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The Michigan Care Improvement Registry (MCIR). Kyle Enger, MPH engerk@michigan.gov March 2009. MCIR’s reason for being. 1. Improve immunization practice Clinicians can access complete child immunization records Automatic assessment of children Remind families that they need immunizations

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the michigan care improvement registry mcir

The Michigan Care Improvement Registry (MCIR)

Kyle Enger, MPH

engerk@michigan.gov

March 2009

mcir s reason for being
MCIR’s reason for being

1. Improve immunization practice

  • Clinicians can access complete child immunization records
  • Automatic assessment of children
  • Remind families that they need immunizations
  • Account for immunizations given
  • Clinicians & LHDs save time and $$$
  • More people get immunized

2. Provide information for public health & research

  • Basic assessments
  • Advanced analysis
data source mcir michigan care improvement registry
Data source: MCIR(Michigan Care Improvement Registry)
  • Operational since 1998 (but has older data)
  • Web-based application
  • Birth-to-death immunization registry
    • < 20 y age restriction removed June 2006
  • ~95% of providers participate
    • Mostly pediatricians & family practice
  • Good coverage nearly everywhere
    • Detroit, Oakland, and Wayne are improving
    • Some border counties have lower coverage
mcir regions
Many MCIR functions are handled at the regional level:

Provider recruitment

Provider training

LHD data requests

Bug reporting

Help desk

Advisory boards

MCIR Regions
mcir activity
MCIR activity
  • 4.7 million person records (MI pop: 10 million)
  • Over 57 million immunizations recorded
  • 13,000 user logins to MCIR every day
  • 2,334 provider sites submitted data in 2007
  • 50% of all MDCH web traffic
  • Over 35,000 registered users
mcir is currently linked with
MCIR is currently linked with:
  • Vital Records
  • Childhood Lead Poisoning Prevention Program
  • WIC
  • Medicaid
  • Department of Education
collection of immunization data
Collection of Immunization Data
  • Direct data entry into MCIR, via web interface
    • Health care providers
    • Local health depts.
    • Schools, daycares
  • Transfer from electronic medical records
  • Transfer from billing systems
  • Paper scan forms
slide11

Current Immunization Profile for 19 - 35 Month Old Children

Based on MCIR Data

Keweenaw

Keweenaw

Houghton

Houghton

Otonagon

Otonagon

Baraga

Baraga

Luce

Luce

Gogebic

Marquette

Gogebic

Marquette

Alger

Chippewa

Alger

Chippewa

Schoolcraft

Schoolcraft

Iron

Iron

Mackinac

Mackinac

Dickinson

Dickinson

Delta

Delta

Cheboygan

Cheboygan

Emmet

Emmet

Menominee

Menominee

Presque Isle

Presque Isle

Charlevoix

Charlevoix

Alpena

Montmorency

Montmorency

Otsego

Antrim

Otsego

0 - 29%

Antrim

Alpena

Leelanau

Leelanau

Grand

Crawford

Grand

Crawford

Oscoda

Alcona

Benzie

Kalkaska

Kalkaska

Oscoda

Alcona

Traverse

Benzie

Traverse

Manistee

Wexford

Missaukee

Iosco

Roscommon

Manistee

Wexford

Missaukee

Roscommon

Ogemaw

Iosco

30 - 49%

Ogemaw

Arenac

Arenac

Gladwin

Gladwin

Mason

Lake

Osceola

Clare

Mason

Lake

Osceola

Clare

Huron

Huron

Midland

Oceana

Newaygo

Mecosta

Isabella

Midland

Bay

50 - 59%

Oceana

Newaygo

Mecosta

Isabella

Bay

Tuscola

Sanilac

Tuscola

Sanilac

Montcalm

Gratiot

Saginaw

Muskegon

Montcalm

Gratiot

Saginaw

Muskegon

Lapeer

Kent

Lapeer

Kent

Genesee

60 - 69%

St. Clair

Genesee

Ottawa

Ionia

Clinton

Shiawassee

St. Clair

Ottawa

Ionia

Clinton

Shiawassee

Macomb

Macomb

Allegan

Barry

Eaton

Ingham

Livingston

Oakland

Allegan

Barry

Eaton

Ingham

Livingston

Oakland

70 - 79%

Van

Buren

Calhoun

Jackson

Washtenaw

Wayne

Detroit

Kalamazoo

Detroit

Kalamazoo

Calhoun

Jackson

Washtenaw

Wayne

Van

Buren

Monroe

Berrien

Lenawee

Cass

St. Joseph

Branch

Hillsdale

Monroe

Berrien

Lenawee

Cass

St. Joseph

Branch

Hillsdale

80 - 89%

August 2008

January 2001

4:3:1:3:3:1

90 - 100%

4:3:1:3:3:0

examples of data in mcir
Birth date

County of residence

Patient address

Gender

Name (parent & patient)

Characteristics of health care provider

School district

Vaccine type

Date vaccine given

Vaccine funding source

Which health care provider gave the vaccine

Vaccines waived

Overall immunization status

Examples of data in MCIR
ways to access mcir data
Ways to access MCIR data
  • Immediately:
    • Publicly available data (mcir.org/mcirdata.html)
  • Fairly quick:
    • Request deidentified or HIPAA-limited dataset
      • potterr1@michigan.gov, engerk@michigan.gov
      • Might require IRB approval or data use agreement
  • MDCH IRB & data use agreement required:
    • Request identifiable data from MDCH
    • Direct access to data
      • MDCH data warehouse (contains most important fields)
      • Oracle database (contains everything)
mcir org mcirdata html
Mcir.org/mcirdata.html

You can access MCIR data resources online via this webpage (mcir.org/mcirdata.html).

Some resources require Michigan Health Alert Network (HAN) access. They can also be provided upon request.

mcir research policy
MCIR research policy
  • Please inform MCIR about any research you do, even if it only uses deidentified data
  • Immunization providers have broad access to MCIR data via its web interface
    • This is for patient care purposes ONLY
    • It DOES NOT allow research using MCIR data
    • Seek MDCH IRB approval & data use agreement
  • MCIR may decline requests for data
    • Limited resources: 1 FTE assigned to MCIR research
  • No formal research policy document exists (yet)
mcir data are good not perfect
MCIR data are good, NOT perfect
  • MCIR only contains what people report
    • Not all clinicians participate (completely)
  • MCIR only contains MI info (exceptions exist)
    • Border counties tend to have lower coverage
  • Adolescent and adult data are incomplete
    • Data on 20+ year olds allowed in June 2006
    • Clinicians still getting used to using MCIR for adults
  • MCIR isn’t notified when people leave MI
    • These people look incomplete to us, and inflate denominators
      • 25% more 11-18 year olds in MCIR than US census estimates
  • Data are sometimes wrong
    • Duplicate records, typos, omissions, mistakes, etc.
mcir research collaborations
MCIR research collaborations
  • Research on reminder/recall methods
    • Kevin Dombkowski, UM Pediatrics
  • UM epi student intern projects
    • Andrea Weston, hepatitis A uptake in 1 year olds
    • Erin Rees, characteristics of LHDs assoc. with iz. coverage
  • Numerous projects with CDC
    • Uptake of influenza, Tdap, & MCV4
    • PCV7 & Hib shortages, etc.
  • Association of waiver clusters with pertussis clusters
    • Saad Omer, Johns Hopkins
  • NIS-Registry study (National Immunization Survey)
    • Use MCIR data to check reliability of NIS results
  • HPV4 uptake (brand-new collaboration)
    • Divya Patel, UM Ob. & Gyn.
questions

Questions?

Kyle Enger

engerk@michigan.gov

http://mcir.org