Thinking Outside the Box: Linking an Immunization Registry with Schools Tina Ellis Coyle RECIN Immunization Registry Marshfield Clinic Marshfield, Wisconsin

2002  Marshfield Clinic 2 Recognizing the Need for a Registry n Barriers to children getting immunizations –Parental barriers –Physician barriers –System barriers n Fragmentation of immunization care across the public/private sector n Development of RECIN began in1994

2002  Marshfield Clinic 4 RECIN Background n One of the few registries developed in the private sector n Collaborative development team of private and public providers n Electronic recording and tracking network that all immunization providers use to record and assess the immunization status n Web based, live immunization registry

2002  Marshfield Clinic 5 RECIN Statistics n 3.2 million immunization records n 430,000 unique patients n Facilities using RECIN: –41 Marshfield Clinic sites –15 Public Health Departments –21 Private Facilities –8 Hospitals –14 School Districts –8 Daycare Facilities –1 Retirement Community

2002  Marshfield Clinic 7 Immunizations in the Schools n In Wisconsin, schools must enforce immunization requirements for all students n Immunization dates are public domain data in Wisconsin n Students must have minimum immunization requirements to attend school n Schools must report on students who are not immunization current within the first 40 days of school to the health department

2002  Marshfield Clinic 8 Immunization Requirements n For new Kindergarten students, and new students must have –4 DPT/DTaP/DT –4 Polio –2 MMR –3 Hep B –1 Varicella (or history of disease) n Personal conviction, medical, religious conviction, and history of waivers

2002  Marshfield Clinic 9 What Schools Need from RECIN n Schools are being asked to do more with less n Both schools and health care facilities must track immunization data n Duplication of record keeping results in wasted time and money spent locating patient’s history by chart pulls, phone calls, etc. n Most schools still have manual tracking systems n Automated schools required data entry of immunizations already in RECIN n Not always accurate from parents

2002  Marshfield Clinic 10 It’s About Time! n In 1999, one school district in Wausau, WI spent before RECIN: –56 hours sending out immunization cards to parents –90 hours entering immunizations reported by the parents into their own system –25 hours filing cards –95 hours generating non-compliant letters to parents –30+ hours calling immunization providers

2002  Marshfield Clinic 11 Getting Started n Public health officials, and school board representatives saw the benefit of linking the two systems together n Taking advantage of work already done and maximize their immunization system n The goals were to: –decrease administrative time tracking immunizations tracking –gain more accurate immunization histories

2002  Marshfield Clinic 12 Development of RECIN in the Schools n Fall 1999: Gave selected schools view rights to RECIN –PROBLEM: still had to maintain other system to run reports…………Dual Entry n December 1999-February 2000: Formed work group to design a system that would integrate RECIN with school immunization law requirements

2002  Marshfield Clinic 13 Development Cont. n Funds were secured via a grant from the Family Health Center of Marshfield to cover the programming costs n Winter 1999 to Summer Specification, design, programming, and testing n Fall Implementation of the RECIN school module Integration of data

2002  Marshfield Clinic 14 System Features n Includes all school district demographics –School, grade, admission date –Access to student records 3 to 21 years of age n Generates reports of children who are behind schedule, in process, no record, and waivers n Prints all required legal notices to parents and the District Attorney n Calculates and prints reports to local health department

2002  Marshfield Clinic 15 System Benefits n Schools –Enormous time savings –Centralized work flow –More accurate data, reports, and letters n Providers –Fewer phone calls and chart pulls –More complete records n Parents –Less paperwork when registering students. No more repeated requests for data –Time savings

2002  Marshfield Clinic 16 Unique Stories n Shift in programming –Immunization providers rely on age of the child –schools track students by the grade they are enrolled n Complexity of school immunization laws n Schedule is more accurate –Catching missed MMR n Fluidity of school populations

2002  Marshfield Clinic 17 Unique Stories n Centralizing –The “guilt factor” n Before RECIN, it took 95 hours to produce the 15- day letters n Post implementation workflow was centralized n 15-day letters generated in under 1 hour –Loss of control –Learning to trust, and question, RECIN n The first year’s immunization rates

2002  Marshfield Clinic 18 In Summary n School Districts are being asked to do more with less n Registries can equip school personnel with an efficient tool to: –Track their students more accurately –Reduce administrative time spent generating reports –More accurate data, reports, and letters n Providers can focus on better patient care due to: –Fewer telephone calls and chart pulls –More complete records

2002  Marshfield Clinic 19 It Takes a Community! Tina Ellis Coyle RECIN System Coordinator Marshfield Clinic