# Presentation: 666873

## Child Health Information Integration

- Marilyn A. Kacica, M.D.,M.P.H.
- Medical Director
- Division of Family Health
- New York State Department of Health
- April 3, 2008

## Objectives

- Maternal and Child Health Data Systems
- Users
- Barriers
- Planning
- Statewide Health Information Technology
- NYSIIS

## Vision for Child Health Information Integration (CHI2)

**Physician with         Patient**
- Immunizations
- Lead
- Newborn screening
- WIC services
- Pharmacy history
- Early intervention program services
- Pharmacy utilization
- EmedNY HIE
- CDC HIE
- Etc.

**PH Researcher**
- Conduct studies to create generalizable knowledge
**Patients/Families**
- Assurance of complete medical history
- Maximize care
- Minimize unnecessary or dangerous care

**PH Program Manager**
- Follow up kids with conditions of public health interest (lead)
- Quality monitoring
- Monitor population health
**PH Administrator**
- Program monitoring and administration
- Reimbursement

## MCH Data Systems

- Statewide Perinatal Data System Electronic Birth Certificate with QI variables
- Neonatal Intensive Care Unit Module
- Lead Registry
- Family Planning Program Clinic Visit Record
- Early Intervention
- Newborn Blood Spot Screening
- Newborn Hearing Screening (future)
- Congenital Malformation Registry

## Foundation for Integrated Child Health Information Systems

- Statewide secure network
- Simultaneous development of a number of child health information systems
- Development work on a prototype Integrated Child Health Information System (ICHIS)
- Looking to the future to link with expanding Electronic Health Records (EHR) systems / standards

## Slide 6

## Overall ICHIS Goal	

**Serve as a single, primary source of child health data and information**

## Possible questions to answer using ICHIS

- Can we identify main health outcomes and possible link to potential risk factors?
- Are health outcomes of children improving?
- Can we assess quality and access to	care?
- Can we create a community level child health report card?

## Barriers to CHIS Development:Silo History, Perspective, Funding

- Separate legal authorization, funding, confidentiality rules
- Insular program function and community
- Isolated data, data definitions, vocabularies, access roles

- Program Function B

- Program Function A

- Program Function C

- Program Function D

- Users

- Access Rules

- Applications

- Data and Vocabulary

## Barriers to Integrating Data

- Communication – Communication – Communication
- Lack of standardization for data elements
- Sustained resources including personnel
- Focusing data collection on program activities
- Different access rules for different data
- Varying consent and confidentiality provisions
- Other statutory and regulatory restrictions

## CHI2 Scope Implications for DOH Planning

- Development of an integrated environment within DOH that fosters the creation of application and infrastructure standards following federal and state guidelines
- Formalized project management approach utilizing project sponsors, establishment of an advisory executive team, identification and involvement of stakeholders through the use of functional teams teams
- Importance of good communication in an integrated environment for planning and efficiency

## Bi-directional informational flow
Leverage existing infrastructure, utilize existing national standards and provide for the privacy and data security of participants as required.
Design should start small and grow – phased approach
Flexibility with integration of applications and the ability to change frequently utilizing middleware approach – mapping / translator software product
Scalable and extensible to other key NYS projects of interest: Regional Health Information Exchange (aka RHIOs), Electronic Health Record (EHR)

- Leverage existing infrastructure, utilize existing national standards and provide for the privacy and data security of participants as required.
- Design should start small and grow – phased approach
- Flexibility with integration of applications and the ability to change frequently utilizing middleware approach – mapping / translator software product
- Scalable and extensible to other key NYS projects of interest: Regional Health Information Exchange (aka RHIOs), Electronic Health Record (EHR)

- CHI2 Scope Implications for DOH Planning (Cont’d)

## Slide 13

## The SHIN-NY

**Physicians         **
**     ****Offices and**** ****Clinics**

**Hospitals and IDNs**

**Pharmacies and PBMs**

**Diagnostic Centers**

**Patients**
**(PHR)**

**Managed**** ****Care**

- NYS DOH

- SHIN-NY**

- Other RHIOs*

**SHIN-NY**

- Medicaid

- Public Health

- CDC

- HEAL V
- Category I

- **RHIOs = Policy
- *SHIN-NY = Technology

**Notes:**
The “Connected Community” Concept 

## CHI2  

- Additional Information
- Dr. Marilyn Kacica  	518-473-9883
- _[mak12@health.state.ny.us](mailto:mak12@health.state.ny.us)_
- Robert Fletcher		518-473-4261
- rbf01@health.state.ny.us

## New York State Immunization Information System (NYSIIS)

**Presentation to **
**American Health Information Community **
**(AHIC) **
**April 3, 2008**

## What is NYSIIS?

**NYSIIS is the New York State Immunization Information System.**
- A confidential, web-based data system designed to collect and consolidate vaccination information from health care providers located in New York State, outside of New York City. (New York City has their own registry - mandatory since 1997).
- Voluntary participation by providers since 1994 in regional registries - HealthyShot and IRIS.  Consent to participate was required.
- Legislatively mandated provider participation as of January 1, 2008 for immunizations given to children less than 19 years of age (including immunization history).  No opt-out provision.
- Lifespan system (with consent, once aged 19 years or older).

## NYSIIS Web-based Application

- EDS awarded contract in 2006 to modify Wisconsin Immunization Registry (WIR) for NYS needs.
- The Wisconsin application is in use in 12 other projects of which EDS is supporting 7.
- User access to NYSIIS is through individual account on the NYSDOH Health Commerce System (secure intranet).
- No fee to use NYSIIS.
- Cost may be incurred to maintain Internet access.

## Key Features of NYSIIS

- Read/write access for health care providers and their designees.
- Read only access for other authorized users (i.e. schools)
- Deduplication algorithm.
- Recommendation “scheduler”.
- Patient level immunization history report.
- AAP Health Appraisal form.
- Reminder and recall notifications.
- Vaccine inventory, VFC reports.
- Assessment, benchmark and ad hoc reports (AFIX).

## Electronic Data Exchange

- Standard HL-7 or flat file specifications.
- Data export files accepted from vendors/providers using electronic billing or EMR systems.
- Vital records birth certificate information, including immunizations administered at birth, “seed” the NYSIIS database. (Pre-loading all births in NYS outside of NYC since 1994).  Weekly updates planned.
- Planning weekly data exchange with NYC based on patient residence.
- Other child health information system linkages . . .

## Potential Data Linkages

- Lead Screening
- Newborn Hearing Screening
- Newborn Bloodspot Screening
- BMI/Obesity
- Public Health Emergency Preparedness
- SNS inventory management
- Countermeasure and response administration
- Health Plans
- Medicaid, Medicare
- WIC
- Indian Health Services
- Congenital Malformations

## National Picture 

- Immunization information systems are operational in 46 states.
*Healthy People 2010* goal (objective 14.26) is 95% of children from birth through age five with two or more shots in a fully functioning immunization information system.

***Participation is defined as having two or more vaccinations recorded in an immunization information system.**

- U.S. total = 65% (compared to 56% for 2005 and 48% for 2004)

- Making Progress

**Notes:**
§ Chicago, Illinois (34%-66%); DC (95%-100%); Houston, Texas (67%-94%); New York City, New York (95%-100%); Philadelphia, Pennsylvania (95%-100%); San Antonio, Texas (67%-94%).

## NYSIIS Implementation Status

- Focus of first year of implementation (2008) is training, data submission, and user support, not compliance/enforcement.
- As of March 31, 2008:
- 664,852 patients
- 7,906,651 immunizations
- 749 active organizations

## Slide 25

## Opportunities

- Clarify perceived level of effort to comply with reporting requirements and value added provider benefits to encourage initial participation.
- Minimize temporary data entry backlog for historical immunizations.
- Expand legal authority to exchange information with other programs/jurisdictions (FERPA, cross border, etc.).
- Increase uptake in adopting national health information technology standards (ONC, CCHIT, etc.).
- Develop universal parameters for matching/ deduplicating records during integration with various data systems.

## Additional Information

- NYSDOH NYSIIS Website:
- http://www.nyhealth.gov/prevention/immunization/information_system/
- CDC: http://www.cdc.gov/vaccines/programs/iis/default.htm
- NYSIIS staff contact info:
- (518) 473-4437		nysiis@health.state.ny.us
- Loretta A. Santilli, Project Manager
- Michael K. Flynn, Technical Lead