Michigan Care Improvement Registry (MCIR)

1. Child Health IntegrationBob Swanson, MPHDivision of ImmunizationMichigan Department of Community Health Michigan Care Improvement Registry (MCIR)

2. Michigan Care Improvement Registry • Web-based application • Populated with electronic birth records (within 2 weeks) • Operational with a regional approach • Majority of the funding from the Healthy Michigan Fund (tobacco tax) • First rolled out in 1998

3. MCIR Activity • 4.7 million records • Over 57 million shot records • 35,000 registered users • 2,334 provider sites submitted data in 2007

6. MCIR Regions Provider recruitment Provider training Help desk Advisory boards

7. MCIR Tools Assessment of patient immunization status at the time of the visit Reminder/Recall Letters Coverage Level Reports High Risk Influenza/Lead Pop-up Lead Results Clinical Record All Hazard Component

8. Schools and DaycaresUtilizing MCIR 4813 Schools 95% enrolled in MCIR 4235 Daycares 89% enrolled in MCIR

9. Reporting Adverse Events (in development) • Integrated VAERS form • Auto populates data • Transmission to CDC

10. MCIR Electronic Interface Activityin February 2008 270,000 immunizations reported from provider offices 860,000 updates from Medicaid with beneficiary information 200,000 WIC ID updates 10,800 Electronic Birth Records

11. MCIR Benefits High provider participation (>90%) Supports all programmatic functions of the Immunization program All Hazard tracking capabilities Population based system Reports to demonstrate “pocket of need” Flexibility to allow linkages with other public health systems Infrastructure setup with regional staffing model

12. Population Based Reporting • State Levels • County Levels • WIC Levels • MEDICAID Health Plan Levels • Clinic Site Levels • School District Levels • School Building Levels • Migrant Schools • Migrant Population

13. 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

15. Lead Data Results • Added a lead pop-up window • Medicaid enrolled • Mapped to HR zip code • 23% increase March – May of 2004 in lead testing as compared to 2003 data. • Increased provider participation

20. Benefits • High provider participation (90%) • Population based system • Reports to demonstrate “pocket of need” • Flexibility to allow linkages with other public health systems • Infrastructure setup with regional staffing model

21. Newborn Hearing

23. EPSDT

25. Newborn Screening

27. Michigan’s BMI Surveillance Efforts • On going discussions to add BMI to the MCIR

28. Emerging Synergies Surveillance

29. Lesson Learned • Health Plan Incentives • Mandated Reporting • Billing Data vs Medical Record • Regional Training and Support