# Presentation: 139619

## Immunization Information Systems 101: What Every Program Manager Should Know 

**Immunization Information Systems 101: ****What Every Program Manager Should Know**** **

***Immunization Information Systems 101***

## Need For This Module

**Educate new immunization and IIS staff**
** ****Provide an introductory IIS education resource**
**Educate partners, providers, and stakeholders**

## Learning Objectives

**Describe what immunization information systems (IIS) are**
**Describe the benefits of IIS**
**Describe the basic functions of IIS**
**Describe how IIS can be used to support immunization and other partner program activities**

## Continuing Education Credit

**Continuing education credit is available only through the CDC/ATSDR Training and Continuing Education Online System at www.cdc.gov/TCEOnline/.**
**You must have a verification code specific to this program to apply for CE credit. The code will be revealed during the course of the program. CE credit for this activity will expire on Change Me, 2007.**

## Financial Interest Disclosure

**CDC, our planners, and our presenters wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters.**

## Unlabeled/Unlicensed Use Disclosure

**Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.**

## IIS 101 Topics

**What are IIS?**
**IIS Benefits**
**Laws, Policies and IIS**
**History of IIS**
**Participation in IIS**
**How IIS Work**
**Guiding Documents for IIS**

**IIS Functional Standards**
**IIS Data Use**
**IIS Linkages**
**Future of IIS**
**Additional Resources**

## What are IIS?

## What are Immunization Information Systems (IIS)?

**IIS are electronic information systems designed to capture and manage data specifically related to immunization. They:**
**are population-based systems.**
**are computerized, primarily web-based systems.**
**ensure confidentiality, privacy, and security of personal data.**
**are a collect and consolidate vaccination-related data from multiple healthcare providers.**
**generate reminder and recall notices.**
**assess vaccination coverage.**
**can capture vaccination-related data on children, adolescents and adults.**** **

## Slide 10

## Other IIS Capabilities

**Integrate with other electronic health information systems**
**Vaccine management at the provider and immunization program levels**
**Forecast next appropriate vaccination(s) due, specific to each patient **
**Emergency preparedness & pandemic influenza planning**

## IIS Funding Sources

**Section 317 **
**Vaccines for Children (VFC)**
**Private sources: private foundations, health plans, service clubs **
**State/local funds: immunization coalitions, state legislature, and State Tobacco Dollars **
**Centers for Medicare & Medicaid Services**

## IIS Stakeholders

**Public health and government agencies**
**Healthcare providers **
**Childcare facilities, schools, & universities **
**Health plans and insurance companies**
**Vendors of clinical management or medical billing software**
**Clinical or medical software vendors**
**National professional organizations**

## IIS Benefits 

## IIS Benefits to Immunization Programs

** ****Retrieve real-time data**
**track and evaluate trends in data/coverage levels **
**monitoring outbreaks and disease coverage levels**
**VFC vaccine usage and provider compliancy **
**Monitor new vaccine uptake**

## IIS Benefits to Parents & Community

**Help prevent disease outbreaks in the community.**
**Keep records kept safe during natural disasters.**
**Ensure children don't miss any shots or get too many shots.**
**Remind parents by mail or telephone when  their child need shots.**
**Help determine pockets of need in a community.**
**Determine where new clinics and provider office**_**s**_** need to be placed.**
**Maintain records of children in foster care.**

## IIS Benefits to Providers

**Consolidating immunization-related information**
**Automatically calculating vaccinations needed**
**Generating reminder and recall notices**
**Reducing paperwork, save time and money**
**Connecting clinicians**
**And many more.**

## IIS Benefits to Health Plans

**Health plans use IIS to measure HEDIS rates to monitor and improve quality of care they deliver **
**This saves health plans time and resources to look up and evaluate medical records. **

## Laws, Policies and IIS

## Privacy and Confidentiality in IIS

**Information in IIS is private and confidential**
**Privacy is the legal right of a person to limit access to information about that person**
**Confidentiality is the treatment in a manner consistent with the understanding made at the time of its disclosure**
**Privacy and confidentiality are governed by state and federal law and IIS policies**

## State Laws Affecting IIS

**Life long or age specific**
**Voluntary or mandated reporting for health care providers**
**Opt-in or Opt-out for individuals/parents**
**Persons/entities that can disclose information to the IIS**
**Person/entities that the IIS can allow to access information in the IIS **
**Privacy and confidentiality of healthcare information**
**Integration with other public/private information systems**
**School/daycare entry **
**Immunizations requirements**
**Exemptions**

## Federal Laws Affecting IIS

**Health Insurance Portability and Accountability Act (HIPAA)**
**HIPAA Privacy Rule governs use and disclosure of “protected health information”**
**Health care providers and payers are subject to HIPAA**
**IIS are not a “covered entity” subject to HIPAA****	**
**Each IIS should have written confidentiality and security policies that addresses the following issues. **
**Family Educational Rights and Privacy Act (FERPA)**
**FERPA protects the privacy of the educational records held by schools**
**Disclosure requires consent**

## History of IIS

## IIS Development

**IIS first created in 1990s through Robert Wood Johnson Foundation and All Kids Count**
**Currently, funding is made available under section 317 (b) of the Public Health Service Act for 50 states, 6 cities and 8 U. S. Territories.**

## Participation in IIS

## Preliminary Data. Percentage of children aged < 6 years participating in a grantee immunization information system -- United States, six cities§, and eight Territories†, 2007

- _Preliminary Data_. Percentage of children aged < 6 years participating in a grantee** **immunization information system -- United States, six cities§, and eight Territories†, 2007

- No Report
- 0-33%
- 34-66%
- 67-94%
- 95-100%

- Source:  CY2007 IISAR

- §Chicago, Illinois (34%-66%); District of Columbia (95%–100%); Houston, Texas (67%–94%); New York City, New York (95%–100%); Philadelphia, Pennsylvania (95%–100%); San Antonio, Texas (67%–94%).

** ****National Participation: 71% **(excluding Territories)

**†**American Somoa (No Report), Marshall Islands (67%-94%), Federated States of Micronesia (95% -100%), Guam (No Report), N. Mariana Islands (No Report), Palau (No Report), Puerto Rico (67%-94%), Virgin Islands (No Report)

## Provider Participation: Key to IIS Success

**Ensuring provider participation is critical to complete and accurate electronic immunization records in IIS. Provider barriers and perceptions include: **
**Participation requires too much cost/staff time. **
**Practices have its own health information systems. **
**Perceived non-compatibility of IIS technology and office computers,. **
**Confidentiality concerns.**
**Lack of support for IIS from the state medical or specialty society. **
**Lack of support from the practice's nursing or administrative staff.**

## How IIS Work

## Slide 29

## Slide 30

## Sources of IIS Data

**Birth Records**
**Direct data entry by providers**
**Electronic medical records**
**Medicaid and insurance billing/claims**

## Information in IIS

**NVAC core data elements **
**Purpose: a) attributes necessary for identifying individuals; b) facilitate record exchange **
**Data are either required or optional**
**Examples of required elements: patient first, middle and last names; birth date, birth order, race, ethnicity, vaccine type, date, lot number, address and phone number.**

## Guiding Documents for IIS 

## Guiding Documents for IIS

**2008-12 Immunization Program Operations Manual (IPOM)-  guidance document for developing objectives, activities, and evaluation measures that maximize immunization program effectiveness, including IIS.**
**IIS Strategic plan provides a roadmap of activities required to reach the 2010 national IIS .objective to increase to 95% the proportion of children (ages 0 - <6 years) participating in a fully operational, population-based IIS **

## Guiding Documents for IIS

**IIS Business Plans- designed to assist grantees in planning, developing, and implementing IIS activities throughout the project lifecycle. **
**317 Grant- Assures the implementation of effective immunization practices and proper use of vaccines to achieve high immunization coverage, and supports infrastructure for immunization activities. **
**Public Health Information Network (PHIN) Standards- a national initiative to improve the capacity of public health to use and exchange information electronically by promoting the use of standards and defining technical requirements. **

## IIS Functional Standards

## Functional Standards

**12 minimal functional standards, including:**
**Electronically store data on all NVAC core data elements**
**Establish a IIS record within 6 weeks of birth **
**Enable access to and retrieval of immunization information in the IIS at the time of encounter**
**Receive and process immunization information *****within 1 month***** of vaccine administration**
**Protect the confidentiality of health care information**
**Ensure security of health care information**

## Functional Standards continued

**Exchange immunization records using HL7 standards**
**Automatically determine the routine childhood immunization needed, in compliance with current ACIP recommendations, **
**Automatically identify individuals due/late for immunization to enable the production of reminder/recall notifications**
**Automatically produce immunization coverage reports by providers, age groups, and geographic areas**
**Produce official immunization records**
**Promote accuracy and completeness of IIS data**

## Forecasting 

**A core function of most IIS is the forecasting algorithm**
**Using patients date of birth and shots already received, create an accurate recommendation of what should be given next**
**Very complex, difficult to design and maintain especially when new vaccines are added or different age ranges are recommended**
**Currently no federal/national set of code available although this has been expressed as a need by many states**

## Slide 41

## Reminder Recall

- Reminders are post cards or autodialers that tell parents when it’s time for the child’s next series of immunizations.
- Recalls are sent when a child is overdue for a series of immunizations.
- IIS at the state and local level or at the provider level are used to track each patient  and to send out reminders and recalls.
- Many IIS can automatically generate reminders/recalls. The format varies by IIS.
- Letters
- Phone calls
- Mailing labels

## Slide 43

## Data Quality

**High data quality is: accurate, timely, meaningful, and complete **
**Data quality focuses on the data coming into IIS and more in-depth   vaccine-specific checks **
**Data quality assurance protocols are used to verifying the reliability and effectiveness of data **
**Maintaining data quality involves updating, standardizing, and de-duplicating records to create a single view of the data, even if it is stored in multiple disparate systems.**

## Patient level de-duplication

** ****The process of identifying possible duplicates and preventing additional duplicates from being added and preventing two records, which truly are unique, from being merged into one**.
-  **IIS use mothers maiden name and mothers first name, along with address, gender, race, and others. **

**Patient level de-duplication**

## Moved or Gone Elsewhere (MOGE)

**Important in coverage assessments, reminder-recall, IIS data linkages. **
**Inappropriate classification of MOGE may result in an inflated or under-inflated coverage measures.  **
**AIRA-MOGE guidelines at: **_**[www.immregistries.org](http://www.immregistries.org/)**_

## Vaccine Level De-duplication

**IIS receive immunization data (vaccination events) from many different sources.**
** ****The decisions made during vaccination level de-duplication affect the forecasting of vaccine administration.**
**Complete and accurate information on the vaccination history of the patient is essential for providers **
**Resource: **_**[www.immregistries.org](http://www.immregistries.org/pdf/AIRA_BP_guide_Vaccine_DeDup_120706.pdf)**__**[/](http://www.immregistries.org/pdf/AIRA_BP_guide_Vaccine_DeDup_120706.pdf)**_

## Data Exchange

**IIS have developed methods of acquiring immunization data through means other than direct data entry. **
**Importing and exporting data from another system to and from the IIS can be done through various methods such as:**
**encrypted email**
**Secure ftp**
**https**
**HL7- standard required by CDC for all IIS**

## IIS Data Use

## List of most commonly used IIS-generated reports

**Reminder/recall**
**Vaccine usage**
**Coverage levels**
**Invalid dose, extra-immunizations, and age-inappropriate vaccination reports**
**Monthly Doses Administered **
**Provider Profile Data Report**
**Profile Reports **
**Monthly Biologics and Ending Inventory Reports **
**And many more**

## IIS data use by Immunization Programs

**Assist in implementing immunization program action plans, measurables, and evaluation processes.**
**Measure immunization coverage levels .**
**Evaluate vaccine uptake and usage.**
**Monitor Universal Hep B birth dose.**
**Comprehensive Clinic Assessment Software Application (CoCASA) tool.**

## Disease Surveillance:
Target pockets of need 
Compare incidences of infection
Disease Outbreak
Evaluation 
Control measures 
Aid in natural or man-made disaster  

**Target pockets of need **
**Compare incidences of infection**
**Disease Outbreak**
**Evaluation **
**Control measures **
**Aid in natural or man-made disaster  **

**IIS Data use by other Health Programs**

## IIS Data Use by health-care Providers

**IIS can help providers to keep track of the vaccines they provide to their patients **
**Vaccine forecasting avoids over-and under-immunization**
**Creates lists of children who need vaccines so providers know who to call in to the office (vaccine reminders)**
**Marks which children in the office practice need to come back in to the office during a vaccine recall, vaccine shortage, or incorrectly stored vaccine.**

## Pandemic Flu 

**Pandemic Flu **
**Natural Disasters- Katrina**

## IIS Linkages

## Data use through Linkages

**Streamline required school immunization reporting**
**Readily available official immunization record to schools and parents**
**Track administered vaccines to ensure proper reimbursement for providers**
**Integrate immunization data with other systems (e.g., newborn and lead screening, WIC, office billing systems and electronic medical records) **
**Reduce or eliminate the need for health plan staff to conduct manual chart pulls to collect immunization data in physician offices**
**Increase immunization data quality and completeness**
**WIC and Immunization Programs share population base**

## IIS and Vaccine Management

**Monitor VFC vaccine usage and ordering**
**Control inventory/biologics**
**Track specific vaccine doses**
**Recall vaccine by lot number, manufacturer, antigen**
**Analyze doses administered and find children requiring immunization or re-administration of vaccines**

## Other Types of Health Information Systems

**Cancer registries**
**Early hearing detection**
**Newborn metabolic screening**
**Childhood lead poisoning **

## Future of IIS

## 
Promote IIS data use 

Linkages with other health information systems

Independent objective analysis of IIS operations

IIS accountability and performance measurement

National Vaccine Advisory Committee functional recommendations/standards of operation.  

IIS Program evaluation 

**Promote IIS data use **
**Linkages with other health information systems**
**Independent objective analysis of IIS operations**
**IIS accountability and performance measurement**
**National Vaccine Advisory Committee functional recommendations/standards of operation.**
**IIS Program evaluation **

**Future of IIS**

## Additional Resources

## NCIRD’s IIS Website

## Subscribe for E-mail Updates to IIS web site pages

**	****	****	****	**_**[Get Email Updates](http://service.govdelivery.com/service/subscribe.html?code=USCDC_11_33)**__** **_

**Notes:**
In addition, on web pages where you see this image and link, click on the link to subscribe to receive e-mail notification of changes made to that page.

## Partner Websites

- Key partner web sites:
- AAP:  _[www.aap.org](http://www.aap.org/)_
- AIM: _[www.immunizationmanagers.org](http://www.immunizationmanagers.org/)_
- AIRA: _[www.immregistries.org](http://www.immregistries.org/)_
- ECBT: _[www.ecbt.org](http://www.ecbt.org/)_
- PHII: _[www.phii.org](http://www.phii.org/)_
- Expanded list on NCIRD’s IIS website at:
_**[http://www.cdc.gov/vaccines/programs/iis/default.htm](http://www.cdc.gov/vaccines/programs/iis/default.htm)**_

## Acknowledgements

**Julie Clark- AIRA/Michigan**
**Elaine Lowery- Colorado **
**Emily Peterson- Minnesota**
**Molly Sander- AIM/North Dakota**
**Jennifer Zavolinsky- ECBT**
**Dale Babcock- CDC**
**Amanda Bryant- CDC**
**Gayle Daniels- CDC**
**Susan Farrall- CDC**
**Lynne McIntyre- CDC**
**Carl Phillip- CDC**
**Bobby Rasulnia- CDC**

## Continuing Education Credit

**Continuing education credit is available for this module only through the CDC ATSDR Training and Continuing Education online system at **
**www2a.cdc.gov/TCEOnline **

## Continuing Education Credit

**Verification Code: NT108F**

## IIS-related documents

**You may also visit the following web page for access to all documents referenced in this module at: **
**www.cdc.gov/vaccines/programs/iis/iis101docs.htm **