What to do before you have a Registry?: Provider Preparation

1. What to do before you have a Registry?: Provider Preparation Presentation to 2002 National Immunization Registry Conference October 28-30, 2002 Philadelphia PA

2. NCIR History • 1995-1996: North Carolina Immunization Registry (NCIR) introduced to Local HDs • a component of Health Services Info (Mainframe) System (HSIS) • main functionality to fulfill vaccine accountability

3. NCIR History - 2 • 1996-1998: Efforts to bring full functionality to NCIR and to make it available to private providers • Key Functionality Still Missing: • No Private Providers • No Automated Recommendations • No Reminder/Recall

4. NCIR History - 3 • 1999-2002: Focus shifts to replacing NCIR with new system • Key Criteria in Selection of New System • Meet all of CDC Minimum Functional Standards • System Proven to Work • System is Web-based

5. While moving towards a Web-Based system . . . • Private Provider Accountability • Assessment Program • Registry Demonstration Project • Readiness Steps

6. Private Provider Accountability • Vaccines Administered Log • Accountability for state supplied vaccine • Page totals entered into VACMAN doses administered • Birth date, Service date, Eligibility entered into annual benchmark tool • Copy to Local HD to enter historical doses on own patients

8. Private Provider Accountability • Vaccines Administered Log (VAL) • Patient Specific vaccine accountability form • Name • Birth date • Eligibility/Insurance • Service date • Vaccine type and dose number in series • Notes section • Record privately purchased vaccine • Document lot #, manufacturer, expiration date of vaccine • Vaccine Information Statement (VIS) • Chart number • Other important or identifying information

9. Private Provider Accountability - 2 • Provider Specific Feedback Reports • Number of vaccine doses unaccounted for • Percent of total vaccine shipped that is not accounted for • Dollar amount of unaccounted for vaccine $$$

10. Success of Provider Preparation Steps -(in terms of registry preparation) • Log forms and accountability feedback reports • In use for over 3 years • Approximately 1,100 providers report monthly • Improvements in Vaccine Accountability • Tedious task endears providers to the concept of new registry

11. Assessments in Public and Private Sector • Public Sector Assessment • Health Departments actively using CASA • Track the widest possible cohort of children • Coordination with private providers • Private Sector Assessment - AFIX • Feedback and Exchange of information • Introduction to CASA • Promotion of the PAiRS Project

12. Success of Provider Preparation Steps (in terms of registry preparation) • Assessments • Statewide “compliance” rate increased by 10% in 3 years • Most counties track over 80% of birth cohort • Local Health Departments have begun to place more emphasis on “Public Health Assurance Role”

13. PAiRS - Provider Access to Immunization Records Securely • Periodic reload of immunization records from state registry and 2 managed care plans into a common database • Built with in kind contributions from partnerships with the private sector • Widely accessible, inexpensive and secure inquiry only access to immunization records via Internet • Reliably identifies relevant records for an individual in the absence of a unique identifier

14. PAiRS - Provider Access to Immunization Records Securely • Identify local early adopters and prepare them for registry implementation • Begin to demonstrate value of registry to stakeholders - project visibility

17. Success of Provider Preparation Steps -(in terms of registry preparation) • PAiRS Project - • 666 Users in 152 sites as of 10/2002 • Users in both public and private sector accustomed to patient matching features and internet use for looking up immunization records • Private Providers have an understanding of the breadth of information that will initially populate the new registry

18. “Registry Readiness” • Promote collaboration between public and private sector • Introduce the concepts of Change of Process and Behaviors • Realize importance of clinical correctness of existing data • Promote the registry as an approaching reality - (finally) • Minimize implementation time

19. Local Health Department Registry Readiness Tool • Identify training needs of all staff who will work with the new registry • Contact person works with state Immunization Branch to discuss potential problems, seek out technical support for increased readiness • Identify how immunization delivery systems will change when the new registry is introduced

20. Success of Provider Preparation Steps -(in terms of registry preparation) • Registry Readiness • Presentations made to regional meetings of local health department staff groups • Presentations made to local health departments and private providers • Central office team working on the process • ~300 Records “cleaned up” in the existing system since 7/2002

21. Additional “Preparation” Measures • Computer Capacities Survey administered at all VFC site visits • Question areas include: registry interest, current office computer systems, staff experience using computers • Over 1000 survey responses since 1998

22. The End! Contact: Kelly.Saldana@ncmail.net 919-715-2707