Warren Williams, MPH

Informatics Team Lead

European Conference on Immunization Information Systems

December 7-8, 2010

Standards in Immunization Information Systems: Why we need them

How we create them

Immunization Information Systems Support Branch

National Center for Immunization and Respiratory Diseases

Objectives

Understand why US Immunization Information

Systems efforts rely on Standards

Understand some of the process and

timeframes used to create standards

Understand the technical assistance and

evaluation efforts

Illustrate some future directions

Background on US network Of IIS

State based network

Different platforms and

technologies-not one

system

Vendor community

Minimal level of

aggregate data is

reporting to CDC

Types of Standards Used in IIS

Functional Standards

“What are the core function that IIS should be able to do”

Operational Standards

“How IIS functioning to operate in certain areas”

Data Exchange Standards

“How information is structured and organized when it is

exchanged

IIS Functions Standards and Core Data Element

1997 Original Core functional Standards were

established.

2007 Revision these include: Electronically store data on Core Data Elements* Establish Record with 6 weeks of birth Enable access to and retrieval of immunization at time of encounter Protect confidentiality of the information Receive and process information within 1 month of vaccine

administration Ensure security of information Exchange date with HL7 standards Support automatic vaccination forecasting as determined ACIP Support Reminder Recall functions Produce coverage reports Produce official immunization records Promote accuracy and completeness s of registry data

IIS Functions Standards and Core Data Element (continued)

Required set: Patient name: first, middle, last

Patient birth date

Patient sex

Patient race

Patient ethnicity

Patient birth order

Patient birth State/country

Mother’s name: first, middle, last, maiden

Vaccine Type and manufacturer

Vaccine Date and Lot number

Options Set can be found on line :http://www.cdc.gov/vaccines/programs/iis/stds/coredata.htm#whatis

Operational Standards

US IIS have evolved over the years

Many have individually developed great

practices and procedures

Different business rules for different procedures

that cause different data validations/changes

Different edits applied for data quality

MIROW

The Modeling of Immunization Registry Operations

Workgroup (MIROW) of the American Immunization

Registry Association (AIRA) develops Best Practices

for IIS Operational functionality.

MIROW Goals Promote operational consistency

Foster communication and collaboration

Increase credibility of IIS

MIROW Approach Facilitated collaboration of contributing IIS experts to evaluate

and combine various operational practices and achieve a

consensus regarding best practices.

Use of business analysis and modeling techniques to support

development of best practices .

Why is consistency of IIS operations important?

Inconsistency among IIS negatively affects

overall data quality and usefulness of registry

information.

MIROW guidelines are intended to support

uniform alignment of IIS operations.

How MIROW works

MIROW efforts are guided by the Steering Committee

Operational topics for analysis are selected based on feedback from IIS community (assessments, surveys, ad-hoc meetings at NIC)

Panel of experts is assembled for each topic

A combination of face-to-face analysis sessions and web-based teleconferences

External reviews of developed guidelines

Assessments and surveys on implementation in IIS

About 1 topic per year

MIROW participants

Subject matter experts

Steering Committee

Facilitation Teams

AIRA staff

State IIS

External Reviewers

Technical Editors at CDC

What do the MIROW recommendations offer?

Peer-reviewed practical guidelines

Experts from 24 IIS participated in MIROW sessions since

2005, as well as many IIS partners and stakeholders from

public health programs, federal agencies, regional and

county health departments, IT vendors, consultancies, and

private registries.

Guidelines include:

1. A set of agreed upon terms and definitions

2. General principles, specific business rules and

recommendations to apply

3. Illustrative examples and templates

4. Strategies on how to address problems, issues, and barriers

Guideline

document

released

Face-to-face

meeting

Experts’

panel

size

Guideline document

highlights

Reminder/Recall in IIS April

2009

October 2008

2.5 days

Tampa, FL

13 29 Principles

23 Business rules

30 General

Recommendations

Data Quality Assurance in

IIS: Incoming Data

February

2008

August 2007

2.5 days

Atlanta, GA

11 13 Principles

32 Business rules

Vaccination

Level Deduplication in IIS

December

2006

May 2006

2.5 days

20 9 Principles,

20 Business rules,

23 Illustrative scenarios

(examples)

Management of

Moved or Gone Elsewhere

(MOGE) Status and other

Patient Designations in IIS

December

2005

August 2005

2.5 days

Atlanta, GA

16 6 Statuses defined on the

Provider level,

5 Statuses on the

Geographic Jurisdiction

level

IIS-VAERS Guide

(pilot project)

April

2005

June 2004

1.5 days

21 10 Functional standards,

8 Business rules,

11 Alternative scenarios

(process)

Topics

Promoting the MIROW guidelines

Presentations, workshops, and organized ad-hoc

meetings at annual national immunization conferences

Brochure-style mini-guides summarizing each of the

guideline documents - to encourage IIS staff to learn

more about the best practices recommendations

Self-assessment tool for the data quality assurance

guidelines - for gap identification between current IIS

practices and the MIROW best practice

recommendations (has been presented at an AIRA

webinar)

Evaluation results summary

Use of MIROW guidelines by IIS according to IISAR data:

- 46% in 2007

- 76% in 2008

Web survey results

- response rate: 41% (30/74)

-18/19 participants familiar with guidelines

found them to be at least somewhat useful

Average satisfaction among MIROW contributors: -

3.56 / 4

Implementations in KS and WA

The Kansas IIS (KSWebIZ) team developed new reports

at both the provider and system levels to enhance

overall data quality measures in accordance with the

MIROW best practice guidelines on data quality.

The Washington IIS reviewed the MIROW data quality

guidelines to compare current data loading and quality

check practices with the best practices guidelines. As a

result, 21 of the 32 MIROW data quality business rules

were adopted and then current IIS business processes,

policies and procedures were revised and improved to

support the adopted business rules.

Where to get MIROW guidelines?

Copies of the MIROW recommendations

documents can be found at the AIRA web site:

http://www.immregistries.org/pubs/mirow.phtml

Data Exchange Standards

Standards use:

Health Level 7 (HL7)

Information can be found at WWW.HL7.org

Why these are so important

Promotes the obvious computer to computer exchange

Uses in a variety of exchange standards (flat files, data

interchange, etc) once content and structure agreed upon

• i.e. Dates and Vaccine type can be send in different ways as

long as representation is agreed upon

Serves as an anchoring point

HL7 History

Health Level 7 (HL7)

ANSI Standard for clinical interoperability

HL7 was founded in 1987 to promote

communication between hospital data systems

Goal was platform independent method of moving

data between different systems

Grammar for messaging was developed

Standardized vocabulary was developed

HL7 is named for the ISO Open Systems

Interconnection Reference Model Application layer

HL7 Is One of the Interoperability Standards

HL7 is part of the effort to connect disparate

information systems

HL7 is focused on communicating health data

The standards are developed using a

consensus based approach

HL7 Immunization Implementation Guide History

Published in 1999 based on HL7 V2.3.1 and

updated several times

Implemented by many IIS and EHR vendors

Model of successful interoperability

Thousands of messages are transmitted daily

New IG published in May 2010, based on HL7

Version 2.5.1

HL7 version 2.5.1 Immunization Guide Scope

Supporting standardized message structure and

vocabulary for

Sending and receiving immunization histories (VXU)

Requesting immunization history for individual (QBP and RSP)

Acknowledging receipt of message/query and reporting

errors (ACK)

ADT is not covered in depth (referred to IHE profiles)

Technical Assistance in Support of Standards

Great partnerships are key!

American Immunization Registry Association

Public Health Informatics Institute

Evaluation and monitoring

Program evaluation tools

Data analysis

• Sentinel site projects

• http://www.cdc.gov/vaccines/programs/iis/activities/se

ntinel-sites.htm

Routine Monitoring

The Future and Lessons Learned

Standards are used and needed in a variety of areas

Functional, operational guidance, data exchange.

Future Standards:

Constantly evolving to changing information

New ones needed for IIS analysis needs

• Which is the best denominator to use?

• Methodologies for coverage estimation adjustments?

Skills and Planning activities needed to support

standards work:

Good facilitation, experts are very helpful

Good logic listening, focus at the system level

Good communication, new technologies as well as old

Need to evolve

New Initiatives in US IIS efforts

Interoperability

Grantee Support

Technical assistance

Clinical Decision Support

Strategies to improve vaccine forecast

Bar Code efforts to improve vaccine identification

Open the door for modern bar codes on vaccine vials

Improving data analysis capabilities in Sentinel Sites

System enhancements

A Thousand Flower Bloom

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

Thank You

Immunization Information Systems Support Branch

National Center for Immunizations and Respiratory Diseases

Warren Williams, MPH

wxw4@cdc.gov

Telephone 404 639-8867