Multi-State Registry Collaboration The Wisconsin Immunization Registry (WIR) Development Collaboration Group

Creating WIR 1999 (WIR - Initial release ) replace non-Y2K compliant application focus on deduplication, validation and recommendation Public & Private provider recruitment 2002 HL7 Batch School & HMO Access 2003 Smallpox vaccination recording Online Vaccine order processing 2004 Real-time HL7 GIS Mapping Registry Assessment report

Sharing the Application l Minnesota was the first to request and adopt the WIR application which occurred in 2001 l License agreements had to be created and agreed to by both states Minnesota had to modify the registry to support regional structure Minnesota Immunization Information Connection

WIR Collaborative Group Wisconsin North Carolina Massachusetts Georgia New Mexico Maine Minnesota Minnesota Minnesota Immunization Information Connection Arkansas Arkansas US Virgin Islands Puerto Rico Puerto Rico Virginia

Methods for Collaboration l Monthly conference calls l Discussion and distribution of proposals for sharing of enhancements l AIRA web forum with member log in area for WIR Collaboration Group l Source code and documentation shared at no cost with all members

Minnesota Contribution 2002 Ability for unlimited comments and added comment “refusal of all childhood vaccines” Store all VIS Dates for combination vaccines Allow VIS Date to be edited Add County-level reporting for recall/reminder and CASA (residents of county versus those immunized by the county)

2003 Rejection Management for batch file loading Modify date entry for use by data entry staff 2004 Reports in different languages Somali Russian Spanish Hmong Minnesota Contribution (cont.)

Collaboration With Shared Development Costs Minnesota and Wisconsin merged staff to: Re-engineer the Validation and Recommendation Wizard Add ability to record for Smallpox vaccinations:  Occupation  Employer  “Take” result  Reporting

Sharing the Application with Georgia l Georgia adopted the WIR application in 2002 l Georgia had to modified the registry to support requirements of Georgia Registry Law Age restriction School & Day Care certificates Combination vaccine group management

Georgia Contribution 2003 Organizational Extract Inventory Management Enhancements 2004 Manage Immunizations for OPT-OUT Clients VFC Reporting Through Registry HIPAA Disclosure Reporting Automated pending client-merge School Access (school nurse able to submit student list through Data Exchange)

North Carolina February 2005 Use duplication engine for initial client search Verify VFC eligibility status with each encounter Indicate whether Dose Date is estimated June 2005 VFC and Universal coverage validation rules Multiple occurrences of Race Code for multi-racial clients Integration with external service (COREid™) for user authentication and authorization.

Massachusetts Early 2005 Enhance Vaccine Management and Organization Hierarchy J2EE “Open Source” architecture compliant Enhance audit trails Enhance the list of contraindications, precautions, refusals, immunities

Maine 2005 Manage Vaccine Inventory via HL7 Interface Create VACMAN interface Modify User roles to include site as well as organizational access Collect and monitor patient height and weight measurements Integrate with Maine’s Public Health Information System

Arkansas 2005 Enhance the audit trail Last provider seen for recall reporting, based on last immunization Allow 4 phone numbers per responsible party

Collaboration Benefits l Save money Joint collaboration on projects Receiving new enhancements at no cost l Save time Getting enhancements from collaborative group months/years before anticipated release l Save effort Ability to move onto other needed enhancements sooner Share ideas for enhancements

Collaboration Benefits Massachusetts *Start From Scratch Projections (*) 3.5 to 5.0 Million Dollars Years of Development Time Current Eight Month Development Timeline Phase 1 Enhancements Approximately 1 Million Dollars *MIIS Strategic Plan 2002, DBM Solutions LLC

Collaboration Challenges l Implementation of shared enhancements still requires implementation effort and time Enhancements must still be tweaked to fit each registry and their unique operating environment l The needs of each registry can vary widely l State privacy laws may not allow sharing of data across state lines Wisconsin and Minnesota poised to do real-time HL7 queries between their registries but MN law does not allow

Conclusions  Wisconsin is not a software vendor, therefore licensing issues, demonstrations and software questions were initially overwhelming.  However, the software enhancements received to date from other registries far out-weigh the time spent making this possible.  All members of the WIR collaborative registry group will be better off due to the collaboration.

Presenter - Thomas Maerz Wisconsin Immunization Registry Collaborative Authors Emily Peterson-Stauffer- Minnesota Immunization Information Connection Thomas Moss - Georgia Registry Immunization Transactions and Services Dennis Michaud - Massachusetts Immunization Information System Walter Kemper - North Carolina Department of Health and Human Services John Pease - Maine Immunization Registry Ron Van Duyne - Centers for Disease Control