1. Data Exchange Between IISs: Benefits and Barriers Presented by: Amy Metroka, Director Rezaul Kabir, City Research Scientist Citywide Immunization Registry New York City Department of Health and Mental Hygiene 42 nd National Immunization Conference Atlanta, GA March 17, 2008

2. 2 Overview Statement of Problem Background Data Sharing Pilot Project Future Directions

3. 3 Problem Residents often receive immunizations from health care providers from adjoining states, but the immunizations are not reported to their respective IIS Immunization records are fragmented –Three regional IISs (New Jersey, New York State, New York City) each contain immunizations of patients living in other IIS jurisdictions –NJ and NYC are geographically close –2,906 patient records in NJ IIS with NYS addresses –46,053 patient records in NYC IIS with NJ addresses

4. 4 Background of IISs: NYC Operational since 1997 and Web-enabled since 2002 Mandatory reporting to the NYC Citywide Immunization Registry (CIR) of all immunizations administered to children age <19 years Vital records (birth certificates) loaded weekly –all births in NYC from 1996 on –~125,000 births annually ~ 1,800 immunizing facilities and offices Provider facilities can report by: –paper, electronic files (batch), Web (Online Registry) 3.3 million patient records in the CIR database 33 million vaccine doses

5. 5 Background of IISs: NJ Operational since 1998 and Web-enabled since 2002 Reporting not mandatory Populated with electronic birth certificate (EBC) records from NJ hospitals –~115,000 births annually ~1,500 immunizing facilities and offices Provider facilities can report by: –paper, electronic files (batch), Web (Online Registry) 1.2 million patient records in the database 11.8 million vaccine doses

6. 6 Health Data Share Project NJ, NYS, NYC established a collaborative Health Data Share (HDS) project in 2007 HDS mission: provide an open-systems, industry standard, easily supportable architecture for sharing of health data held by collaborative members (public health) with provider electronic health records (EHRs) to improve patient care

7. 7 HDS Members NJ e-HIT Thomas Edison State College NJ Medicaid, DHSS NJ Vaccine Preventable Disease Program NJ Immunization Information System (IIS), DHSS NYS Office of Health Systems Management, DOH NYS Immunization Information System, DOH NYS Office of Health Insurance Programs, DOH NYS Center for Community Health, Office of Health Systems Management, DOH NYC Primary Care Information Project, DOHMH NY Citywide Immunization Registry (CIR), DOHMH

8. 8 HDS Scope May include but not limited to the following applications: –Electronic Birth Certificates –Electronic Death Records –Immunization Registry –Lead Registry –Early Intervention –Women, Infant and Children –Newborn Metabolic Screening –Medicaid/Child Health Plus –Managed Care Encounter data –EmedNY –SPARCS –Congenital Malformations Registry

9. 9 Method: Pilot HDS using IISs HDS partners decided the pilot phase would be exchange of immunization information between NJ IIS and NY CIR NYS IIS (covers NY state outside of NYC) to participate after statewide roll-out (2009) NJ and NYC IISs already contain data for patients crossing borders NYC have experience with batch file data exchange (mostly with Managed Care Organizations)

10. 10 HDS Pilot I NJ IIS was given access to CIR’s secure Web site to upload patients input file CIR’s input and output file specifications for data exchange were used CIR received from NJ IIS input file with patient records having any New York address Year of birth ranged from 1938 to 2007 The records were matched against CIR database

11. 11 HDS Pilot II CIR using extra steps for de-duplication produced output file CIR returned to NJ IIS output file with immunization information for patients found NJ IIS processed the file and added missing immunization doses to their patient records Similarly, CIR received a file from NJ IIS with immunization data for NJ patients with NYC addresses

12. 12 Results for NJ IIS - I NJ IIS patient input file to CIR had 2,906 records with NYS addresses; 919 with NYC addresses Of the 919 with NYC addresses, 492 (53.5%) were found in CIR database 482 (98%) had one or more immunizations in the CIR database Total of 7,004 immunization doses were returned to NJ IIS

13. 13 Results for NJ IIS - II 5,594 (80%) of 7,004 doses identified in CIR database were new immunization doses and were added to NJ IIS 1,410 doses were not added –1,193 already existed in NJ IIS –217 did not match due to the two IISs using different coding systems

14. 14 Results for NYC CIR NJ IIS sent file including 681 patient immunization records with NYC address 211 patients were new to CIR and were added to CIR database 3,723 new immunization doses were added to CIR database UTD for 4:3:1:3:3:1 series vaccines for the 681 patients improved from 25.20% to 32.32 %

15. 15 Barriers - Legal NYC can no longer directly exchange data with NJ IIS –a new NY State law requires that data must be exchanged between states (not city to state) Interstate MOU required by new NY State law – currently under development

16. 16 Barriers - Technical Interoperability challenges: –File format –NJ IIS uses CPT vaccine codes (mapped to CVX codes) and CIR uses CVX codes; some CVX codes do not have a corresponding CPT code (e.g., CVX 106 - DTaP, 5 pertussis antigens; 107- DTaP, NOS; 109 - pneumococcal, NOS; 122 - rotavirus, NOS) –CIR returned more data elements than NJ IIS needed

17. 17 Conclusions Batch file data exchange is feasible between technologically different IISs Interoperability challenges can be overcome to engage in regular bi-directional, inter-state data exchange

18. 18 Next Steps Agree on revising the batch file specifications Automate bi-directional batch file data exchange at regular intervals Finalize interstate data sharing MOU

19. 19 Future Directions Identify funding to support HDS Recruit more states (CT, PA) to become HDS collaborative partners Build standard (HL7) Web service for real-time data exchange (under development in NYC) Use Web service to exchange data between HDS partners (public health) and provider electronic health records systems (EHRs)

20. 20 Acknowledgements William O’Byrne, NJ e-HIT Arnie Miller, HDS Consultant Zina Kleyman, NJ IIS Michael Flynn, NYS IIS Sheila L Palevsky, NYC DOHMH Vikki Papadouka, NYC DOHMH

21. 21 Contact Information Citywide Immunization Registry NYC Department of Health & Mental Hygiene www.nyc.gov/health/cir Amy Metroka, M.S.W. Director Tel.: 212-676-2319 ametroka@health.nyc.gov Rezaul Kabir, M.B.B.S., M.P.H. City Research Scientist Tel.: 212-676-2329 rkabir@health.nyc.gov