# Presentation: 002430

## Building Regional Registries - a Progress Report from California 

**Ayesha E. Gill, California Department of Health Services Immunization Branch; Susan**
**    ****M. Salkowitz, Salkowitz Associates, LLC; Noam H. Arzt, HLN Consulting, LLC**** **

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

- _Author Contact Information - Phone; email_
- AEG: (510) 540-3452; agill1@dhs.ca.gov
- SMS: (215) 438-6352; salkowit@hln.com
- NHA: (856) 719-1590; arzt@hln.com

## Background

- California is a large and diverse state
- Total population : 34 million
- Number of live births / year: 530,000
- 58 counties; 92% urban; rural population spread over great distances
- A year ago the state made a transition from local immunization registries to regional registries.  This is the tale of the transition.

## Background: Standards & Planning

- California has used a standards based model for registry guidelines, software evaluation, and technical planning.
- Regions are using four mature and tested software products developed by CA registries. All are now web based.
- The state moved to regions based on patient and provider activity to achieve economy of scale.

## Biggest Challenges in Forming Regions

**Organizational strategy:** how to unite autonomous, diverse counties.
**Fiscal strategy: **how to receive funds, make fair fiscal decisions, and disperse funds.** **
**Regional communication & agreements: **thinking regionally; agreements among counties, with providers, patients & families.
**Technical strategy:** data migration, merging, testing; IT support, maintain old system while transitioning to new.

## Constraints

- No new money to form regions.
- State spreads same $3.5 million annual support among 7 new regions formed by counties.
- Regions are mixed: some counties with local registries; others inexperienced.
- Current systems and users must be maintained during transition.
-  Legislation allows new sharing partners; new agreements needed.

## Approaches to Organizational Strategy

- Counties meet regularly to establish regional infrastructure & agreements
- Agreements need approval of county supervisors.
- Hire consultant to work on regional charter
- Bay Area Regional Registry
- Establish region as a governmental agency
- Central Valley Immunization Information System
- Joint Powers of Agreement & Commissioners

## Approaches to Fiscal Strategy

- Agree on division of labor, and the money follows the responsibilities.
- State funds the region’s selected organizational lead county.
- Subcontracts allot money to jurisdictions
- State funds separate contracts for each jurisdiction within region.
- Select a fiscal agent for region.

## Handling Regional Agreements  

- Agreements among jurisdictions in region on regional structure
- Charters, Joint Powers of Agreement, Contracts
- Agreements with providers & other users on sharing data beyond county or city borders
- Agreements among jurisdictions to share data outside of borders
- Disclosure statements to patients & families

## Communicating As A Region

- Development of MOUs, outreach material, website, brochures & other communication
- Meshing regional and local infrastructure and communication
- Communicating with local jurisdiction decision makers to pave transition
- Helping providers through the transition

## Technical Approaches and Solutions

- Region selects host county to maintain regional database
- Support of host county IS Department is crucial
- HW/SW, security, testing, and training, etc.
- 3rd party user support
- Expand established software to new regional users (San Diego/Imperial, IEITS, NCRIDE)
- Install state-supported CCAIR software (BARR, CCIR, CVIIS, LACRIR, SFT)

## Technical Approaches and Solutions - 2

- Migrate records to regional database
- Merge records from jurisdictions in new regional database (CCIR)
- Maintain current providers during transition
- On local or stand-alone system & other software (Acclaim, Adios, etc.)
- Move from client/server to web-enablement

## What’s Next?  California’s Ongoing Plans

- The statewide semi-annual registry meeting was held April 2-3, 2001.
- All Stakeholders invited.
- Open discussion of regional plan and future directions
- Regional updates
- Coherent statewide deployment plan
- SIIS state hub & architecture approved
- RFP for implementation in process
- New funding opportunities: state & federal