Presentation on theme: "Presented by: Rebecca Coyle MSEd. AIRA Executive Director A Summary of the Methods, Successes and Challenges of Pharmacy-IIS Interfaces."— Presentation transcript:
Presented by: Rebecca Coyle MSEd. AIRA Executive Director A Summary of the Methods, Successes and Challenges of Pharmacy-IIS Interfaces
What is AIRA AIRA is viewed by its members as the centralized core of activity for IIS development, standardization, and best practices Provides knowledge sharing opportunities and capacity building activities Promotes, advocates for, develops, and disseminates IIS data exchange standards consistent with national standards that increase the visibility of IIS as public health best practice models for interoperable and integrated health management systems
Percentage of children aged <6 years participating* in an Immunization Information System (IIS) – United States, five cities +, and the District of Columbia, 2012 * Participation is defined as having two or more vaccinations recorded in the IIS + Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas. National child participation: 86% ≥95% 67%-94% 34%-66% ≤33% No IIS No data NYC Philadelphia DC San Antonio Chicago Houston
Percentage of adolescents aged 11 through 17 years participating* in an Immunization Information System (IIS) – United States, five cities +, and the District of Columbia, 2012 * Participation is defined as having two or more vaccinations administered during adolescence recorded in the IIS + Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas. NYC Philadelphia DC San Antonio Chicago Houston National adolescent participation: 54% ≥95% 67%-94% 34%-66% ≤33% No IIS No data
Percentage of adults aged ≥19 years participating* in an Immunization Information System (IIS) – United States, five cities +, and the District of Columbia, 2012 * Participation is defined as having one or more vaccinations administered during adulthood recorded in the IIS + Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas. NYC Philadelphia DC San Antonio Chicago Houston National adult participation: 25% ≥95% 67%-94% 34%-66% ≤33% No IIS No data
Methods Phase 1: Online survey issued to all State, Territory, and Local IIS CDC Awardee Projects Phase 2: Interviews with representatives from the five largest pharmacy chains actively interfacing with IIS in multiple states
Survey Purpose Examine what is being done to connect IIS and Pharmacies and how it is being done. Which pharmacies are providing immunizations Which pharmacies are reporting vaccinations administered to the IIS, and Of those reporting, what is the nature and quality of the data being received Capture the successes and challenges of the pharmacy-IIS reporting relationship and What efforts are being made to increase the number of pharmacies reporting to the IIS
Pharmacy Interview Purpose Gain a better understanding of the chain’s corporate approach to vaccination and reporting Provide balance and validation of responses captured during the IIS Survey phase
Map of IIS Survey Responses
Major Findings Of the state and project areas responding to the survey (n=45) Pharmacies are allowed to provide vaccinations in 42 (93%) of the project areas. Pharmacies report doses administered to IIS in 36 (80%) jurisdictions and are required to report in 22 (49%). Pharmacists will generally administer whatever vaccinations they are allowed to administer in accordance with individual state laws
Types of Vaccinations Reported by Frequency
Most Common Data Submission Methods & Frequency Flat files loaded manually (26%), HL7 batch (25%) and Manual data entry (23%) For Electronic Interfaces: Weekly data feeds (42%) Daily feeds (28%)
Reporting Methods by Frequency
Reporting (cont.) For pharmacies reporting electronically (n = 64), a multi-site feed including all sites/clinics in the jurisdiction was by far the most common practice (83%). For manual submissions (n=22), data entry is almost always performed at the individual site/clinic level (82%).
Most Common Transport Methods FTP/SFTP (47%) SOAP over HTTP(s) (24%)
Success IISPharmacy Partnerships with the pharmacy community is critical when recruiting & interfacing with new pharmacy partners Significant increase in adult immunization records Improved quality of adult data The improvement of overall patient care Role of pharmacies in the patient care continuum System improvements
Challenges – IIS Perspective Data quality issues Lack of unique patient identifiers Variations in patient’s name Lack of patient address Inability to collect required data elements Inability to generate a file format supported by the IIS
Challenges – Pharmacy Perspective Restrictions on the type of files that IIS are willing or able to accept (e.g. pharmacy can generate a flat file but state requires HL7 or vice versa) Limited staffing resources and infrastructure on the IIS side can lead to a lengthy onboarding process State variations in the IIS specifications IIS consent requirements mandated through state/local law
Recommendations 1. Evaluate IIS reporting specifications/recommendations on a more global scale to standardize the reporting process for external partners that span multiple states/jurisdictions (specifically required fields, reporting methods supported, reporting timelines). 2. Assemble partners with the ability to influence public health policy and pharmacy vaccination practice to recommend standardization in laws defining pharmacy vaccination programs, mandatory reporting requirements, and consent/disclosure limitations.
Recommendations (cont.) 3. IIS should work with pharmacy reporting partners to identify alternative reporting options and/or establish feasible transition plans and timelines to facilitate reporting until pharmacy systems can report in the IIS’s preferred reporting method. All efforts should be made to avoid requiring pharmacies to perform unnecessary duplicate data entry. 4. IIS not capable of supporting the most current HL7 2.5 specification should establish timelines for implementing the new standards and communicate those timelines to the more advanced pharmacy partners.
Recommendations (cont.) 5. Consider moving to NDC as the standard for vaccine type and manufacturer reporting, or enhance IIS to support NDC in addition to CPT/CVX codes. 6. Include pharmacy partners in immunization and IIS related meetings and educational opportunities whenever appropriate.
Recommendations (cont.) 7. Leverage partnerships to increase the number of Pharmacy-IIS interfaces, evolve reporting processes and improve patient care. 8. Consider future study opportunities to evaluate pharmacy data quality when compared to other provider submissions, investigate possibility of getting pharmacy data through a centralized billing system, and assess the feasibility of pharmacies incorporating review of records in the IIS into the routine vaccination workflow.
AIRA Website Resources
Danielle Reader-Jolley Participating Immunization Information Systems CVS Kroger Rite Aid Safeway Surescripts Walgreens