# Presentation: 134787

## Integrating Systems: The Challenges of Developing a Master Child Index to Integrate the NYC Immunization and LeadQuest Registries 

**Robert Brackbill**
**Deborah Walker**
**Amy Metroka**
**Paul Schaeffer**
**Alex Ternier**
**Nicolas Gaglioti**
**John Somma **
**Carla Rodriguez**
**Noam Arzt (HLN Consulting, LLC)**
-  New York City Department of Health
-  e-mail : rbrackbi@health.nyc.gov

***35******th****** National Immunization Conference**** *
*May 29 - June 1, 2001*
*Atlanta, GA*

## Objectives of Talk

- To describe the data processing issues related to child health registries
- To provide conceptual basis for integrating two child health registries
- To give an overview of challenges faced by project developers and how they were overcome

## Size and scope of City Immunization Registry (CIR)

- Mandated by Amendment to NYC Health Code on January 1, 1997; required to have immunizations reported for children up to 7 years old
- Contains demographics and immunizations of children up to 18 years of age
- 91% of private providers are currently reporting
- Contains nearly 2 million children with over  11.6 million immunization events

## Size and scope of LeadQuest (Lead Poisoning Registry)

- Originated in 1982
- Contains demographic data, blood lead test results, and follow-up of children up to 18 years of age
- 60 laboratories report blood lead tests for NYC residents; 49 report electronically
- Contains approximately 3.9 million blood tests from 1.7 million children
- Contains 21,800 cases with elevated blood lead levels
- Approximately 49% of NYC children (6 months - < 6 years) were tested in 2000

## Data Base Issues of CIR

- Matching and de-duplication of records
- Having consistent and standardized address information
- Finding answers to analytic questions
- Reducing back-end processing

## Data Base Issues of LeadQuest

- Improving information on children without high test results
- Having access to better provider data
- Finding answers to analytic questions

## Commonalities of Two Registries

- Each registry covers all children in NYC
- Each registry matches new information with existing records
- Each registry seeks being able to provide complete child specific information

## Other Considerations

- Increasing accuracy of registry matching processing
- Creating system links for knowing as much as possible about individual children
- Obtaining the capacity to guide comprehensive prevention and intervention programs

## Concept of Master Child Index (MCI)

- Create a core demographic data base into which demographic data on each child would be loaded from participating registries
- Provide front end registry matching for new immunizations and lead test data
- Generate a common ID linking participating data systems

## Basic Development Steps in Creating MCI

- Select data elements required by MCI
- Design logical relational database
- “Training” and “testing” of matching algorithm (program) MEDD (Maximum Entropy De-duplication
- Formulate business rules governing the loading/translation of data from registries to MCI
- Initial data-load (order of loading is important) from CIR, LQ, and vital records
- Build application primary interfaces (API’s) between components in system

## Basic Development Steps in Creating MCI

- Build communication services for linking components of system including MCI, LQ, CIR, MEDD and geocoding service
- Design and develop MCI administration and query tools
- Synchronize all the databases and generate MCI ID for linking two registries

## Steps 1 and 2 – Select Data 

**Steps 1 and 2 – Select Data **
**Elements and Design Logical **
**Relational Database**

**Master Child**
**Index (MCI)**

**Entity**** ****Diagram**

**Child ID**

**Table structure**

**Address**

**Birth**
**Date**

## Step 3 – Training And Testing of MEDD

**SEARCHING **
**AND BLOCKING**

**MEDD**

**Manual **
**Review**

**CIR/LQ**

## Steps 4 and 5 - Initial Loading and Translation of Data From Registries to MCI and MEDD

**Steps 4 and 5 - Initial Loading and Translation of Data From Registries to MCI and MEDD**

**MCI**

**Error File**

**MCI**
** ****Services**

**Vital Records**

**Geo-coding**
**(City Planning)**

**MEDD**

**CIR**

**Load **
**using **
**Business **
**Rules**

**LQ**

**Error File**

## Steps 6 and 7 – Build APIs and Communication Services

**Steps 6 and 7 – Build APIs and Communication Services**

**MCI Services**
**(NT)**
** **

**CIR Database **
**Server (UNIX)**

**LQ Client**

**LQ **
**Database **
**Server (NT)**

**CIR Clients**
**[Power builder**
**Provider client**
**Batch processing]**

**MCI Client**

**Geo-coding**

**MEDD**

**MCI **
**Database**
**(Oracle)**

**MCI Database **
**Server **
**(Unix)**

**CIR **
**Database**
** ****(Oracle)**

**LQ **
**(Microsoft **
**SQL)**

## Steps 6 and 7 (Continued) – Build APIs and Communication Services

**MCI **
**Database**
**(Oracle)**

**Communication Service (CORBA)**

**CIR **
**Powerbuilder **
**Application**
**Provider Client**
**Batch processing**

**MCI **
**Visual Basic **
**Application**

**LQ**
**Powerbuilder **
**Application**

## Organizational Challenges		

- Working with multi-vendors and DOH programs
- Coordinating feedback from DOH programs with building of data system
- Maintaining momentum on project and avoiding de-synchronized development steps
- Making decisions on communication technology with insufficient information

## Technological Challenges

- CIR and LQ registries contain different data elements
- CIR and LQ registries apply different processes to registry matching/updating records
- Conflicting CDC standards
- Lack of over-arching DOH technical architecture
- CIR resides on a UNIX system and LQ on NT platform

## Meeting These Challenges

- Bi weekly DOH and vendor meetings and weekly DOH management meetings
- Formal, detailed requirements and specifications documents
- Separate workgroup meetings
- Providing vendors explicit criteria for each deliverable
- Achieving consensus from all parties on major decisions
- Maintaining a focus on the conceptual goals of the project

## Conclusions

- Developing strategies to overcome organizational and technological challenges is central to project management
- Maintaining consistent leadership encourages programmatic buy-in
- Fact finding and consensus building maximizes ownership by separate program areas