MSIPC Fundamentals: Interaction between IPs and Local and State Health Departments www.michigan.gov/hai Joyce Lai, MPH– Michigan Department of Health and Human Services Noreen Mollon, MS CIC– Michigan Department of Health and Human Services October 21, 2015

Outline MDHHS Organization Communicable Disease Surveillance Reportable Diseases Michigan Surveillance Data Systems MDSS MSSS Sentinel Surveillance for ILI SHARP Outbreak Response Surveillance and Reporting Prevention Initiatives Other MDHHS Entities that frequently interact with IPs

MDHHS Vision Statement MDHHS will promote better health outcomes, reduce health risks and support stable and safe families while encouraging self-sufficiency

and Community Services MDHHS Organization DIRECTOR Chief Operating Officer Office of Inspector General Aging and Adult Services Financial Operations External Relations And Communications Population Health and Community Services Behavioral Health & Developmental Disabilities Administration Medical Services Administration

Bureau of Disease Control, Prevention, and Epidemiology MDHHS Organization Population Health and Community Services Administration Bureau of Disease Control, Prevention, and Epidemiology Bureau of Local Health & Administrative Services Bureau of Laboratories Bureau of Family, Maternal And Child Health Bureau of EMS, Trauma and Preparedness (formerly OPHP) Bureau of Community Services

MDHHS Organization Bureau of Disease Control, Prevention, and Epidemiology Division of Environmental Health Division of Genomics, Perinatal Health, and Chronic Disease Division of Communicable Disease Division of Immunization Surveillance Section Surveillance of Healthcare-Associated and Resistant Pathogens (SHARP) Unit Regional Epidemiology Unit

Communicable Disease Surveillance Communicable disease reporting is required by Michigan law: Michigan Public Health Act No. 368 Communicable Disease Rules: R 325.171-3, 333.5111 Rule revision allows the State the right to periodically update the list of reportable diseases This reporting is expressly allowed under HIPAA Hepatitis C Virus Neisseria meningitidis Histoplasma capsulatum Bordetella pertussis

Why Communicable Disease Surveillance is Important To identify outbreaks To assure treatment, preventive treatment and/or education To evaluate prevention and control programs To help target prevention resources To facilitate epidemiologic research To assist national and global surveillance efforts Chlamydia trachomatis Influenza Virus Mycobacterium tuberculosis Salmonella sp.

Public Health Depends on Collaboration Healthcare Providers Clinical Laboratories Local Health Department Isolates and specimens sent to State Lab for additional testing State Health Department Centers for Disease Control and Prevention

Communicable Disease Reporting Entities Physicians* Laboratories* Hospital ICP Private citizens School systems* Pharmacists Veterinarians Medical Examiners Hospitals* Child care facilities Long-term care facilities* Pre-hospital emergency services Police Fire EMS *Required to report

Communicable Disease “Brick Book” The current 2015 version provides a good summary of the communicable disease rules, requirements, and responsibilities

Michigan Reportable Diseases ~90 disease/conditions are reportable in Michigan Also reportable are ‘unusual occurrences’, outbreaks and epidemics of any disease or condition (including healthcare-associated infections) Specific reporting rules and definitions can be found at www.michigan.gov/cdinfo List available by condition or by pathogen

Case Rules and Definitions Example of Streptococcus pneumoniae reporting algorithm

Case Rules and Definitions Acute / Chronic Hepatitis C Reporting Flowchart

Timeliness and Completeness of Communicable Disease Reports In general, all reportable diseases are required to be reported within 24 hours of confirmation Report contents Demographic info – name, date of birth, sex, race Contact info – address, phone number Disease details – onset date, lab results Surveillance is only as good as the data received The timeliness and effectiveness of public health responses are dependent on prompt and accurate surveillance reporting

Authority of State and Local HDs Michigan is a “home rule” state, meaning local HDs have autonomy within their jurisdiction The MDHHS operates independently from the local HDs The primary role of the MDHHS in communicable disease control is to provide: expert consultation reference level diagnostics laboratory services childhood vaccines support local HDs upon their request Maintenance and administration of the MDSS All communicable disease reports should be reported to your local HDs

Map of Michigan Local HDs

Public Health Investigative Authority State and local HD personnel are authorized to investigate reported diseases, including: Contacting health providers Conducting additional case-finding Conducting epidemiological studies Conducting specimen collection Gathering information on medical history, lab results, diagnostic procedures, treatment, and health outcomes The MDHHS works collaboratively with the local HDs and participates in investigations when requested

Confidentiality, HIPAA, and PHI Disclosure of protected health information (PHI) to health authorities without individual consent or authorization is permitted when disclosure is required by law or is authorized by law for a public health purpose (www.hhs.gov/ocr/hipaa/) All information provided to public health authorities is kept confidential

Helpful Links www.michigan.gov/mdhhs Click on ‘Providers’ and then ‘Chronic and Communicable Diseases’ www.michigan.gov/hivstd - HIV/STD/Viral Hepatitis www.michigan.gov/cdinfo - Communicable Disease resources, forms, links, reports, and publications www.michigan.gov/mdss - Michigan Disease Surveillance System (MDSS) www.michigan.gov/hai- Healthcare-Associated Infection Surveillance & Prevention

Michigan Surveillance Systems Michigan Disease Surveillance System (MDSS) Michigan (Emergency Department) Syndromic Surveillance System (MSSS) Sentinel Surveillance for Influenza-Like Illness

Disease Detection/Reporting Timeline Symptom Onset Seeking of Medical Care Reported to Local HD Reported to State HD Exposure Diagnosis Time ED Syndromic Surveillance Michigan Disease Surveillance System

Michigan Disease Surveillance System Web-based communicable disease surveillance system Disease can be reported 24/7 from your computer Used to facilitate coordination between local, State, and federal public health agencies Streamlines disease reporting; more efficient and closer to real-time Allows for more timely public health interventions Reduces delays in public health follow-up by grouping disease based on county of patient residence

Michigan Disease Surveillance System Data in the MDSS can be accessed and edited by multiple parties which facilitates the sharing of information without requiring multiple phone calls Allows for instantaneous retrieval of summary reports MDHHS Weekly Surveillance Report (www.michigan.gov/cdinfo) Data sent to CDC National Notifiable Disease Surveillance System (NNDSS – www.cdc.gov/nndss) for Morbidity and Mortality Weekly Reports (MMWR – www.cdc.gov/mmwr)

MDSS Reporting Pathways Community Physicians Infection Preventionists Hospital Labs Local Health Department MDSS Case Follow-up Local Surveillance Electronic Reports CDC MDHHS National Notifiable Disease Surveillance System (NNDSS) Morbidity and Mortality Weekly Report (MMWR) Statewide Surveillance Weekly Surveillance Reports (WSR)

Adding/Editing Cases in MDSS

Searching Records in MDSS

Pulling MDSS Data

Pulling MDSS Data

Individual Case Reports MDSS Statistics Year Referrals Individual Case Reports Transactions Unique User Log Ins 2007 83,876 77,686 400,000 ---- 2008 136,057 104,616 429,848 783 2009 160,326 119,843 618,731 893 2010 158,225 113,765 697,258 906 2011 213,639 159,185 803,092 982 2012 211,150 146,069 1,018,304 1,126 2013 185,362 126,812 1,059,023 1,155 2014 174,237 134,896 1,245,493 1,218

MDSS System Use Statistics

More Info on the MDSS http://www.michigan.gov/mdss (517) 335-8165 Contact: Your Local Health Department Communicable Disease Program Your Regional Epidemiologist Edward Hartwick, MS, MDSS Coordinator HartwickE@michigan.gov http://www.michigan.gov/mdss (517) 335-8165

Michigan (Emergency Department) Syndromic Surveillance (MSSS) A surveillance system that detects and tracks the chief complaints of ED patients throughout the state Chief complaints are classified into syndromic categories that could indicate a possible public health emergency Web-based application displays the data in real-time Alerts are automatically sent when rates of a given syndrome are detected to be higher than the predicted norm

MSSS # of facilities: 95 # of users: 173 # of referrals per day, Statewide: 12,343 # of referrals per day, per facility: 130

MSSS Data Each message sent to the MSSS consists of: Demographics: date of birth, sex Residence: home zip code Visit Info: date, time, class (e.g. urgent care, ER) Chief Complaint

MSSS Chief Complaints Chief complaints are classified into the following syndromes: Hemorrhagic Botulinic Neurological Other Default Gastrointestinal Constitutional Respiratory Rash

MSSS Classification Examples Chief Complaint Syndrome “slurred speech” Botulinic “general weakness” Constitutional “stomach pain” Gastrointestinal “difficulty breathing” Respiratory “nose bleed” Hemorrhagic “headache” Neurological “hives and itching” Rash “right foot injury” Other “med refill” Default

MSSS Alerts A detection algorithm monitors the data hourly An e-mail alert is sent to State and regional epidemiologists if an aberration is detected If the actual value of a syndrome exceeds the predicted value for a given syndrome in a geographic area Users can view the data in charts, graphs, or maps

Use of MSS Data Early detection of outbreaks Enhanced surveillance during high-profile events: World Series Super Bowl MLB All-Star Game Final Four Detroit Auto Show Seasonal influenza monitoring Situational awareness

Sentinel Provider Surveillance for Influenza-Like Illness (ILI) Michigan component of the CDC U.S. Outpatient Influenza-like Illness Surveillance Network Influenza sentinel reports provide data on over 12,000 outpatient office visits per week and are an important part of influenza surveillance in Michigan Contact Stefanie Cole at 517-335-9104 or DevitaS1@michigan.gov for more information

Michigan Influenza Sentinel Hospital Network MDHHS is working to establish a network of sentinel hospitals that report influenza-associated hospitalizations Hospitals that agree to participate would be asked to provide: Weekly report consisting of the number of influenza-associated hospitalizations in each of five age categories Total number of admissions during that time frame Contact: Seth Eckel (EckelS1@michigan.gov) 517-335-1194

Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit Objectives of the SHARP Unit: Coordinate activities related to HAI surveillance and prevention in Michigan Improve surveillance and detection of antimicrobial-resistant pathogens and HAIs Identify and respond to disease outbreaks Use collected data to monitor trends Educate healthcare providers, state and local public health partners, and the public on HAIs www.michigan.gov/hai

SHARP Activities Outbreak Response Surveillance and Reporting www.michigan.gov/hai SHARP Activities Outbreak Response Surveillance and Reporting CRE Surveillance and Prevention Initiative Consulting/Education Staphylococcus aureus Klebsiella pneumoniae Clostridium difficile

www.michigan.gov/hai Outbreak Response The MDHHS SHARP staff are available to offer our services and expertise in healthcare-associated outbreak investigations MDHHS can help facilities coordinate molecular testing with the MDHHS Bureau of Laboratories to identify genetic-relatedness between patient isolates (at no cost) Acinetobacter baumannii

Recent Outbreaks Investigated by SHARP www.michigan.gov/hai Recent Outbreaks Investigated by SHARP Mycobacterium chelonae associated with tattoos Community-onset, invasive MSSA infections Ventilator-associated Stenotrophomonas maltophila Clostridium difficile in a long-term care facility Serratia marcescens SSIs post-cardiac surgery Pseudomonas aeruginosa SSIs post-cardiac surgery Pseudomonas aeruginosa respiratory infections associated with contaminated transesophageal echocardiogram (TEE) gel Healthcare-associated Hepatitis C Virus (HCV) related to drug diversion Multidrug-resistant Pseudomonas aeruginosa urinary tract infections associated with cystoscopy procedures in an outpatient urology clinic First New Delhi Metallo-beta-lactamase-1 (NDM-1) detected in Escherichia coli (CRE)

Surveillance and Reporting www.michigan.gov/hai Surveillance and Reporting Vancomycin-Intermediate Staphylococcus aureus (VISA) and Vancomycin-Resistant Staphylococcus aureus (VRSA) are required to be reported according to the communicable disease rules Unusual occurrences and outbreaks of HAIs are also mandated by law to be reported However, individual HAIs (like a CLABSI), are not required to be reported to state or local health departments

Surveillance and Reporting www.michigan.gov/hai Surveillance and Reporting 33 states have laws requiring HAIs to be reported to state health departments, the majority of which publically release hospital HAI rates (http://www.jstor.org/stable/10.1086/663204)

Surveillance and Reporting www.michigan.gov/hai Surveillance and Reporting In Michigan, hospitals can voluntarily report HAIs to MDHHS SHARP via the National Healthcare Safety Network (NHSN) NHSN is a web-based surveillance program designed by CDC: Uses standardized HAI surveillance definitions Users can enter and analyze HAI data The data sent to SHARP from Michigan hospitals are de-identified and the numbers aggregated for the purposes of producing state-wide HAI surveillance reports

Surveillance and Reporting www.michigan.gov/hai Surveillance and Reporting HAIs tracked by MDHHS SHARP surveillance: Central Line-Associated Blood Stream Infection (CLABSI) Surgical Site Infection (SSI) Catheter-Associated Urinary Tract Infection (CAUTI) Ventilator-Associated Events (VAE) Clostridium difficile LabID surveillance MRSA LabID surveillance Antimicrobial resistance in select pathogens

HAI Surveillance SSI CLABSI VAP CAUTI CDI LabID MRSA LabID Surgical incision showing signs of infection Subclavian central venous line VAP CAUTI Foley catheter insertion kit Mechanical ventilator CDI LabID MRSA LabID Clostridium difficile Staphylococcus aureus

www.michigan.gov/hai SHARP Surveillance Currently there are 104 Michigan hospitals sharing HAI data with SHARP, with all 104 hospitals releasing their data to the Michigan Health and Hospital Association (MHA) Keystone Center, and 14 hospitals releasing their NICU data to the Vermont Oxford Network (10/7/15).

SHARP Surveillance 86 of 109 (79%) of Acute Care Hospitals in Michigan are sharing data 17 of 36 (47%) of Critical Access Hospitals in Michigan are sharing data 1 of 4 (25%) of Rehab Hospitals in Michigan are sharing data Total: 104 of 168 (62%) of hospitals “A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CAH (fewer in some circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals.” (http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/critical.html) LTAC: “A long term acute care facility is a specialty-care hospital designed for patients with serious medical problems that require intense, special treatment for an extended period of time—usually 20 to 30 days. Long term acute care facilities offer more individualized and resource-intensive care than a skilled nursing facility, nursing home or acute rehabilitation facility. Patients are typically transferred to a long term acute care hospital from the intensive care unit of a traditional hospital because they no longer require intensive diagnostic procedures offered by a traditional facility.” (http://www.dekalbmedical.org/downtown-decatur/about-us/long-term-acute-care)

www.michigan.gov/hai SHARP Reports SHARP releases state-wide HAI reports quarterly, semiannually, and annually which are posted at www.michigan.gov/hai All hospital data are de-identified and aggregated Individual hospital data is not made public SHARP also compiles hospital specific HAI reports which are only shared with those individual hospitals

www.michigan.gov/hai SIR Standardized Infection Ratio (SIR) is a ratio comparing the number of observed infections to predicted infections. It controls for variables such as bed size, location type, medical affiliation, and procedure type (for SSIs only). The number of expected or predicted infections comes from national baseline data. SIR=Number of Observed Infections Number of Expected Infections *=Significantly different from 1 **=Significantly different from previous report

Cumulative Attributable Difference (CAD) TAP reports use the cumulative attributable difference (CAD) to rank hospitals CAD is generally calculated based on a target or goal SIR Michigan reports use the HHS Target SIR CAD = Observed – (Predicted * SIRtarget) Interpretation: CAD>0 = “more infections than predicted” OR “number of infections needed to be prevented to reach the HHS target SIR” CAD<0 = “fewer infections than predicted” OR “number of infections prevented beyond the HHS target SIR” Courtesy of Allie Murad

TAP Reports Targeted Assessment Prevention (TAP) reports gives hospitals a way to target problem areas and see where they rank within a group  The group is the SHARP-participating Michigan hospitals. Courtesy of Allie Murad Source: http://www.cdc.gov/nhsn/pdfs/training/2015/runningtapreports_md.pdf

Courtesy of Allie Murad

www.michigan.gov/hai SHARP HAI Data

2014 Device-Associated SIRs www.michigan.gov/hai 2014 Device-Associated SIRs

www.michigan.gov/hai 2014 LabID SIRs

CRE Surveillance and Prevention Initiative Staphylococcus aureus SHARP also has started a prevention initiative aimed to reduce the incidence and prevalence of MDROs in healthcare facilities in Michigan: Carbapenem-Resistant Enterobacteriaceae (CRE) surveillance and prevention initiative Citrobacter freundii Escherichia coli Klebsiella pneumoniae Enterobacter cloacae

CRE Surveillance and Prevention Initiative www.michigan.gov/hai CRE Surveillance and Prevention Initiative 2011 Awarded ELC funding Hired CRE Coordinator 2012 Met with 8 healthcare systems across the state Developed detection and infection prevention practices survey Formed Collaborative group Recruited 21 facilities Surveillance began September 1, 2012 CRE Educational Conference Kick-off! 2013 Baseline surveillance ends February 28, 2013 CRE Prevention Plans implemented March 1, 2013 2014 Recruited 9 new facilities and maintained all current facilities for Phase 2 Phase 1 ends August 31, 2014 Phase 2 begins September 1, 2014 - all CRE Prevention Plans implemented 2015 Surveillance continues Prevention continues Confirmatory testing, regional incidence, geography, and interest will drive recruitment for Phase 3 in early 2016… In 2011, Michigan was funded through Epidemiology and Laboratory Capacity (ELC) for Infectious Diseases grant from CDC to begin a CRE Surveillance and Prevention Initiative. Coordinator hired in the fall of 2011 and through the spring 2012, we conducted surveys, formed collaborative group, recruited facilities and began surveillance in September 2012. Planning Stage Baseline Stage Intervention Stage

CRE Incidence in Michigan- Phase 1 327 total cases – 284 inpatients Baseline (Sept 2012 – Feb 2013) 102 cases (89 inpatients) 957,220 patient-days 0.93 cases per 10,000 p-d Intervention (March 2013 – August 2014) 225 cases (195 inpatients) 2,791,350 patient-days 0.70 cases per 10,000 p-d 327 total cases… can only calculate incidence on 284 (other cases are outpatients/referrals) Rate difference between baseline and intervention (p=0.03) is statistically significant!! Mid-P exact

Successes the first 2 years Established a baseline incidence rate for CRE September 2012 – February 2013 0.93 cases per 10,000 p-d CRE incidence rate decreased during intervention period March 2013 – August 2014 0.70 case per 10,000 p-d Statistically significant (p=0.03) Michigan prevented 86 infections of CRE 26 infections of CRE prevented in LTACs Baseline 0.93 / Intervention 0.70 (p=0.03)

Past, Present, and Future Phase 1 Phase 2 Phase 3 Time Period September 2012 – August 2014 March 2014 – February 2016 September 2015–August 2017 # Acute Care Facilities 17 24 # Long-Term Acute Care Facilities 4 6 # CRE Prevention Plans 34 43 Baseline Incidence Rate 0.93 0.94 Post-Intervention Incidence Rate 0.70 0.73 # Infections Prevented 86 (26 in LTACs) * 80 (10 in LTACs) Won’t start recruiting until early 2016… * Data as of 4/2015 (work in progress)

Education and Consulting www.michigan.gov/hai Education and Consulting Another primary focus of the SHARP unit is increasing awareness of HAIs, answering FAQs, and disseminating best-practice and evidence-based recommendations and guidelines Examples of entities/persons that ask for our guidance: IPs Gyms Local HDs Correctional Facilities Healthcare workers Students Schools Public

Special Collaboration www.michigan.gov/hai Special Collaboration SHARP collaborates with the MDHHS Viral Hepatitis Unit: Investigating potentially healthcare-related viral hepatitis infections (e.g. David Kwiatkowski)   Works jointly on injection safety-related educational campaigns (e.g. One and Only campaign) Contact information (517)335-8165 www.michigan.gov/hepatitis

SHARP Unit Contacts (517) 335-8165 www. michigan SHARP Unit Contacts (517) 335-8165 www.michigan.gov/hai MDHHS-SHARP@michigan.gov www.michigan.gov/hai Jennie Finks, DVM, MVPH – HAI Coordinator and Unit Manager finksj@michigan.gov Mike Balke, MPH- CSTE HAI fellow balkem@michigan.gov Jennifer Beggs, MPH – Infectious Disease and Preparedness Epidemiologist beggsj@michigan.gov Brenda Brennan, MSPH – CRE Prevention Initiative Coordinator brennanb@michigan.gov Allison Murad, MPH – National Healthcare Safety Network (NHSN) Epidemiologist murada@michigan.gov Noreen Mollon, MS CIC – Infection Prevention Consultant mollonn@michigan.gov

Other MDHHS Entities that Interact with IPs Bureau of Labs (BOL) Office of Public Health Preparedness (OPHP) Licensing and Regulatory Affairs (LARA) Michigan Occupational Safety and Health Administration (MIOSHA) Healthcare Facility Engineering Michigan Care Improvement Registry (MCIR)

MDHHS Bureau of Labs (BOL) Main Phone: (517) 335-8063 Tours available quarterly, to schedule call (517) 335-9654

MDHHS BOL Testing www.michigan.gov/mdhhslab List of Tests performed By MDHHS BOL Forms required to Request testing

Regional Reference Labs Report Suspected Bioterrorism: Lansing: (517) 335-8063 Kalamazoo: (269) 373-5360 Grand Rapids: (616) 632-7210 Saginaw: (989) 758-3825 Oakland County: (248) 858-1310

Bureau of EMS, Trauma & Preparedness Formerly OPHP, BTEP combines the OPHP with EMS and Trauma. This bureau will better serve the citizens through administration and continuous improvement of emergency medical services, trauma system as well as all-hazards preparedness planning and response Division of Emergency Preparedness and Response (DEPR) Division of EMS and Trauma

Michigan Emergency Management System President of US Governor www.fema.gov/nims Michigan State Police State Director of Emergency Management DHS / FEMA Emergency Management Division (EMD) MDHHS EMD District Coordinators Health Preparedness Regions Local Emergency Management Local Health Departments All emergencies and disasters are local

Emergency Preparedness Collaboration Utilities Transportation Emergency Management Fire & Rescue Public Health Hospitals EMS Law Enforcement Public Works Industry / Private Sector www.fema.gov/nims

Emergency Preparedness Training MI-TRAIN (http://mi.train.org)

Emergency Preparedness Communication Statewide communication capabilities: Michigan Statewide Comprehensive Interoperable Communication Plan Public Health Safety Communication System (800Mhz radios) Health Alert Network (HAN)

MI HAN (https://michiganhan.org)

Emergency Preparedness Regions 8 Michigan Emergency Preparedness Regions: Modeled after State Police Regions Encompass 45 Local HD Emergency Preparedness Centers Each Region contains: Medical Director Hospital Bioterrorism Coordinator Epidemiologist

Strategic National Stockpile Able to distribute large quantities of pharmaceuticals and medical supplies during an emergency Local HDs and hospitals are prepared to receive MISNS assets MISNS is capable of delivering assets via ground or air transport

BTEP Contacts Linda Scott – Division of Emergency Hospital Preparedness Coordinator (517) 335-8150 scottl12@michigan.gov Mary Macqueen – Public Health Preparedness Coordinator macqueenm@michigan.gov

MIOSHA – Michigan Occupational Safety and Health Administration MIOSHA operates under Licensing and Regulatory Affairs (LARA) For healthcare inquiries contact MSIPC’s MIOSHA liaison Eric Zaban: (517) 882-1022 For general consultation and/or training contact: (517) 322-1809 www.michigan.gov/miosha

LARA- Health Facilities Engineering Provide enforcement and interpretation of the minimum healthcare facility design standards to reduce the risk of transmission Kasra Zarbinian (517) 241-3422 www.michigan.gov/hfes

Michigan Care Improvement Registry (MCIR) www.mcir.org Web-based system created in 1998 to collect children’s immunization information Expanded in 2006 to include adults (lifespan registry) Consolidates immunization information from multiple data sources and provides immediate, real-time, patient immunization history Assists with all-hazard preparedness by tracking vaccines and medications during a public health emergency

MCIR Activity 9 million records Over 83 million shot records 29,000 registered users 5,500 active provider sites

The Benefits of MCIR High healthcare provider participation (90%) Reports indicate ‘pockets of need’ Flexibility, allowing linkages with other public health systems Types of information available in MCIR: Patient Immunization status at time of visit Reminders/recall letters Coverage level reports High risk influenza Newborn screening Lead results Early hearing detection and intervention (EHDI)

Immunization Information Annual Fall Conferences – www.michigan.gov/immunize AIM Kits – www.aimtoolkit.org Influenza information “FluBytes”– www.michigan.gov/flu Quarterly Newsletters – send an e-mail with SUBSCRIBE in the subject line to franklinr@michigan.gov Beatrice Salada, State MCIR Coordinator saladab@michigan.gov www.mcir.org

Thanks! Questions or comments? Joyce Lai Noreen Mollon (734) 727-7204 LaiJ@michigan.gov Noreen Mollon (517) 335-6582 MollonN@michigan.gov