Immunization Registry for NC NICU patients

1. Immunization Registry for NC NICU patients PQCNC Project Proposal Chip Walter-Mike Cotten

2. Outline • Introduction • Aims • Challenges • First steps • Future directions

3. Here’s a common story: Hi Marty, I've got a quick question for you about B/B O who was d/c'd from the NICU on 10/xx/07. He came into peds surg clinic today. Parents had a question about the immunization record. Dad seems to remember that the baby got Hep B vaccine on his last day in the NICU. However, it is not noted on the baby's immunization card or on any other piece of paper that I can locate. The parents said that the pediatrician was asking what, if any, vaccines the baby got while in the NICU. No one could tell him for sure if the baby actually got the shot. Do you know if he did or how I can find out if he did? Also, I don't think that the nurses regularly note on the immunization cards which vaccines the babies got while in NICU and then parents and pediatricians aren't sure. Do you think it would be possible for them to note this, at least on a piece of paper or in the d/c summary and give it to the parents to take to the pediatrician's on the first visit? (Maybe they do normally and I'm just out of the loop). Email from M McCaffrey 11/12/2007

4. Introduction • One national health objective for 2010 (Healthy People 2010) is to increase the proportion of children aged <6 years who participate in fully operational, population-based immunization registries to at least 95%; as of 2005, 56% of kids < 6 yrs old. MMWR 2005 ; 54(29):722-724

5. Introduction • Immunization registries: confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area • A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS) MMWR 2006 ;55(49):1327-1329

7. Introduction • North Carolina has a good rate of vaccinations (> 80%); can efficiency and effectiveness be improved for NICU patients? • North Carolina has a new (2005) on-line vaccination system: North Carolina Immunization Registry – NCIR http://www.immunizenc.com/NCIR.htm • Based on Wisconsin system ( >90% private practice participation; > 95% public) • NCIR will be NC's safety net in tracking childhood immunization rates and driving up coverage percentages for children by age two.

8. NCIR Mission and Goals • The North Carolina Immunization Registry (NCIR) is a comprehensive, high-quality, confidential, population-based system that offers numerous benefits to providers and parents. • NCIR is a clinical tool that assists immunization staff with vaccine recommendations by utilizing: • the age, history and contraindications for the patient, • the current Advisory Committee on Immunization Practices (ACIP) schedule. • NCIR is user-friendly and greatly streamlines the fulfillment of federal and state reporting requirements tied to the Universal Childhood Vaccine Distribution Program (UCVDP) by eliminating the manual paper-intensive accountability reports that providers must currently submit. http://www.immunizenc.com/NewImmRegistry.htm, accessed 11/12/2007

9. HIPAA Effect HIPAA and the Privacy Rule do not interfere with the NC state law that defines the reporting and sharing of immunization information. Slide from: 2005 NC state vaccination conference-NCIR intro: Ivers and Helton

10. NC Immunization Advisory Committee report 2007 Organizations and participation by type in NCIR goal is 75% overall by end of 2008.

11. Specific Aims for PQCNC Immunization Project • Assess in hospital compliance with delivery of vaccines to high risk NICU infants vs. ACIP recommendations • Assess effect of inclusion in NCIR on post-discharge vaccination compliance

12. Immediate Challenges • Identify obstacles to hospital participation in NCIR • Identify possible financial advantages for hospitals to participate (break on vaccine costs? Where do hospitals get vaccines? ) • Add the “upload info” job to someone’s job description; (We’ve done this for newborn screening)

13. Immediate actions • Survey hospitals/NICUs for current status • Look for precedence in other states (Wisconsin?) • Link PQCNC with NCIR and NC Immunization Advisory Committee • NCIR to develop “NICU report” for us to follow progress

14. Future directions • Assess in hospital vaccination compliance with post-discharge health outcomes. • Link parental or hospital employee flu vaccines/ post-discharge hospitalizations among ELBW survivors

15. Why this project? • Valuable collaboration between NC Neonatology providers and a statewide healthcare initiative that has momentum and resources • Likely to improve measured NC health quality, if not actual outcomes, for NC NICU newborns • No need to develop the guidelines for best practice: ACIP guidelines generally acceptable (????) • Opportunity to develop most efficient practices for NICU led hospital collaboration with NC health agency.

16. State Neonatology ConferenceDialogues in Neonatal-Perinatal Medicine • Sunday April 20th – Tuesday April 22nd • Washington-Duke Inn • State sessions start Sunday night dinner//speaker • Monday morning • Business meeting PQCNC update; newborn screening update • Fellow-faculty presentations • Dialogues: case-based review of extremely preterm infant delivery room – discharge • Jobe • Seri • Phelps • Heller • Marlow • Wilson-Costello • Ohls

17. Thanks…. • Marty McCaffrey • Chip Walter • Parents and colleagues • Duke (for supporting VON membership and full participation in PQCNC)