1. Letty Cherry Kreger, MHA California Immunization Registry (CAIR) Inland Empire Region

2. Outline Background Transition Benefits Steps to Successful Transition (Planning, Prioritizing, Merging & Monitoring Program and Transition Activities) Triumphs and Challenges Lessons Learned

3. Background VaxTrack was one of 10 regional IISs in California At the time of the transition, there were: >800 participating providers Approx. 4900 users > 1.2M records >7.6 M immunizations

4. Benefits of the Transition Improved access to data for providers (11% of children to 84%) Consistency of operations Shared best practices

5. Steps to a Successful Transition Obtain help from others Plan activities to achieve goals Prioritize and blend “regular” and transition-specific tasks Develop and refine new/existing operating procedures

6. Obtain Help from Others Identify registry partners who can assist with work plan tasks Health Plan and VFC staff helped market the transition (newsletters, FAX blasts) State and regional registry staff collaborated on work plan tasks Technical (data mapping, testing) General guidance and support as needed

7. Transition Planning Determine basic tasks needed to complete the transition Develop work groups Administrative / Legal Marketing / Training Technical Blend day-to-day registry operations with transition specific activities. Continuity of Operations Plan (COOP)

8. Transition Planning - Goals Programmatic (Grant- driven) Transition 16,500 new children < 6 years of age will have IZ records added to IIS 45 new providers will be fully trained and properly use the IIS 120,000 Reminder/Recall postcards will be mailed The Help Desk will make 450 referrals for IZs /well child exams > 800 providers will be notified of the transition > 1.2 M patient records and >7.6 M immunizations will be migrated to CAIR Inactive providers will be re- engaged as part of transition All high use providers will receive training prior to Go Live CAIR will debut on 7/13/09

9. Planning Activities to Meet Goals Grant Performance Goals Related Activities Market Registry Participation to VaxTrack (simplify the transition) Continue to recruit providers in the 4 th qtr as needed Continue with decentralized training for VaxTrack Re-engaging providers before transition will help meet other performance targets 16,500 new children < 6 years of age will have IZ records added to IIS 45 new providers will be fully trained and properly use the IIS 120,000 Reminder/Recall postcards will be mailed The Help Desk will make 450 referrals for IZs /well child exams

10. Planning Activities to Meet Goals, continued Transition Goals Examples of Transition Related Activities > 800 providers will be notified of the transition > 1.2 M patient records and >7.6 M immunizations will be migrated to CAIR Inactive providers will be re- engaged as part of transition All high use providers will receive training prior to Go Live CAIR will debut on 7/13/09 Market CAIR Transition to providers Active provider recruitment through 3/31 Shift to centralized training 80/20 Rule – prioritize providers for training

11. Prioritize and Blend Activities Create task-specific transition work plans for each work group Utilize COOP to prioritize daily operational tasks Use a combined work plan to maintain the “big picture” Plug key non-transition activities into combined work plan to meet operational goals Monitor progress

12. Create Task-Specific Transition Work Plans

13. Prioritize with COOP

14. Prioritize with COOP, continued Market registry to new providers through third quarter Continue reminder/recall Continue VaxTrack training into April, then shift focus to CAIR training Continue routine follow-up calls through May, then focus on transition Stop provider mailings unrelated to transition

15. Blend into Key Monthly Tasks to Retain the “Big Picture”

16. Integrate Key Non-Transition Activities

17. Monitor Progress Monthly Performance Indicator TargetJan 09Feb 09 Mar 09 Apr 09May 09 Jun 09 # New Children < 6 yrs with Immunizations 16,5009,809 59% 10,809 66% 12,006 73% 13,226 80% 14,453 88% 15,771 96% # New Providers Trained and Using IIS 4524 53% 28 62% 37 82% 46 102% 48 107% 53 118% # Reminder / Recall Cards Sent 120,00065,628 55% 78,208 65% 89,924 75% 101,200 84% 101,200 84% 116,576 97% # Referrals for IZ or Well Child Exams Made by Help Desk 450273 61% 296 66% 334 74% 391 87% 439 98% 466 104%

18. Develop and Refine Operational Procedures Expect changes in how business is done New account naming conventions New log-in procedures New paperwork New training methods New name Practice change management with staff Positive attitude/messages

19. Snapshot – January 5, 2009 Programmatic (Grant) Transition 8,565 (52%) new children < 6 years of age had IZ records added to IIS 14 (31%) new providers were fully trained and properly use the IIS 47,900 (40%) Reminder/ Recall postcards were mailed The Help Desk referred 242 (54%) children for IZs /well child exams > 800 providers will be notified of the transition > 1.2 M patient records and >7.6 M immunizations will be migrated to CAIR Inactive providers will be re- engaged as part of transition All high use providers will receive training prior to Go Live CAIR will debut on 7/13/09

20. Triumphs All grant performance targets were met* or exceeded 15,771 of 16,500 new children < 6 years 53 of 45 new providers 116,576 of 120,000 reminder postcards 466 of 450 referrals Transition went smoothly Staff reacted quickly to common questions and errors by refining training & creating and posting additional reference materials on the website *For a performance target to be met, grantees must achieve at least 90% of the target

21. Challenges Transition activities did not end with Go Live Infrequent and Inactive Providers still needed to be trained Read Only Providers (schools and childcare) Inconsistent routine follow-up calls Physical move for staff H1N1 Activities

22. Lessons Learned If it is not possible to dedicate staff to work solely on a software transition, it is critical to prioritize key registry tasks and blend them with the work plan. “The end is just the beginning” Programmatic components of the transition continue beyond the Go Live date Without a combined work plan, it is easy to focus on one part of the big picture

23. Lessons Learned, continued Business continuity work plans help balance activities during and after the transition, as staff responsibilities shift between software transition and business as usual. Help staff maintain focus Can be customized to deal with unexpected events Revisit the work plan as needed to maintain focus and make course corrections.

24. Acknowledgments State CAIR staff State VFC Staff Inland Empire Health Plan and Molina Medical Care CAIR Inland Empire Staff

25. Contact information: Letty Cherry Kreger, MHA Regional Manager, CAIR Inland Empire E-mail: lcherry@co.riverside.ca.us