Enhancing Registry Data with School Nurse Data Collection Quan Le Louisiana Office of Public Health Stacey Goodall Scientific Technologies Corporation March 24, 2005

Goals of Project Provide schools nurses with access to registry to view immunization records Allow school nurses to add missing immunization data  enhance value of registry Streamline annual reporting process by utilizing registry to collect data Simplify management of process by automating all reporting

Key Facts About Louisiana 64 parishes 9 regions/regional immunization consultants 1,500 public schools 400 private schools Each school required to submit annual immunization reports to LA OPH for all new students LINKS in place since million patients 12 million vaccinations

Current Reporting Process Initial report submitted to regional immunization consultants (RICs) by Nov. 15 of each year RICs review reports, conduct follow up, and receive all final/amended reports by Jan. 15 RICs compile data by parish then region and submit to state for further aggregation Data is collected for public and private schools, separately

Reporting Under Current Process By grade:  Number of students with complete records  Number with incomplete records  Number of students needing DTaP/Td, IPV, 1 st MMR, 2 nd MMR, 1 st HepB, 2 nd HepB, 3 rd HepB, or VAR  Number with Medical Exemption or Dissent  Number with No Valid Reason for Incomplete Record

Limitations of Current Process All reporting is done on paper No detailed information provided on students, just aggregate Follow up takes time  Per region: 2 months to gather data, 2 more weeks to compile Several steps involved to compile final statewide report – very time consuming  A minimum of 2 weeks to complete state totals

Considerations for New Process What level of registry access should school nurses have? Will data quality be compromised? Who owns the records in the registry? Are there any current processes that should be changed to ensure proper use of registry? What happens if schools do not have access to a computer or the Internet? How can process be streamlined to minimize extra work for schools? How will FERPA be addressed?

Family Education Rights and Privacy Act (FERPA) Federal Law passed in 1993 Protects the privacy of student education records, including health records Applies to all schools that receive funds from the U.S. Department of Education Supercedes HIPAA Require parental consent for release of information  Added release of student immunization record to registry to existing documents

New Reporting Process School nurses will be given access to registry to complete report by:  Identify school that they are completing report for (they will be able to select >= 1 with their login)  Locate appropriate students and update simplified demographic record  Create records for students not found in registry  View vaccination history and update if necessary  Indicate if child has medical exemption on file  Generate report once all students are selected and updated

Simplified Demographic Screen First, Middle, Last Name Date of Birth Guardian Name Address Phone Number Parish/Region School Grade

New Reporting – Scenario 1 Nurse finds student in LINKS Nurse reviews simplified demographic screen that has been pre-populated with current demographic information Nurse reviews immunization record and finds that student has complete immunization record School nurse selects the report on which the student should appear

New Reporting – Scenario 2 Nurse finds student in LINKS Nurse reviews and edits simplified demographic screen, if necessary Nurse reviews immunization record and finds that student has some but not all immunizations Nurse enters additional immunizations into system then makes selection to include student on report  Dates entered by school followed by symbol to indicate they were not entered by a clinic/immunization provider

New Reporting – Scenario 3 Nurse does not find a record in LINKS New record created in LINKS using simplified demographic screen Nurse enters immunization history with all dates formatted as described in Scenario 2

New Registry Reports Annual School Immunization Report Action Report  Details all children on report that are in need of immunizations or have no immunization record Schools Not Reporting  Details all schools for which data has not been entered Summary of Annual School Data  Compiles data at parish, region and state level for public and private schools

Benefits of New Process Registry offers legible, credible consolidated data to view  Universal Certificate, Vaccination Summary Registry tools help nurses to forecast for needed shots and follow up in a timely manner Streamlined data compilation process for annual reports Using LINKS, school nurse saves time used to track student immunization records Providers (private and public) save time copying records for school use

Benefits of New Process More complete information available for schools, immunization consultants and state to use for follow up Updated demographic and patient records collected in registry – improves credibility of registry with timely information Facilitates efficient process management for state:  Follow up  Enforcement of deadlines  Final aggregation of data Assists in further identification of pockets of need in state School nurses invest in LINKS value and advocate for other providers to enroll as users → recruitment

Current Status of Project Pilot began in February schools participating – 1 from each region Each school will recreate annual report for school year – data will be validated by regional consultants Feedback to date is very positive – minor streamlining changes requested All schools will be in production for school year Plans underway to add Head Start programs