Laura Heermann Langford, RN, PhD Connect: Registry to Private Provider USIIS & Intermountain Health Care: A Partnership with an HL7 Backbone Joseph L. Nay, BS Utah Department of Health David J. Richards, BS Laura Heermann Langford, RN, PhD Intermountain Health Care Salt Lake City, Utah Copyright 2002 D.J. Richards, Intermountain Health Care Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Why Health Plans? HEDIS Vested interest in Immunization Rates Historical Data Advanced health record management Copyright 2002 D.J. Richards, Intermountain Health Care

What IHC required of USIIS… HL7 back-end interface Phase 1: ADT messages Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Real Time ADT messages Copyright 2002 D.J. Richards, Intermountain Health Care

What IHC required of USIIS… HL7 back-end interface Phase 1: ADT messages Phase 3: Vaccines messages Copyright 2002 D.J. Richards, Intermountain Health Care

VXU Real Time vaccine message Copyright 2002 D.J. Richards, Intermountain Health Care

VXU Nightly Batch Updates Copyright 2002 D.J. Richards, Intermountain Health Care

What IHC required of USIIS… HL7 back-end interface Phase 1: ADT messages Phase 3: Vaccines messages Application Performance Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Where we were and are… Copyright 2002 D.J. Richards, Intermountain Health Care

What IHC required of USIIS… HL7 back-end interface Phase 1: ADT messages Phase 3: Vaccines messages Application Performance Service Level Agreement Security Measures Copyright 2002 D.J. Richards, Intermountain Health Care

What did IHC do for USIIS? ~ 60% of private health data Quality of data (Saturation Rate Increase of 14.3%) Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care USIIS Saturation Rate Percentage of children in USIIS with 2 or more vaccines IHC Data Load Aug. 2001 Copyright 2002 D.J. Richards, Intermountain Health Care

What did IHC do for USIIS? ~ 60% of private health data Quality of data (Penetration Rate Increase of 14.3%) 46 private health clinics Enhanced Enrollment Copyright 2002 D.J. Richards, Intermountain Health Care

Enrollment Rates This includes all IHC clinics Copyright 2002 D.J. Richards, Intermountain Health Care

What did IHC do for USIIS? ~ 60% of private health data Quality of data (Penetration Rate Increase of 14.3%) 46 private health clinics Enhanced Enrollment Image of registry as valid resource of information Quality of testing application $$$$$$-Money Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Why did IHC want USIIS? HL7 interface available Support for real time data transfer Willingness to work with IHC and seamless integration of systems Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Why did IHC want USIIS? Missed opportunities Need for reminders Multiple sites of care Burdensome documentation/charting Difficulty keeping current with Recommendations Time consuming, incomplete methods for determining immunization rates and creating reports Introduce each reason separately without detail. Say each reason as it comes up on the screen. Copyright 2002 D.J. Richards, Intermountain Health Care Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Missed Opportunities Problem: Children are seen in the clinic for reasons other than a preventive care visit and their immunizations are overlooked USIIS Solution: Forecast report shows shots That are complete Due or overdue Can be printed the day prior to visit Easy look up for other family members present Problem: Easy for provider and parent to “not remember” immunizations when immunizations aren’t the reason for the clinic visit. Previous attempts/solutions that didn’t work? (ask Tamara, will time allow?) Solution: Forecast (which shows due date and status – complete, current, due, overdue, immune – for each vaccine type or series) is viewed prior to every child’s appointment – whether the appointment is a Well or Sick visit. *Put in new slide showing Forecast Rpt example? (If looking for more time) Copyright 2002 D.J. Richards, Intermountain Health Care Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Need for Reminders Problem: No efficient method for identifying patients not up to date with immunizations USIIS Solution: Allows the state, clinic or IHC to create lists of children not up to date Copyright 2002 D.J. Richards, Intermountain Health Care Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Multiple Sites of Care Problem: Full record not present when child seen Shots given to patient outside primary clinic (hospital, shot van, public health clinics). USIIS Solution: Information from various sources Hep B given at hospital automatically entered (7-14 days post birth) Copyright 2002 D.J. Richards, Intermountain Health Care

Burdensome Documentation/Charting Problem: Documentation requires 4-6 separate entries by nurse to chart a given immunization USIIS Solution: Nurse documents only once per shot and prints reports accordingly Don’t need to put on slide but remember to mention the 4-6 sites are between mediums, computer, chart, other “sheets” around the clinic for ordering etc. Copyright 2002 D.J. Richards, Intermountain Health Care Copyright 2002 D.J. Richards, Intermountain Health Care

Difficulty keeping current with Recommendations Problem: ACIP/AAP recommendations change every 6-12 months without notification of update. Clinic can be following outdated recommendations USIIS Solution: USIIS contracts with a firm to keep logic updated as per the latest CDC guidelines Tamara emphasized to me how difficult it was to communicate the changes to all clinicians. First a small group would only hear about them at monthly meetings, then word would have to be communicated numerous clinics, and there was no good medium to do so. People don’t keep up in reading newsletters, etc The time between the CDC change and the actual impl. In routine pt care could be considerable Copyright 2002 D.J. Richards, Intermountain Health Care Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Time consuming, incomplete methods for determining immunization rates and creating reports Problem: Reports all had to be filled out by hand using billing databases or by going through patient charts HEDIS® School Entry Reports Immunization History VFC Report CASA Reports Copyright 2002 D.J. Richards, Intermountain Health Care

Copyright 2002 D.J. Richards, Intermountain Health Care Time consuming, incomplete methods for determining immunization rates and creating reports USIIS Solution: Health Plans have access to USIIS for HEDIS® reporting A built-in CASA report VFC reports automatically tallied and sent electronically to VFC Program School report and patient specific reports available Copyright 2002 D.J. Richards, Intermountain Health Care

Results From Using WebKIDS at IHC Users do not want to return to their old process End users have accepted WebKIDS reports Users found WebKIDS to be time-saving and efficient Copyright 2002 D.J. Richards, Intermountain Health Care

Time savings at IHC using USIIS Process Pre-USIIS Post-USIIS Time Saved Vaccine Administration per patient 11:21 8:04 3:17 Determine patient’s need for immunization 1:38 0:10 1:28 Create new Individual Immunization Record 10:02 1:29 8:33 Create new School Report 5:47 2:22 3:25 Look-up/Edit history of contraindications/exemptions 3:33 1:01 2:32 Record reaction to immunization 1:46 0:49 0:57 Copyright 2002 D.J. Richards, Intermountain Health Care

Increased Immunization Rates at IHC (1999 – 2000) The most dramatic one-year increase to date HEDIS® measurement for commercial members increased from 64.7% to 76.2% Absolute increase of 11.5 percentage points HEDIS® measurement for Medicaid members increased from 66.4% to 76.9% Absolute increase of 10.5 percentage points Copyright 2002 D.J. Richards, Intermountain Health Care