Plenary #2 -- Grow

1. Plenary #2 -- Grow Promoting Registry Growth through Programmatic Collaboration and Data Quality Improvement Initiatives 4th Annual National Immunization Program Immunization Registry Conference Atlanta, GA Thomas M. Moss State of Georgia Immunization Registry Manager

2. PROW – Effort to Implement • LEVEL I • Relatively easy to implement • LEVEL II • Moderately advanced to implement • LEVEL III • Challenging or resource-intensive to implement

3. PROW – Plan to Meet • FULLY • Has fully implemented or exceeded • PARTIALLY • In the process of being implemented or partially implemented • COULD • Could be implemented within the next 2 years with moderate resource investment, policy chagnes, or application enhancements • CANNOT • Cannot be considered at this time or would take a prohibitive amount of resources • NO PLAN TO • Not a priority or no plans to implement in the future

4. Vaccine Management • Principle • Immunization registries provide users with information and functions that support proper storage and handling of vaccines, and can internally support management of the VFC program. • IPOM Activity Areas • Vaccine Ordering, Distribution, and Storage Systems • Vaccine Accountability (Provider Level)

5. Vaccine Management • Level I Standards - FULLY • GRITS implements from its main page a series of URL Links to various sites providing ordering, distribution and storage information • GRITS implements from its main page an announcement section that provides us the capability to post storage and handling procedure tips • As part of the registry and immunization program training, this information is provided

6. Vaccine Management • Level II Standards - FULLY • GRITS inventory management includes the capability to adjust doses due to wastage, transfer, error, etc • GRITS displays on its main page any lots that are due to expire within the next 10 days • GRITS captures VFC eligibility status and reporting information • GRITS contains a link to the VFC Home Page for registration • GRITS offers communications with providers for alert/broadcast messaging • Vaccine Accountability Activities • Vaccine Usage, Doses Administered by Eligibility Reports

7. Vaccine Management • Level III Standards - PARTIAL • VFC Providers are able to report lost doses directly from the registry • GRITS providers as part of the Reminder/Recall functionality to call-back clients deferred due to vaccine shortages • GRITS contains a link to the VFC Home Page for registration and surveys • GRITS as no plans at this time to automatically order supports via VACMAN

8. Provider Quality Assurance • Principle • By enabling access to complete immunizations records, immunization registries support providers in delivering age-appropriate and timely immunizations, and in reducing both under- and over-immunization. • IPOM Activity Areas • Provider education • Provider Site Visits • Perinatal Hepatitis B Prevention

9. Provider Quality Assurance • Level I Standards - PARTIALLY • GRITS data is used as part of CASA / AFIX visits • GRITS is used to identify clinic-specific practice issues for training • GRITS provides an announcements section during login • GRITS provides link to VIS and other information • GRITS has no plans at this time to send recall notices to providers for patients who are behind in their shots.

10. Provider Quality Assurance • Level II Standards - PARTIAL • GRITS is used to monitor provider trends • GRITS is used to send reminder notices to parents/patients when vaccines are due • GRITS ACIP Wizard incorporates the 4-day grace period as well a highlight invalid shots • GRITS data is used to prioritize AFIX/VFC visits • GRITS currently receives immunization shot information from birthing hospitals to capture HBV, HBIG information given at birth • GRITS currently tracks the most resent version of the VIS documents, but does not track older versions. There is no plan to implement this enhancement at this time.

11. Provider Quality Assurance • Level III Standards - FULLY • GRITS is able to display the reason for an invalid dose • GRITS is able to run clinic-specific VFC reports • GRITS received HBV and HBIG data fields via the EBC system during Vital Records uploads • The Immunization program works with long-term care facilities to track influenza and pneumococcal coverage levels

12. Service Delivery • Principle • Immunization Registries are an effective tool for identifying and reaching under-served populations, and for supporting the delivery of immunizations in a child’s medical home. • IPOM Activity Areas • Underserved Populations • Medical Home Promotion

13. Service Delivery • Level I Standards - FULLY • WIC has been established with access to the immunization information available in GRITS • In 2004 School and Daycare facilities will be allowed to access the information in GRITS • GRITS generates coverage reports for public immunization clinics to identify pockets of under-immunization • GRITS is being used to identify high-volume immunization providers that are not part of the VFC program

14. Service Delivery • Level II Standards - PARTIAL • GRITS is used to identify immunization-delayed individuals for outreach • GRITS is used to identify children without a medical home • GRITS provides remind notices on vaccines coming due by provider organization

15. Service Delivery • Level III Standards – PARTIAL • As part of the Immunization Program audits of child care facilities, rosters are used to identify children not up to date. • GRITS provides individual immunization reports to WIC based on a list of names supplied. • The Immunization Program plans to use GRITS to team with long term care facilities once the age limitation is remove from the registry.

16. Consumer Information • Principle • Immunization Registries are a source of credible immunization information and official immunization records. • IPOM Activity Areas • Information Development and Dissemination • Vaccine Benefit and Risk Communications

17. Customer Information • Level I Standards - FULLY • GRITS is the official source of the State of Georgia Immunization Program for generating immunization records for consumer use • GRITS notification and promotional materials include immunization information

18. Consumer Information • Level II Standards - FULLY • GRITS Main page contacts links to the Vaccine Information Statements and CDC Question/Answer sheets

19. Consumer Information • Level III Standards – COULD • GRITS could be enhanced to send parents or guardians electronic reminder notices with the appropriated VIS documents. • By using the State of Georgia Portal Environment, direct access to GRITS could be provided for school and other enrollment purposes • GRITS could be enhanced to send consumer alerts to inform the public of important events, outbreaks, etc

20. Surveillance • Principle • Immunization Registries support the reporting and investigation of Vaccine-Preventable Diseases. • IPOM Activity Areas • Disease Surveillance and Response • VPD Reporting • Perinatal Hepatitis B Screening • Vaccine Safety

21. Surveillance • Level I Standards - FULLY • GRITS is available to provide immunization histories to disease investigators • Disease investigators can be enabled to add immunization histories to the registry

22. Surveillance • Level II Standards - PARTIAL • GRITS currently tracks limited adverse events for the purpose of contraindicating vaccines to individuals • GRITS tracks the provider and date that each shot was given • GRITS provides a link to the CDC VAERS application • There is no plan to provide links from the registry to the NEDSS application

23. Surveillance • Level III Standards – COULD • Currently the registry team is working with the developers of the 5 different Clinical Information Systems used by the 159 counties Public Health Clinics to identify and build portals through which information can be shared. • Currently the registry team is working with vendors such as JMJ, MiSys, IDX, and others to identify and build portals through which information can be shared.

24. Assessment • Principle • Immunization Registries are a primary source of accurate assessment data on children. • IPOM Activity Areas • General Population Assessments • Special Population Assessments

25. Assessment • Level I Standards - FULLY • GRITS will be used to provide immunization information to the schools to validate the reports that schools must submit as part of the state school immunization law • GRITS data will be used to generate coverage and exemption rates for childcare facilities • GRITS data will be used to conduct, supplement, and/or verify population coverage and exemption rates • GRITS creates an CASA extract to identify geographic pockets of under-immunization

26. Assessment • Level II Standards - PARTIAL • GRITS will be used to assess coverage levels among WIC participants • GRITS data is available to medicaid and HMO organizations. We currently have a working relationship with Kaiser Permenente, and Children’s Healthcare of Atlanta • GRITS is limited to children under the age of 18, adult immunization assessment is not possible through GRITS • There is not plan to use GRITS to track vaccines given for occupational reason

27. Assessment • Level III Standards – NO PLAN • There is no plan to provide Geographic Information System capability to GRITS • GRITS has the capability to assess Hepatitis B coverage at STD, HIV, correctional, and other high-risk settings. We are currently working with the Department of Juvenile Justice • GRITS has the capability to assess Hepatitis B coverage information among various races.

28. Thank You for your time.