Registry Impact on Program Operations Plenary – Immunization Programs Registry Impact on Program Operations Barbara C. Canavan, Director Oregon Immunization ALERT

Registry Impact on Program Operations ALERT is integrated with most aspects of Oregon’s Immunization Program. Strategic directions include: Target immunization services based on registry data Build on lessons learned with the registry to integrate early childhood services in Oregon “ALERT is the cornerstone of Oregon’s Immunization Program” - Lorraine Duncan, Immunization Program Manager

Registry Impact on Program Operations Background on Oregon’s registry (ALERT): 1994 - created by a public-private partnership 1996 - first immunizations from private sector 1998 - first use of registry data Current Status – 2002: 950K child records (ages 0-18) 13.5 million immunizations Largest health plans (7) and hospitals (23) voluntarily contribute 35% of funding ALERT team has 10 staff members

Registry Impact on Program Operations Current Status: Provider participation in ALERT: 84% of private providers 100% of county health departments and most other public sites Major health plans send data regularly Records are sent to ALERT electronically, and about 25% by barcode (paper) system ~93% of Oregon preschool kids are in ALERT with immunizations

Provider Participation Registry Impact on Program Operations Providers, Plans, Schools Immunization records Recall postcards Data for HEDIS Identify high risk kids Reduce school exclusions Vaccine trends Evaluate interventions Support disease surveillance Identify barriers Partners Registry Data AFIX Vaccine accountability VFC Program Program Mgmt Provider Participation

Registry Impact on Program Operations Source of Shot Records in ALERT 8.5 million immunizations submitted in last 3 years

Registry Impact on Program Operations Produce child shot records for clinics, schools, plans, hospitals How do providers access immunization histories in ALERT?

Registry Impact on Program Operations Vaccine Accountability Ensure that VFC providers identify eligibility VFC codes are entered in ALERT from many electronic and paper sources ALERT generates reports showing the # of children seen for each clinic by age group Provider Participation Reports – compare VFC Profiles to # of kids in ALERT Joint VFC-ALERT newsletter to providers. Currently no interface from VACMAN to ALERT.

Registry Impact on Program Operations Provider Quality Assurance: VFC-AFIX activities use ALERT data for all provider and clinic assessments. ALERT data feed into CASA. No chart pulls. ~112 data extracts for AFIX and other assessments in the past 7 months: 62 for public sites assessments (multiple runs) 14 for AFIX process in private sector 4 for Medicaid (OMAP) - GRPA and SCHIP 17 for OMAP managed care for HEDIS 15 for antigen trends, CDC studies

Registry Impact on Program Operations Provider Quality Assurance: Use registry data to prioritize VFC site visits: Identify clinics with low coverage rates and/or reporting level of VFC eligibility Use ALERT as an incentive – vaccine accountability, coverage assessments, recall reports, recognition Identify patterns in dose administration (invalid doses, etc.) Registry data can be powerful evidence to improve immunization practice.

Registry Impact on Program Operations Provider Quality Assurance - Relationship Between Missed Opportunities (MO) and Up-to-Date (UTD) Rate for 46 clinics

Registry Impact on Program Operations Provider Quality Assurance & Education: Promote ALERT as a core public health function Public health clinics promote ALERT with private providers in their community Focus for local VISTA workers Improve options to submit data Largest private clinics in Oregon submit data to ALERT electronically Update websites to include more current links

Registry Impact on Program Operations Statewide Recall Postcards Children at 24 months of age overdue for at least one immunization based on ACIP recommendations for 4:3:1:3:3:1 Monthly mailing for statewide postcards. Clinics get advance notice of kids overdue. 300 private clinics and many public clinics 2200-2500 postcards monthly Recall process creates good opportunities to: improve data completeness reinforce simultaneous administration of vaccines

Registry Impact on Program Operations Use registry data to measure the impact of interventions to raise rates

Registry Impact on Program Operations Provider Quality Assurance – Perinatal Hep B 213 kids born 99-01 to HBsAg moms were “lost”: ALERT tracked last provider of record Epidemiologist worked with the local health departments to locate, immunize and give post-vaccine serology tests % with 3 doses of Hep B vaccine improved from 69% to 78%

Registry Impact on Program Operations Service Delivery - Assess Underserved Kids Oregon Medicaid (OMAP) has been one of Oregon Immunization Program’s and ALERT’s primary funders. Great collaboration to: Improve pre-school immunization rates Participate in national GPRA process Identify factors that contribute to low rates for this population (such as late starts) Measure interventions (such as recalls)

Registry Impact on Program Operations Service Delivery - Assess Kids under Medicaid Government Performance and Results Act (GPRA) 4:3:1 @19-35 months for all kids covered by Medicaid Managed Care (OMAP) plans. Used registry data only. No chart pulls. OMAP achieved its 3rd year goal in the first year

Registry Impact on Program Operations Service Delivery - Assess Kids under Medicaid Key results of GPRA project to date: ALERT data revealed barriers in administrative systems that contribute to late starts: Proved to be powerful evidence to convince policymakers, OMAP Medical Directors, and health plans #1 policy recommendation by advisory group Incentive for plans to submit data to ALERT OMAP now uses ALERT data to publish HEDIS rates for all Medicaid MCOs

Registry Impact on Program Operations Service Delivery – Assess MCO rates (HEDIS) This plan immediately took action to improve regional participation in ALERT

Registry Impact on Program Operations Service Delivery – Schools and Child Care ALERT produces immunization status for childcare providers based on enrollment rosters. School access to ALERT from Oregon’s largest district serving 85K kids in Portland: District found additional records in ALERT for 33%-49% of kids at risk for school exclusion. ALERT and the school district won the 2002 “Innovative Partnership” Award from the Oregon Partnership to Immunize Children (OPIC).

Registry Impact on Program Operations Disease Surveillance ALERT participates in a CDC study to: Link registries with disease surveillance to help evaluate the efficacy of PCV 7 in children Supports prevention and control efforts for: Perinatal Hep B - track series completion Hep A - identify clinics needing follow-up, plan interventions

Registry Impact on Program Operations Hepatitis A project: Communicable disease specialists asked ALERT to help with the following questions: Have providers been giving Hep A doses according to the year 2000 ACIP schedule? What age groups are being immunized? What clinics have incorporated Hep A into their practices?

Distribution of Oregon Children born 1983 to 1998 with Hep A Dose 1 reported to ALERT (n=91096) Hep A immunization rate in Oregon is ~25% for kids ages 2-5 Pre-school Adolescents Oregon is a state that has periodic resurgence of Hep A. Imm rates are still very low (about 10%). Used ALERT to assess what children, ages 2-18, are getting immunized. CD specialists have noted that year 2000 has the lowest incidence ever recorded. Oregon is anticipating that we are soon to go into a disease cycle. Edis and CDs will look to ALERT to see who is vaccinated, from what regions, and what docs are giving the vaccine.

Registry Impact on Program Operations Help identify clinics for education and follow up

Registry Impact on Program Operations Monitor schedule changes – Thimerosal and Hep B Birth Dose 0-56 days Mid- 1999 0-5 days after birth

Registry Impact on Program Operations Birth Cohort = 46K 76% of the kids born in 2000 have at least PCV 1 Monitor the impact of changes to the childhood vaccine schedule Prevnar has been very well accepted by private providers in Oregon. Clinicians are making a clear choice to administer this vaccine. Most doses on record are given to children <1 year of age, but the uptake for all kids <2 is quite good. 63% of children born in Sept 2000 have had PCV1, based on birth cert records and imms in ALERT. Prevnar harmonizes well with the well-child visits at 2, 4, and 6 months of age.

Good ways to get involved Registry Impact on Program Operations Conclusion: Registries are valuable tools to enhance immunization services. Programs can reduce the “learning curve” and take advantage of lessons learned: AIRA (American Immunization Registry Association) - network of registry managers, developers, staff and supporters. Created to advance the important work of registries. PROW (Programmatic Registry Operations Workgroup) - AIRA/CDC. Identify and share registry best practices that support immunization program goals. Good ways to get involved Thank you !