic health and government agenciesHealthcare providers Healthcare providers Childcare facilities, schools, & universities Childcare facilities, schools, & universities Health plans and insurance companiesHealth plans and insurance companiesVendors of clinical management or medical Vendors of clinical management or medical billing softwarebilling softwareClinical or medical software vendorsClinical or medical software vendorsNational professional organizationsNational professional organizations

IIS Benefits IIS Benefits

IIS Benefits to Immunization IIS Benefits to Immunization ProgramsPrograms

Retrieve real-time dataRetrieve real-time datatrack and evaluate trends in track and evaluate trends in data/coverage levels data/coverage levels monitoring outbreaks and disease monitoring outbreaks and disease coverage levelscoverage levelsVFC vaccine usage and provider VFC vaccine usage and provider compliancy compliancy Monitor new vaccine uptakeMonitor new vaccine uptake

IIS Benefits to Parents IIS Benefits to Parents & Community& Community

Help prevent disease outbreaks in the community.Help prevent disease outbreaks in the community.

Keep records kept safe during natural disasters.Keep records kept safe during natural disasters.

Ensure children don't miss any shots or get too many shots.Ensure children don't miss any shots or get too many shots.

Remind parents by mail or telephone when their child need shots.Remind parents by mail or telephone when their child need shots.

Help determine pockets of need in a community.Help determine pockets of need in a community.

Determine where new clinics and provider officeDetermine where new clinics and provider officess need to be placed. need to be placed.

Maintain records of children in foster care.Maintain records of children in foster care.

IIS Benefits to IIS Benefits to ProvidersProviders

Consolidating immunization-related Consolidating immunization-related informationinformationAutomatically calculating vaccinations neededAutomatically calculating vaccinations neededGenerating reminder and recall noticesGenerating reminder and recall noticesReducing paperwork, save time and moneyReducing paperwork, save time and moneyConnecting cliniciansConnecting cliniciansAnd many more.And many more.

IIS Benefits to Health IIS Benefits to Health PlansPlans

Health plans use IIS to measure HEDIS Health plans use IIS to measure HEDIS rates to monitor and improve quality of rates to monitor and improve quality of care they deliver care they deliver

–This saves health plans time and resources This saves health plans time and resources to look up and evaluate medical records. to look up and evaluate medical records.

Laws, Policies and IISLaws, Policies and IIS

Privacy and Privacy and Confidentiality in IISConfidentiality in IIS

Information in IIS is private and confidentialInformation in IIS is private and confidentialPrivacy is the legal right of a person to limit Privacy is the legal right of a person to limit access to information about that personaccess to information about that personConfidentiality is the treatment in a manner Confidentiality is the treatment in a manner consistent with the understanding made at the consistent with the understanding made at the time of its disclosuretime of its disclosurePrivacy and confidentiality are governed by Privacy and confidentiality are governed by state and federal law and IIS policiesstate and federal law and IIS policies

State Laws Affecting IISState Laws Affecting IIS

Life long or age specificLife long or age specificVoluntary or mandated reporting for health care providersVoluntary or mandated reporting for health care providersOpt-in or Opt-out for individuals/parentsOpt-in or Opt-out for individuals/parentsPersons/entities that can disclose information to the IISPersons/entities that can disclose information to the IISPerson/entities that the IIS can allow to access Person/entities that the IIS can allow to access information in the IIS information in the IIS Privacy and confidentiality of healthcare informationPrivacy and confidentiality of healthcare informationIntegration with other public/private information systemsIntegration with other public/private information systemsSchool/daycare entry School/daycare entry Immunizations requirementsImmunizations requirementsExemptionsExemptions

Federal Laws Affecting IISFederal Laws Affecting IIS

Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA)(HIPAA)

–HIPAA Privacy Rule governs use and disclosure of HIPAA Privacy Rule governs use and disclosure of ““protected health informationprotected health information””–Health care providers and payers are subject to HIPAAHealth care providers and payers are subject to HIPAA–IIS are not a IIS are not a ““covered entitycovered entity”” subject to HIPAA subject to HIPAA

•Each IIS should have written confidentiality and security Each IIS should have written confidentiality and security policies that addresses the following issues. policies that addresses the following issues.

Family Educational Rights and Privacy Act (FERPA)Family Educational Rights and Privacy Act (FERPA)–FERPA protects the privacy of the educational records FERPA protects the privacy of the educational records held by schoolsheld by schools–Disclosure requires consentDisclosure requires consent

History of IISHistory of IIS

IIS DevelopmentIIS Development

IIS first created in 1990s IIS first created in 1990s through Robert Wood through Robert Wood Johnson Foundation and Johnson Foundation and All Kids CountAll Kids Count

Currently, funding is made Currently, funding is made available under section 317 available under section 317 (b) of the Public Health (b) of the Public Health Service Act for 50 states, 6 Service Act for 50 states, 6 cities and 8 U. S. cities and 8 U. S. Territories.Territories.

Participation in IISParticipation in IIS

Provider Participation: Provider Participation: Key to IIS SuccessKey to IIS Success

Ensuring provider participation is critical to complete Ensuring provider participation is critical to complete and accurate electronic immunization records in IIS. and accurate electronic immunization records in IIS. Provider barriers and perceptions include: Provider barriers and perceptions include:

1.1. Participation requires too much cost/staff time. Participation requires too much cost/staff time. 2.2. Practices have its own health information systems. Practices have its own health information systems. 3.3. Perceived non-compatibility of IIS technology and office Perceived non-compatibility of IIS technology and office

computers. computers. 4.4. Limited on-site technical assistance from IIS staff.Limited on-site technical assistance from IIS staff.5.5. Confidentiality concerns.Confidentiality concerns.6.6. Lack of support for IIS from the state medical or specialty Lack of support for IIS from the state medical or specialty

society. society. 7.7. Lack of support from the practice's nursing or administrative Lack of support from the practice's nursing or administrative

staff.staff.

How IIS WorkHow IIS Work

Sources of IIS DataSources of IIS Data

Birth RecordsBirth Records Direct data entry by providersDirect data entry by providers Electronic medical recordsElectronic medical records Medicaid and insurance billing/claimsMedicaid and insurance billing/claims

Information in IISInformation in IIS

NVAC core data elements NVAC core data elements – Purpose: a) attributes necessary for Purpose: a) attributes necessary for

identifying individuals; b) facilitate record identifying individuals; b) facilitate record exchange exchange

– Data are either required or optionalData are either required or optional– Examples of required elements: patient first, Examples of required elements: patient first,

middle and last names; birth date, birth middle and last names; birth date, birth order, race, ethnicity, vaccine type, date, lot order, race, ethnicity, vaccine type, date, lot number, address and phone number.number, address and phone number.

Guiding Documents for IIS Guiding Documents for IIS

Guiding Documents for IISGuiding Documents for IIS

2008-12 Immunization Program Operations Manual 2008-12 Immunization Program Operations Manual (IPOM)- guidance document for developing (IPOM)- guidance document for developing objectives, activities, and evaluation measures that objectives, activities, and evaluation measures that maximize immunization program effectiveness, maximize immunization program effectiveness, including IIS.including IIS.

IIS Strategic plan provides a roadmap of activities IIS Strategic plan provides a roadmap of activities required to reach the 2010 national IIS .objective to required to reach the 2010 national IIS .objective to increase to 95% the proportion of children (ages 0 - increase to 95% the proportion of children (ages 0 - <6 years) participating in a fully operational, <6 years) participating in a fully operational, population-based IIS population-based IIS

Guiding Documents for IISGuiding Documents for IIS IIS Business Plans- designed to assist grantees in IIS Business Plans- designed to assist grantees in

planning, developing, and implementing IIS activities planning, developing, and implementing IIS activities throughout the project lifecycle. throughout the project lifecycle.

317 Grant- Assures the implementation of effective 317 Grant- Assures the implementation of effective immunization practices and proper use of vaccines to immunization practices and proper use of vaccines to achieve high immunization coverage, and supports achieve high immunization coverage, and supports infrastructure for immunization activities. infrastructure for immunization activities.

Public Health Information Network (PHIN) Standards- a Public Health Information Network (PHIN) Standards- a national initiative to improve the capacity of public national initiative to improve the capacity of public health to use and exchange information electronically health to use and exchange information electronically by promoting the use of standards and defining by promoting the use of standards and defining technical requirements. technical requirements.

IIS Functional IIS Functional StandardsStandards

Functional StandardsFunctional Standards 12 minimal functional standards, including:12 minimal functional standards, including:

1.1. Electronically store data on all NVAC core data Electronically store data on all NVAC core data elementselements

2.2. Establish a IIS record within 6 weeks of birth Establish a IIS record within 6 weeks of birth

3.3. Enable access to and retrieval of immunization Enable access to and retrieval of immunization information in the IIS at the time of encounterinformation in the IIS at the time of encounter

4.4. Receive and process immunization information Receive and process immunization information within 1 monthwithin 1 month of vaccine administration of vaccine administration

5.5. Protect the confidentiality of health care informationProtect the confidentiality of health care information

6.6. Ensure security of health care informationEnsure security of health care information

Functional Standards continuedFunctional Standards continued

7.7. Exchange immunization records using HL7 standardsExchange immunization records using HL7 standards

8.8. Automatically determine the routine childhood Automatically determine the routine childhood immunization needed, in compliance with current ACIP immunization needed, in compliance with current ACIP recommendations, recommendations,

9.9. Automatically identify individuals due/late for Automatically identify individuals due/late for immunization to enable the production of immunization to enable the production of reminder/recall notificationsreminder/recall notifications

10.10. Automatically produce immunization coverage reports Automatically produce immunization coverage reports by providers, age groups, and geographic areasby providers, age groups, and geographic areas

11.11. Produce official immunization recordsProduce official immunization records

12.12. Promote accuracy and completeness of IIS dataPromote accuracy and completeness of IIS data

ForecastingForecasting A core function of most IIS is the forecasting A core function of most IIS is the forecasting

algorithmalgorithm Using patients date of birth and shots already Using patients date of birth and shots already

received, create an accurate recommendation of received, create an accurate recommendation of what should be given nextwhat should be given next

Very complex, difficult to design and maintain Very complex, difficult to design and maintain especially when new vaccines are added or different especially when new vaccines are added or different age ranges are recommendedage ranges are recommended

Currently no federal/national set of code available Currently no federal/national set of code available although this has been expressed as a need by although this has been expressed as a need by many statesmany states

Reminder RecallReminder Recall

Reminders are post cards or autodialers that tell Reminders are post cards or autodialers that tell parents when itparents when it’’s time for the childs time for the child’’s next series s next series of immunizations.of immunizations.

Recalls are sent when a child is overdue for a Recalls are sent when a child is overdue for a series of immunizations.series of immunizations.

IIS at the state and local level or at the provider IIS at the state and local level or at the provider level are used to track each patient and to send level are used to track each patient and to send out reminders and recalls.out reminders and recalls.

• Many IIS can automatically generate reminders/recalls. The Many IIS can automatically generate reminders/recalls. The format varies by IIS.format varies by IIS.

– LettersLetters– Phone callsPhone calls– Mailing labelsMailing labels

Data QualityData Quality

High data quality is: accurate, timely, High data quality is: accurate, timely, meaningful, and complete meaningful, and complete

Data quality focuses on the data coming into IIS Data quality focuses on the data coming into IIS and more in-depth vaccine-specific checks and more in-depth vaccine-specific checks

Data quality assurance protocols are used to Data quality assurance protocols are used to verifying the reliability and effectiveness of data verifying the reliability and effectiveness of data

Maintaining data quality involves updating, Maintaining data quality involves updating, standardizing, and de-duplicating records to standardizing, and de-duplicating records to create a single view of the data, even if it is create a single view of the data, even if it is stored in multiple disparate systems.stored in multiple disparate systems.

• Important for clinical follow-up and outreach; Important for clinical follow-up and outreach; reminder-recall; and coverage assessments.reminder-recall; and coverage assessments.

• The process of identifying possible duplicates and The process of identifying possible duplicates and preventing additional duplicates from being added and preventing additional duplicates from being added and preventing two records, which truly are unique, from preventing two records, which truly are unique, from being merged into onebeing merged into one.

• IIS use mothers maiden name and mothers first name, IIS use mothers maiden name and mothers first name, along with address, gender, race, and others. along with address, gender, race, and others.

Patient level de-Patient level de-duplicationduplication

Moved or Gone Elsewhere (MOGE)Moved or Gone Elsewhere (MOGE)

Important in coverage assessments, Important in coverage assessments, reminder-recall, IIS data linkages. reminder-recall, IIS data linkages.

Inappropriate classification of MOGE Inappropriate classification of MOGE may result in an inflated or under-may result in an inflated or under-inflated coverage measures. inflated coverage measures.

AIRA-MOGE guidelines at: AIRA-MOGE guidelines at: www.immregistries.org

Vaccine Level De-Vaccine Level De-duplicationduplication

IIS receive immunization data (vaccination IIS receive immunization data (vaccination events) from many different sources.events) from many different sources.

The decisions made during vaccination level The decisions made during vaccination level de-duplication affect the forecasting of de-duplication affect the forecasting of vaccine administration.vaccine administration.

Complete and accurate information on the Complete and accurate information on the vaccination history of the patient is essential vaccination history of the patient is essential for providers for providers

Resource: Resource: www.immregistries.org/

Data ExchangeData Exchange

IIS have developed methods of IIS have developed methods of acquiring immunization data through acquiring immunization data through means other than direct data entry. means other than direct data entry.

Importing and exporting data from Importing and exporting data from another system to and from the IIS can another system to and from the IIS can be done through various methods such be done through various methods such as:as:– encrypted emailencrypted email– Secure ftpSecure ftp– httpshttps– HL7- standard required by CDC for all IISHL7- standard required by CDC for all IIS

IIS Data UseIIS Data Use

List of most commonly used IIS-List of most commonly used IIS-generated reportsgenerated reports

Reminder/recallReminder/recall Vaccine usageVaccine usage Coverage levelsCoverage levels Invalid dose, extra-immunizations, and age-Invalid dose, extra-immunizations, and age-

inappropriate vaccination reportsinappropriate vaccination reports Monthly Doses Administered Monthly Doses Administered Provider Profile Data ReportProvider Profile Data Report Profile Reports Profile Reports Monthly Biologics and Ending Inventory Reports Monthly Biologics and Ending Inventory Reports And many moreAnd many more

IIS data use by Immunization IIS data use by Immunization ProgramsPrograms

Assist in implementing immunization Assist in implementing immunization program action plans, measurables, and program action plans, measurables, and evaluation processes.evaluation processes.

Measure immunization coverage levels .Measure immunization coverage levels . Evaluate vaccine uptake and usage.Evaluate vaccine uptake and usage. Monitor Universal Hep B birth dose.Monitor Universal Hep B birth dose. Comprehensive Clinic Assessment Software Comprehensive Clinic Assessment Software

Application (CoCASA) tool.Application (CoCASA) tool.

– Disease Surveillance:Disease Surveillance:• Target pockets of need Target pockets of need • Compare incidences of infectionCompare incidences of infection

– Disease OutbreakDisease Outbreak• Evaluation Evaluation • Control measures Control measures

– Aid in natural or man-made disaster Aid in natural or man-made disaster

IIS Data use by other IIS Data use by other Health ProgramsHealth Programs

IIS Data Use by health-IIS Data Use by health-care Providerscare Providers

IIS can help providers to keep track of the vaccines IIS can help providers to keep track of the vaccines they provide to their patients they provide to their patients

Vaccine forecasting avoids over-and under-Vaccine forecasting avoids over-and under-immunizationimmunization

Creates lists of children who need vaccines so Creates lists of children who need vaccines so providers know who to call in to the office (vaccine providers know who to call in to the office (vaccine reminders)reminders)

Marks which children in the office practice need to Marks which children in the office practice need to come back in to the office during a vaccine recall, come back in to the office during a vaccine recall, vaccine shortage, or incorrectly stored vaccine.vaccine shortage, or incorrectly stored vaccine.

Examples of how IIS have been Examples of how IIS have been used in various capacitiesused in various capacities

• Pandemic Flu

• Natural Disasters- Katrina

IIS LinkagesIIS Linkages

Data use through LinkagesData use through Linkages Streamline required school immunization reportingStreamline required school immunization reporting Readily available official immunization record to Readily available official immunization record to

schools and parentsschools and parents Track administered vaccines to ensure proper Track administered vaccines to ensure proper

reimbursement for providersreimbursement for providers Integrate immunization data with other systems (e.g., Integrate immunization data with other systems (e.g.,

newborn and lead screening, WIC, office billing newborn and lead screening, WIC, office billing systems and electronic medical records) systems and electronic medical records)

Reduce or eliminate the need for health plan staff to Reduce or eliminate the need for health plan staff to conduct manual chart pulls to collect immunization conduct manual chart pulls to collect immunization data in physician officesdata in physician offices

Increase immunization data quality and completenessIncrease immunization data quality and completeness WIC and Immunization Programs share population WIC and Immunization Programs share population

basebase

IIS and Vaccine ManagementIIS and Vaccine Management

Monitor VFC vaccine usage and orderingMonitor VFC vaccine usage and ordering Control inventory/biologicsControl inventory/biologics Track specific vaccine dosesTrack specific vaccine doses Recall vaccine by lot number, manufacturer, antigenRecall vaccine by lot number, manufacturer, antigen Analyze doses administered and find children Analyze doses administered and find children

requiring immunization or re-administration of requiring immunization or re-administration of vaccinesvaccines

Other Types of Health Other Types of Health Information SystemsInformation Systems

Cancer registriesCancer registries Early hearing detectionEarly hearing detection Newborn metabolic screeningNewborn metabolic screening Childhood lead poisoning Childhood lead poisoning

Future of IISFuture of IIS

• Promote IIS data use Promote IIS data use

• Linkages with other health information systemsLinkages with other health information systems

• Independent objective analysis of IIS operationsIndependent objective analysis of IIS operations

• IIS accountability and performance measurementIIS accountability and performance measurement

• National Vaccine Advisory Committee functional National Vaccine Advisory Committee functional recommendations/standards of operation.recommendations/standards of operation.

• IIS Program evaluation IIS Program evaluation

Future of IISFuture of IIS

Additional ResourcesAdditional Resources

NCIRDNCIRD’’s IIS Websites IIS Website

Subscribe for E-mail Subscribe for E-mail Updates to IIS web site Updates to IIS web site

pagespages

Get Email Updates

Partner WebsitesPartner Websites

Key partner web sites:

AAP: www.aap.org AIM: www.immunizationmanagers.org AIRA: www.immregistries.org ECBT: www.ecbt.org PHII: www.phii.org

Expanded list on NCIRD’s IIS website at:http://www.cdc.gov/vaccines/programs/iis/default.htm

AcknowledgementsAcknowledgements

Julie Clark- AIRA/MichiganJulie Clark- AIRA/Michigan Elaine Lowery- Colorado Elaine Lowery- Colorado Emily Peterson- MinnesotaEmily Peterson- Minnesota Molly Sander- AIM/North DakotaMolly Sander- AIM/North Dakota Jennifer Zavolinsky- ECBTJennifer Zavolinsky- ECBT Dale Babcock- CDCDale Babcock- CDC Amanda Bryant- CDCAmanda Bryant- CDC Gayle Daniels- CDCGayle Daniels- CDC Susan Farrall- CDCSusan Farrall- CDC Lynne McIntyre- CDCLynne McIntyre- CDC Carl Phillip- CDCCarl Phillip- CDC Bobby Rasulnia- CDCBobby Rasulnia- CDC

Continuing Education Continuing Education CreditCredit

Continuing education credit is available Continuing education credit is available for this module only through the CDC for this module only through the CDC

ATSDR Training and Continuing Education ATSDR Training and Continuing Education online system at online system at

www2a.cdc.gov/TCEOnline www2a.cdc.gov/TCEOnline

Continuing Education Continuing Education CreditCredit

Verification Code: NT108FVerification Code: NT108F

IIS-related documentsIIS-related documents

You may also visit the following web page for You may also visit the following web page for access to all documents referenced in this access to all documents referenced in this

module at: module at: http://www.cdc.gov/vaccines/programs/iis/web-http://www.cdc.gov/vaccines/programs/iis/web-

resources.htmresources.htm