Ensuring Data Quality… New Jersey Statewide Quality Assurance Initiative

BACKGROUND New Jersey Immunization Information System (NJIIS), established in 1997, is a web enabled immunization information system that provides an electronic immunization history, generates recommended immunization schedules, provides reminder/recall notices and other reports for physicians, clinics and other approved medical providers. 1.4 million people enrolled                 1,500 active users                 15.4 million vaccine doses

BACKGROUND cont. NJIIS is designed to assist healthcare providers accurately assess patients immunization status. Quality Assurance is a vital process in ensuring data integrity and increasing provider usage History of NJIIS- current # of users, # records, Mandate: By January 1, 2010 all health care providers who vaccinate children six years of age or younger use NJIIS to record immunization administered within 14 days past recruitment efforts, new mandates etc. Staff and structure- #state team, # MCH staff (Recruiters and trainers)

Partners New Jersey Department of Health and Senior Services, Vaccine Preventable Disease Program Regional Maternal and Child Health Consortia VFC Providers

POLICY To ensure immunization data submitted to NJIIS from healthcare providers is accurate and complete when compared to the patient’s clinical data documented in the provider’s medical record.

MEDICAL RECORD SAMPLING The QA record sample guideline in determining the number of medical records to review is 10% (maximum 100 patients) of the total number of children ages 0-6 years old enrolled in the provider’s practice. A list of children in this age group is randomly selected from the NJIIS Provider’s Patient Master Listing for the provider in which the immunization assessment is being conducted.

Patient Master listing is used to determine the total # of patients a provider has within the target age range and to ensure the sample size is correct.

PROCEDURE/PROCESS A letter is sent to the healthcare provider requesting copies of patient’s immunization information from medical record for quality assurance review (5 days to respond). The QA representative will fax the provider a list of patients’ needed to conduct the audit. The QA representative will also send provider a form requesting the names of all NJIIS users in that practice. If a user is currently listed as active for a provider but not on the list returned by the practice the user is revoked. (QA reps makes sure that user is not connected to any other provider before the request is made)

Chart Comparison Upon receiving immunization information from the provider, the QA representative will compare NJIIS information against the provider’s medical record for errors, invalids, omissions and demographic errors.

Process Cont.. The QA representative will record all findings of immunization assessment on the audit summary form. The QA representative will provide feedback to the provider regarding the audit findings and recommend corrective measures to correct any errors and omissions. Clock starts ticking……

Process Cont.. The audits in progress are filed as pending until all errors have been corrected by the provider. Once the errors have been corrected, the audit is filed as completed for future reference. The QA representative records all communications with the provider regarding request to complete the assessment in the QA Memo section of the Provider’s Profile.

QA Memo

Provider Follow-up (corrective actions) Provider has 2-5 business days to make corrections on errors Follow-up call to check on status of corrections, extension of an additional 5 days, with mention of office visit Schedule/unscheduled office visit Final step- referred to Registry Coordinator Note: Corrections made no later than 28 days

Results To date 104,918 shots reviewed Error rate 2% Omissions rate 20% 207 providers audited (% of active providers)

Provider challenges Limited provider resources to make corrections Noncompliance of provider offices with suggested timeline given by NJIIS staff Legibility of patient records Difficulty accessing/finding records of patients no longer with the practice

Next Steps BATCHLOADS An electronic file containing demographic and immunization information on multiple individuals. The file is generated by OITS Office of Information Technology Systems

NJIIS Batchload Audit Policy Before any batch data from a provider, health plan or WIC system new to NJIIS can be loaded into NJIIS, it must be compared to the medical record to determine the completeness and accuracy of the batch data. A site must have at least 90% accuracy for their historical data to be loaded and for NJIIS.

Batchload Policy cont. OITS will generate audit sample list of 5 percent of data load or a maximum of 200 patients from each site’s batch file. QA Representative will establish date for audit, instructs site to have charts pulled and to provide space for the audit.

Batchload cont. QA will generate the site audit forms for the sample patients and compare each audit form against the medical record, marking any vaccines missing from the audit form/batch file, any discrepancies in vaccine types or dates, and any vaccines in the audit form/batch file not in the medical record. Results of the audit are documented on the Audit Summary form and monthly spreadsheet. The Audit Summary will indicate the status of the chart audit for completeness and accuracy for each site.

Batchload cont. A satisfactory score is reported to OITS data load staff, who will then schedule the data upload. An unsatisfactory score is reported back to the site submitting the data file to investigate systematically erroneous coding procedures or incomplete documentation that could impact accuracy and/or completeness. A site with an unsatisfactory score must take corrective action and schedule a follow up chart audit. Immunization data is not loaded in NJIIS until the data pass the audit review.

Contact Information Velva Dawson, MPA Eltonette Byrd Director of Operations Lead QA Specialist CNJMCHC CNJMCHC (732)937-5437 (732)937-5437 vdawson@cnjmchc.org ebyrd@cnjmchc.org Dorothy Williams McCall Statewide Registry Coordinator NJDHSS (609)588-7520 Dorothy.Williams@doh.state.nj.us