iis measurement and improvement: connecting … slides...what aira does. what are immunization...
TRANSCRIPT
IIS Measurement and Improvement: Connecting Immunization Information
Systems (IIS) with EHRs to Reduce Burden and Improve Care
HIMSS Spring I&HIE Community RoundtableApril 10, 2019
Purpose
Promote the development,
implementation and
interoperability of Immunization Information
Systems
Collaborate
Provide a way to work
collaboratively to develop
standards, best practices,
strategies and provide education
about IIS
Measurement & Improvement
Identify the key aspects of an IIS
that can be evaluated and
measuredProvide technical assistance to IIS
programs to foster improvement
Support
Support IIS and immunization
programs through education, targeted
assistance, and advocacy
What AIRA does
What are Immunization Information Systems (IIS)?Hint – they are immunization registries, but so much more
3
Assist with vaccine
ordering & inventory
management
Create consolidated
reports
Create comprehensive
records
Generate reminders to ensure on-
time vaccinations
Assist with disease
surveillance & outbreak response
Confidential
Population-based
Identify pockets of need
Assist schools & child care providers
Help improve vaccination rates &Reduce vaccine-preventable disease
are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.
Assist with clinical
decision support &
forecasting
Exchange data with multiple providers
IIS…
4
Where are IIS located? All but one state operate an IIS
IIS are also in:• New York City• Philadelphia• San Antonio• Washington D.C.• San Diego • Imperial County• San Joaquin County (RIDE)
• American Samoa• Guam• Marshall Islands• Micronesia• North Mariana Islands• Palau• Puerto Rico• U.S. Virgin Islands
5
IIS…Capture the vaccination status of the population
Percentage of children <6 participating in an IIS in the United States -2017
Percentage of adolescents 11-17 participating in an IIS in the United States - 2017
Percentage of adults greater than or equal to 19 years of age participating in an IIS in the United States - 2017
IISAR https://www.cdc.gov/vaccines/programs/iis/annual-report-iisar/rates-maps-table.html
Maturity
• Each system operates independently• Newest IIS is planning to launch in late 2019• Oldest have been in existence for 30+ years
7
Why isn’t there a national registry?
• 1993: Congress rejected national IIS provisions in the Comprehensive Child Health Immunization Act• As introduced, it would have created a national immunization
registry • Derailed amid a firestorm of political protest
• 10th Amendment – states dictate what their system can and cannot do
8
Measurement and Improvement
Value of IIS Measurement and Improvement
• Increases IIS function and helps streamline data in/data out operations
• Providers/end users can trust the data they use for clinical decision support
• Public and private health partners (Medicaid, Accountable Care Organizations, EHR hubs, etc.) can be confident in data used population-based assessment
• M&I helps the IIS community prioritize and accelerate essential improvements together
Content Area
Transport
Submission / Acknowledgement
Query / Response
CDS
Data Quality
Testing & Discovery Assessment Validation
Testing & Discovery Assessment Validation
Testing & Discovery Assessment Validation
Testing & Discovery Assessment
Testing & Discovery
1 2 3
Validation is a public-facing summary stage to acknowledge IIS that are progressing toward or achieving
alignment with community-selected measures.
Measurement and Improvement: Validation
SDIR
MT
WY
ID
WA
OR
NV
UT
CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN
WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VAWV
OH
MI
NY
PA
MD
DE
NJ
CTRI
MA
ME
VT
NH
AK
HI
NYC
PHIL
SDIR
NYC
PHIL
DC
Guam
CNMI
Puerto Rico
Virgin Islands
Connected
Actively Working
on Connection
Great Participation Nationwide
Aggregate Analysis Reporting Tool (AART)
• AIRA Developed Measurement Tool
• Testing is performed on a regular basis
• Each IIS has a Dashboard of their individual results
• Quarterly National Aggregate Reports are developed and published
Nationwide Validation Reports – Now Available
• Gradations of “validated with minor differences” and “major differences” to better demonstrate incremental progress.
• Quarterly identified maps with gradations and footnotes that clarify policy differences.
Assessment Results: Transport
21
26
30
33
3637 37
40 4038
40
19
23
27
30
3433 33
37 3735
37
17
21
26
29
3335
34
37 3736
38
56
1214
1516 16
2022
2325
0
5
10
15
20
25
30
35
40
45
Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 Q1 2018 Q2 2018 Q3 2018 Q4 2018 Q1 2019
CDC WSDLs Assessed Connectivity Test Submit Single Message Security Fault
Assessment Results: Submission and Acknowledgement
26
29
33
29
42
46 47
43
47
1821
25
22
29
3235
30
35
1
4 5 6
12 11
1413
15
21
24
28 28
37
4345
4244
0
5
10
15
20
25
30
35
40
45
50
2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1
Measured VXU Pass Average ACK Pass Average Timeliness Pass Average
Query and Response – Huge Value
Query
Response
“The Minnesota IIS saves us time. With the click of a button, we can
compare the EHR and IIS records. We rely on the Minnesota IIS to make sure that our immunizations are
given correctly.”
Drilling Down on EHR-IIS Query – Why Is It Important?
• EHR-IIS query is available in the majority of IIS jurisdictions nationwide
• Results demonstrate progress toward standardization and adoption of query
• Coupled with EHR adoption of certified technology, this will speed up onboarding and interoperability substantially
“Our best defense against missed immunization opportunities is the ability to conduct an Immunization Query. Our bi-directional interface with our state
immunization database has put accurate immunization history and the current CDC recommendations based on that history at our clinicians fingertips.”
Drilling Down on EHR-IIS Query – Why Is It Important?
A 2016 study in the journal Pediatrics demonstrated an increase in up-to-date statusand a decrease in missed opportunities following implementation of query
Stockwell et al., Pediatrics, 2016
75.0%
81.6%
70%
72%
74%
76%
78%
80%
82%
84%
Prior to Query Post Query
UP-TO-DATE RATE
8.8%
4.7%
0%
2%
4%
6%
8%
10%
Prior to Query Post Query
MISSED
OPPORTUNITIES
Assessment Results: Query and Response
24
27
31
28
39
43 44
40
44
2123
2725
37
41 41
37
43
10 11
14 15
26
29 30
27
35
12
4 4
10 10 119
12
1719
2523
2729 30 29
32
20
25
28
24
37
41
38 37
40
0
5
10
15
20
25
30
35
40
45
50
2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1
Measured Query Support Pass Average MU3 Query Support Pass Average
RSP Conformance Pass Average Core Data Elements Pass Average Timeliness Pass Average
Clinical Decision Support
ACIP Recommendations and Clarifications
System A
System B
System C
System C Recommendation
System B Recommendation
System A Recommendation
Individual Interpretation And Implementation
Before CDSi
https://www.cdc.gov/vaccines/programs/iis/cdsi.html
With CDSi
ACIP Recommendations and Clarifications
Individual Implementation
CDSi Resources
Consistent System Recommendations
WorkgroupInterpretation and Documentation
https://www.cdc.gov/vaccines/programs/iis/cdsi.html
CDS Measures
CDS Concept Supports Accuracy
Evaluation StatusDid the dose count?
PediatricAdolescent
Adult
Earliest DateWhen could the next dose be given?
PediatricAdolescent
Adult
Recommended DateWhen should the next dose be given?
PediatricAdolescent
Adult
HIMSS/AIRA Collaborative
AIRA Measurement
and Improvement
HIMSS Immunization
Integration Program
HIMSS/ AIRA Collaborative
For more information:[email protected]
• Improve immunization management, workflow, standards, usability and data sharing practices
• Harmonize communications to achieve structured data sharing to support clinical care and public health
• Enable collaboration between organizations that can implement necessary changes (in EHRs or IIS, and/or in the standards that support them)
• Build on the work of the HIMSS Immunization Integration Program
Goals of the HIMSS/AIRA Collaborative
For more information:[email protected]
Standardization activities have directly improved interoperability with EHRs and IIS, as well as improved the quality of data within IIS
This has strengthened IIS as important analytic tools that support a wealth of population health needs
Providers can access these data seamlessly through EHR query at the point of care, supporting clinical decisions, ensuring appropriate immunization, and lowering burden
In Summary
• Thank you to:• The AIRA Measurement for Assessment and Certification Advisory
Workgroup (MACAW) Members for their work in recommending concepts and measures
• The AIRA Board of Directors for approval of measures and oversight of the process
• All IIS and EHRs for doing the hard work to implement and improve interoperability and functionality
Acknowledgements
Thank You!
Eric Larson
HIMSS/AIRA Collaborative
www.immregistries.org