1. PRESENTED BY: REBECCA COYLE M.S. ED. AIRA EXECUTIVE DIRECTOR Inconsistency among registries negatively affects overall data quality, comparability, operational cost, and usefulness of information.

2. UNITED STATES  U.S. Population 317,000,000  50 Federated States  1 District  5 Territories

4. BACKGROUND  AIRA was formed as an independent organization to bring together the registry /immunization information systems (IIS) community to support the continued use of registries.  AIRA provides a way to work together to develop standards, best practices, strategies and provide education to IIS.  AIRA began developing standards early on, but there are still many areas that need standardization.

5. HOW NOT TO RE-INVENT THE WHEEL

6. BACKGROUND  Over time jurisdictions (states/cities) that prioritized and invested in the use of IIS have been successful.  Other jurisdictions have not been as successful for various reasons  Local politics and/or policies  Funding  IT structure  Local product/lack of internal ability to support and enhance the system

7. NATIONAL THEMES Interoperability with EHRs StandardizationJoint DevelopmentInterstate Exchange 2013-2017 Functional Stds, Core Data Elements Small Area Analysis/AFIX Certification

8. CHALLENGES & SUCCESSES  Successes  All but one state has a IIS  Most IIS are able to electronically exchange information with the medical providers  Have standardized many operations and functions  Patient de-duplication  Vaccine Data Quality  Patient status  Vaccine Forecasting  Challenges  Policy issues still exist  Can’t easily exchange data with another state  Difficult to compare data from one state to another  Implementing standards takes time  No mandate to implement standards  There are still many areas that we would like to standardize  Assessment criteria  Bi-directional data exchange  Clinical decision support (forecasting)

12. DATA EXCHANGE - HOW DATA FLOWS State or City Immunization Information System Doctor Electronic Manually Health Clinic Electronic Manually Pharmacy Electronic Manually Health Information Exchange Hospital Electronic Manual Vital Records (Birth Certificate/ Death Certificate)

13. DATA EXCHANGE – COMMON DATA EXCHANGE

14. DATA EXCHANGE - HOW DATA MAY FLOW

15. MIROW A PROCESS FOR IMPROVING IMMUNIZATION INFORMATION SYSTEMS

16. WHAT IS MIROW?  The Modeling of Immunization Registry Operations Workgroup AIRA workgroup comprised of volunteers from state registry programs Formed in 2005 AIRA works in partnership with the registry branch at the Centers for Disease Control & Prevention (CDC)  Objective Develop and promote IIS Best Practices  Goal Provide the basis and support for uniform alignment of IIS processes

17. 17 IIS Functional Standards Specific Generic MIROW Best Practices IIS Software Functional Requirements for IIS MIROW Efforts in Context Level 1 Level 2 Level 3 Level 4

18. BEST PRACTICE DEVELOPMENT PROCESS MIROW Steering Committee identifies topics 1 SME are identified 2 SME submit local information & guidelines 3 Local guidelines are reviewed & condensed 4 SME review and discuss local guidelines and identify national guidelines 5 SME reach consensus on national guidelines 6 Timeline – Approximately One Year

19. HOW MIROW WORKS  Oversight from the MIROW Steering Committee (volunteers from the community)  Business analysis and development process support provided by CDC  Organizational support for in-person meetings from AIRA staff  Facilitation support for in-person meetings provided by external consultants  Volunteer subject matter experts from the IIS community

20. Consensus = “I can live with that and support it” BrainstormDiscussionConsensus THE MIROW PROCESS

21. COMPLETED TOPICS  Chapter 1: Management of Moved or Gone Elsewhere (MOGE) Status and Other Patient Designations in IIS  Chapter 2: Vaccine Level Deduplication in Immunization Information Systems  Chapter 3: Data Quality Assurance in IIS: Incoming Data  Chapter 4: Reminder/Recall in Immunization Information Systems  Chapter 5: Immunization Information System Collaboration with Vaccines For Children Program and Grantee Immunization Programs  Chapter 6: Immunization Information System Inventory Management Operations  Chapter 7: Data Quality Assurance in Immunization Information Systems: Selected Aspects

22. EVALUATION

23.  MIROW implementation is evaluated annually via the CDC Immunization Information System Annual Report (IISAR)  MIROW impact/implementation was recently evaluated by the University of Michigan

24. OTHER BEST PRACTICE/STANDARDIZATION WORK

25.  Implementation Guide CDC and AIRA jointly make changes to the published HL7 Implementation Guide  HL7 HL7 Organization, Immunization User Group  Functional Standards – (CDC, PHII, AIRA) Identify operational, programmatic, and technical capacities that all IIS should achieve by the end of 2017  AFIX – (Assessment, Feedback, Incentive, eXchange) IIS approach to standardizing and creating best practices for using an IIS to implement AFIX  Meaningful Use

26. IIS FUNCTIONAL STANDARDS, 2013-2017 Support the delivery of clinical immunization services at the point of immunization administration, regardless of setting. Support the activities and requirements for publicly- purchased vaccine, including the Vaccines For Children (VFC) and state purchase programs. Maintain data quality (accurate, complete, timely data) on all immunization and demographic information in the IIS. Preserve the integrity, security, availability and privacy of all personally- identifiable health and demographic data in the IIS. Provide immunization information to all authorized stakeholders. Promote vaccine safety in public and private provider settings

27. ONGOING CHALLENGES  Sustainable funding  Policies  Provider participation  Aging technology (IT Lifecycle)  Interoperability – connecting with the right system(s)  Unique identifiers  Data quality  Data Usage – ensure data is comparable from system to system  Evaluation  Competing priorities  Workforce  Validation = Certification

28. AIRA WEBSITE RESOURCES www.immregistries.org

29. MIROW DOCUMENTS Download MIROW documents at: AIRA web site: http://www.immregistries.org/pubs/mirow.html http://www.immregistries.org/pubs/mirow.html CDC web site: http://www.cdc.gov/vaccines/programs/iis/ activities/mirow.html http://www.cdc.gov/vaccines/programs/iis/ activities/mirow.html Currently available in: English Spanish

30. THANK YOU

31. VT NH WA OR CA NV ID UT AZ MT ND WY CO SD NM TX MN MO IA OK AR KS NE IL WI LA MS TN AL FL GA AK HI SC NC VA IN MI OH KY WV NY PA MD DE NJ MA CT ME RI As of 11/2013

32. HOW DO WE WORK? Grant money from Center for Disease Control & Prevention fund the organization to complete activities 1. Education 2. Assessment – how do we asses ourselves 3. Standards Development 4. Technical Assistance 2.5 staff support the work Currently all registry staff time is volunteered Volunteers run our working groups Staff advocate for immunization information systems at the national and state level

33. HOW DO WE WORK? We work with multiple organizations that: Develop standards (or want to develop) Develop Clinical Decision Support Conduct immunization activities Have an interest in data sharing Affect policy for an immunization program or registry

34. TERMS  Immunization Information System (IIS) and Registry are often used interchangeably  CDC = U.S. Centers for Disease Control and Prevention  MIROW = AIRA organizational workgroup that oversees best practice development  Subject Matter Expert = SME  Health Information Exchange = HIE

35. THE HISTORY OF AIRA  All Kids Count Project from 1992-1999 Robert Wood Johnson grant funded the start-up of several state registries Provided conferences & technical assistance for the sharing of successes and challenges  Need for continuation of this type of support was recognized by state registry staff  Founded the organization in 1999