Texas Department of State Health Services Immunization Resources and Updates ImmTrac Program & HPV Updates 2016 HPV Seminar February 26, 2016 James Loiselle, MPA Legislative Liaison, IDCU www.ImmunizeTexas.com

Outline ImmTrac Snapshot Registering for ImmTrac ImmTrac Replacement Project Project Update Benefits for Providers Reminder/Recall Functionality HPV Update Summary

ImmTrac Snapshot: Q4 2015 138.7 million immunizations recorded 7.3 million Texas children 2.3 million children under age 6 years 92.8% parents “grant” consent for their newborn babies 499,134 ImmTrac Adult Clients 202,343 immunization history reports generated per month (average)

ImmTrac Snapshot: Q4 2015 cont. 9,581 active online user sites 39,488 first responders or first responder family members 18 years of age and older 1,257,416 disaster-only clients

Immunization Records Total Vaccine Doses (Total as of this Quarter) 2012 2013 2014 2015

Immunization Records Total Vaccine Doses (Annual)

Active Online User Sites (Total as of this Quarter) Number of user sites logging on to the web application during the previous 6 months. ImmTrac - Texas Immunization Registry

Active Online User Sites Number of user sites logging on to the web application during the previous 6 months. ImmTrac - Texas Immunization Registry

Registering for ImmTrac www.immtrac.org It’s Free Register online at http://www.immtrac.org It Helps Increase Vaccine Coverage Rates It allows providers to search for immunization histories on new patients It assists with lost records or records that are difficult to interpret It provides a method for doctors to send recall and reminder notices of pending or overdue immunizations It’s the Law House Bill 1921 requires all health-care providers to report to ImmTrac all vaccines administered to children younger than 18 years of age

Registering for ImmTrac www.immtrac.org

Registering for ImmTrac www.immtrac.org

Registering for ImmTrac www.immtrac.org

ImmTrac2 Update Largely federally funded project with some GR funding Estimated project expenditures for the complete system 2013-2017 are $7.3M Wisconsin Immunization Registry (WIR)-based system Phase one rollout – Registry functionality scheduled for May 2016

Remaining Timeline Present – March 2016: March - May 2016 May 23, 2016 System Testing (internal and external users) March - May 2016 Training Users May 23, 2016 Registry Go-Live Date

ImmTrac2 Benefits for Providers This new system will: Provide more detailed immunization history and forecasting, making it easier to determine vaccine duplication and maintain an immunization schedule Enhance user functionality by allowing providers to reset their own password Allow ad-hoc report capability and simplify report development Provide enhanced Reminder/Recall functionality

Current Reminder/Recall Functionality Checks patients against the ACIP schedule Reports can be run at set intervals (e.g., Daily, Weekly, Monthly, Quarterly, Yearly) or at custom intervals Selectable Age or Date Range Providers can choose by organization, with or without subordinates Providers can choose County or ZIP code

Current Reminder/Recall Functionality cont. Reports can be output to different formats Hard Copy CSV file Letters Labels Letters are generated by the ImmTrac system and cannot be modified by providers

ImmTrac2 Reminder/Recall Functionality Create specific reports and save them Select vaccines (i.e., one, some, or all) Ability to include subpotent doses Choose Due Dates (Due Now, Past Due, or both) Dates Target Date Range Date of Birth Range Age Range

ImmTrac2 Reminder/Recall Functionality cont. Occupation (First Responders and Families) High Risk or Exemptions Sorting Options (e.g., last name, first name, provider, county, etc.) Output Options Customizable letters that can be saved CSV file Hard Copy

ImmTrac2 Reminder/Recall Report

ImmTrac2 Reminder/Recall Report cont.

ImmTrac2 Reminder/Recall Report cont.

ImmTrac2 Reminder/Recall Letter

ImmTrac2 Summary ImmTrac2 is designed to: Allow for existing functionality of ImmTrac to be enhanced to honor stakeholder feedback and provide improved functionality for system users Meet CDC requirements Uphold Modeling of Immunization Registry Operations Workgroup (MIROW) best practices

HPV Vaccine Availability Texas Vaccines for Children Program Uninsured or underinsured children CHIP Native American or Native Alaskan heritage Medicaid Adult Safety Net Providers include FQHC’s, RHC’s, FPC’s, Community Health Centers, and STD/HIV clinics HPV vaccine available for uninsured adults -

HPV Vaccine Uptake in Texas 2014 vaccine ordering data was analyzed to compare Tdap and HPV vaccine among TVFC providers 1.4 doses of HPV vaccine ordered for every dose of Tdap Ideal ratio 3.0 (meaning for every 1 Tdap, 3 HPV are administered) Customized adolescent vaccine ordering profiles were sent to over 2,300 providers HPV Vaccine Orders Among TVFC Providers Region HPV:Tdap Ratio PHR 01 1.2 PHR 02 PHR 03 1.4 PHR 04 1.3 PHR 05 0.9 PHR 06 PHR 07 1.7 PHR 08 PHR 09 PHR 10 1.9 PHR 11 1.6 Statewide

Customized VFC Provider HPV Ordering Mailout Vaccine ordering data from iTEAMS assessed for all adolescent vaccines (HPV, Tdap, MCV4) Examined ordering data from 2013-2015 Created customized profiles with HPV:Tdap ratio and overall ordering data Sent customized email reports to providers

HPV Customized Tables Tables included in customized report sent to TVFC providers

HPV-Tdap Vaccine Ordering Ratios Ideal Ratio: 1 Tdap:3 HPV Jun-Sept 2014 1 Tdap:1.15 HPV Total HPV orders: 215,769 Jun-Sept 2015 1 Tdap:1.35 HPV Total HPV ordering: 231,158

Evidence-Based Strategies to Improve Vaccination Coverage at the Clinic Level Reminder/recall system Provider level Parent/patient level (e.g., postcards, telephone calls, text messaging) Standing orders Provider assessment and feedback Assessment of vaccination coverage levels within the practice and discussion of strategies to improve vaccine delivery Utilizing an Immunization Information System, ImmTrac www.thecommunityguide.org/vaccines/universally/index.html

A Call to Action for Texas Healthcare Professionals Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines Educate yourself about HPV and HPV vaccines Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents Communicate vaccination benefits to patients, parents at every opportunity Make vaccination procedures routine and focus on ways to reduce missed opportunities

Questions? James Loiselle, MPA James.Loiselle@dshs.texas.gov