# ![](media/image1.jpeg){width="0.9694444444444444in" height="1.0in"}Minnesota Sentinel Site Project Description

## *February 2005* 

The immunization registry sentinel site for Minnesota is the state's
oldest, most mature, and most awarded regional immunization
registry---the Southwest Minnesota Immunization Information Connection
(SW-MIIC). Currently comprising 29 mostly rural counties, SW-MIIC was an
All Kids Count (AKC) II site, and earned the highest award from AKC for
"Best Overall Achievement."

SW-MIIC has been Minnesota's *de facto* sentinel site for many years,
creatively using its data to monitor coverage, to identify practice
issues needing intervention, to support disease investigators, and even
to help a clinic decide if they should hire another pediatrician!
SW-MIIC---and the statewide MIIC application that it uses---meets most
if not all of the requirements of an Implementation Sentinel Site except
for population size. Because SW-MIIC covers a wide region in rural
Minnesota, and the population is not sufficient to be an Implementation
Sentinel Site, it was added as a Capacity Building Site.

**Summary of Minnesota's Eligibility for Being a Capacity Building
Site**

  --------------------------------- ------------------- -----------------
  **Eligibility Factor**            **Requirement**     **SW-MIIC**

  Children \<6 years of age         \>10,000            14,053\*

  Data processed within 30 days     ≥75%                90%

  Private and public participation  \>95%               96%

  Child participation for those \<6 \>95%               101%\*\*
  years                                                 

  Population-based                  Yes                 Yes
  --------------------------------- ------------------- -----------------

\* Includes only those children with shots in the registry

\*\* Includes births and in-migration

[Background on the SW-MIIC registry.]{.underline} One of the main
reasons AKC added SW-MIIC (then known as the Southwest Immunization
Information System or SIIS) to its family of AKCII sites was that they
recognized the importance of understanding immunization and immunization
registries in rural America. Like many areas of the country, rural
Minnesota features rapidly growing urban areas that function as economic
and social centers for otherwise dwindling rural and largely agrarian
areas. Health care has dramatically shifted from independent clinics to
large and scattered multi-site health systems that include hospitals and
clinics in extensive referral networks. The interest and investment in
clinical information systems has grown as these health systems have
expanded and grow more competitive.

These health systems provide care for families on both commercial and
Medicaid managed care plans. All the clinics in the study area are
enrolled VFC providers, and all but a few small practices participate in
SW-MIIC.

Despite changes in the health care environment, relationships with
public health---and particularly the registry---have remained strong
since IAP. A major reason for this is that SW-MIIC has always emphasized
using registry data for health care and public health decision-making.
Its uses of data include:

-   Routine tracking of coverage levels by county so public health
    directors can monitor progress toward the 2010 immunization goal.
    *This tracking highlighted how an interruption in reminder-recall
    for over a year led to rapid and alarming decreases in coverage
    levels.*

-   Highlighting to clinics how they compare to neighboring clinics on
    uptake of new vaccines or recommendations. Clinics that previously
    were slow to give hepatitis B or varicella vaccine quickly moved to
    universal use when made aware that neighboring clinics had already
    done so.

-   Using reminder-recall to continually improve the quality of registry
    data by using parent and clinic feedback about missing or erroneous
    data to add or correct registry data.

-   Using the registry to support disease investigators during
    outbreaks. Relying on registry data means investigators do not have
    to travel to clinics nor page through medical records to obtain
    immunization histories, thus actually protecting the confidentiality
    of medical data.

-   Using registry data for AFIX visits to clinics.

SW-MIIC created its own registry application in 1994, steadily growing
its functionality over time. It emphasized use of its data for
reminder-recall to patients, and used printed adhesive labels as a way
to readily and inexpensively get immunization histories and forecasts
into patient charts. Today, SW-MIIC, along with the other regional
registry services in Minnesota, has migrated to the statewide web-based
application named the Minnesota Immunization Information Connection
(MIIC). MIIC is hosted and operated by MDH and is a modified version of
the Wisconsin Immunization Registry application. The model for
registries in Minnesota is a decentralized one, with regional staff
recruiting, training, and supporting users, and MDH hosting the
statewide application and providing financial and technical support to
the regions.

All 87 local health departments participate in MIIC, with around 75% of
private providers enrolled statewide.

The Sentinel Site Project Coordinator is Karen White, M.P.H. Ms.White is
currently the database administrator for MIIC, and was one of the chief
architects of Minnesota's immunization assessment strategy at the
beginning of the IAP initiative in 1993-1994. She was also the Project
Director for Minnesota's NEDSS project

Karen White, MPH Sandy Macziewski

Sentinel Site Project Coordinator SW-MIIC Coordinator

\(612\) 676-5586 (320) 843-2325

<karen.white@state.mn.us> <smacziewski@countryside.co.swift.mn.us>

Emily Peterson-Stauffer

MIIC Project Director

\(612\) 676-5471

<emily.peterson-stauffer@state.mn.us>