Registry support of immunization program activities
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Registry Support of Immunization Program Activities. Lance Rodewald, M.D. Director Immunization Services Division, NIP/CDC Bill Brand, M.P.H. Vice-President, American Immunization Registry Association. Population Assessment Consumer Information Program Management

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Registry Support of Immunization Program Activities

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Registry support of immunization program activities

Registry Support of Immunization ProgramActivities

Lance 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

Immunization Grantee Requirements

Implement required and locally-identified

activities in eight core areas:


Nip cdc support

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

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.


Current situation

Current Situation

  • Immunizationregistries 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.


Potential benefits of new standards

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

Registry Support for an Immunization Program –

The PROW Project


Purpose of 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

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

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.


Registry support of immunization program activities

Registry Support of Core Program Components

Vaccine Management

Provider QA

Registries

Surveillance

Assessment

Consumer Information

Service Delivery


Prow standards of excellence

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 excellence1

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

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 management1

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 management2

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

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 assurance1

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.


Use of an immunization registry to track hepatitis b immunization

Use of an Immunization Registry to Track Hepatitis B Immunization

Hep B given 0-56 days after birth

Thimerosal

700

and Hep B

Hep B given 0-5 days after birth

600

500

T-free widely

400

available—VFC

Number of Children

300

T-free available

in Hospitals

200

100

0

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

1999

2000

Week

Source: Immunization ALERT (Oct 2000)

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


Provider quality assurance2

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 assurance3

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

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

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

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

For more information…

www.immregistries.org

or

Bill Brand

Minnesota Department of Health

[email protected]


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