1. Registry Impact on Program Operations
Plenary – Immunization Programs
Registry Impact on Program Operations
Barbara C. Canavan, Director
Oregon Immunization ALERT

2. Registry Impact on Program Operations
ALERT is integrated with most aspects of Oregon’s Immunization Program. Strategic directions include:
Target immunization services based on registry data
Build on lessons learned with the registry to integrate early childhood services in Oregon
“ALERT is the cornerstone of Oregon’s Immunization Program” - Lorraine Duncan, Immunization Program Manager

3. Registry Impact on Program Operations
Background on Oregon’s registry (ALERT):
created by a public-private partnership
first immunizations from private sector
first use of registry data
Current Status – 2002:
950K child records (ages 0-18)
13.5 million immunizations
Largest health plans (7) and hospitals (23) voluntarily contribute 35% of funding
ALERT team has 10 staff members

4. Registry Impact on Program Operations
Current Status:
Provider participation in ALERT:
84% of private providers
100% of county health departments and most other public sites
Major health plans send data regularly
Records are sent to ALERT electronically, and about 25% by barcode (paper) system
~93% of Oregon preschool kids are in ALERT with immunizations

5. Provider Participation
Registry Impact on Program Operations
Providers, Plans, Schools
Immunization records
Recall postcards
Data for HEDIS
Identify high risk kids
Reduce school exclusions
Vaccine trends
Evaluate interventions
Support disease surveillance
Identify barriers
Partners
Registry Data
AFIX
Vaccine accountability
VFC Program
Program Mgmt
Provider Participation

6. Registry Impact on Program Operations
Source of Shot Records in ALERT
8.5 million immunizations submitted in last 3 years

7. Registry Impact on Program Operations
Produce child shot records for clinics, schools, plans, hospitals
How do providers access immunization histories in ALERT?

8. Registry Impact on Program Operations
Vaccine Accountability
Ensure that VFC providers identify eligibility
VFC codes are entered in ALERT from many electronic and paper sources
ALERT generates reports showing the # of children seen for each clinic by age group
Provider Participation Reports – compare VFC Profiles to # of kids in ALERT
Joint VFC-ALERT newsletter to providers.
Currently no interface from VACMAN to ALERT.

9. Registry Impact on Program Operations
Provider Quality Assurance:
VFC-AFIX activities use ALERT data for all provider and clinic assessments. ALERT data feed into CASA. No chart pulls.
~112 data extracts for AFIX and other assessments in the past 7 months:
62 for public sites assessments (multiple runs)
14 for AFIX process in private sector
4 for Medicaid (OMAP) - GRPA and SCHIP
17 for OMAP managed care for HEDIS
15 for antigen trends, CDC studies

10. Registry Impact on Program Operations
Provider Quality Assurance:
Use registry data to prioritize VFC site visits:
Identify clinics with low coverage rates and/or reporting level of VFC eligibility
Use ALERT as an incentive – vaccine accountability, coverage assessments, recall reports, recognition
Identify patterns in dose administration (invalid doses, etc.)
Registry data can be powerful evidence to improve immunization practice.

11. Registry Impact on Program Operations
Provider Quality Assurance - Relationship Between Missed Opportunities (MO) and Up-to-Date (UTD) Rate for 46 clinics

12. Registry Impact on Program Operations
Provider Quality Assurance & Education:
Promote ALERT as a core public health function
Public health clinics promote ALERT with private providers in their community
Focus for local VISTA workers
Improve options to submit data
Largest private clinics in Oregon submit data to ALERT electronically
Update websites to include more current links

13. Registry Impact on Program Operations
Statewide Recall Postcards Children at 24 months of age overdue for at least one immunization based on ACIP recommendations for 4:3:1:3:3:1
Monthly mailing for statewide postcards. Clinics get advance notice of kids overdue.
300 private clinics and many public clinics
postcards monthly
Recall process creates good opportunities to:
improve data completeness
reinforce simultaneous administration of vaccines

14. Registry Impact on Program Operations
Use registry data to measure the impact
of interventions to raise rates

15. Registry Impact on Program Operations
Provider Quality Assurance – Perinatal Hep B
213 kids born to HBsAg moms were “lost”:
ALERT tracked last provider of record
Epidemiologist worked with the local health departments to locate, immunize and give post-vaccine serology tests
% with 3 doses of Hep B vaccine improved from 69% to 78%

16. Registry Impact on Program Operations
Service Delivery - Assess Underserved Kids
Oregon Medicaid (OMAP) has been one of Oregon Immunization Program’s and ALERT’s primary funders. Great collaboration to:
Improve pre-school immunization rates
Participate in national GPRA process
Identify factors that contribute to low rates for this population (such as late starts)
Measure interventions (such as recalls)

17. Registry Impact on Program Operations
Service Delivery - Assess Kids under Medicaid
Government Performance and Results Act (GPRA)
months for all kids covered by Medicaid Managed Care (OMAP) plans. Used registry data only. No chart pulls.
OMAP achieved its 3rd year goal in the first year

18. Registry Impact on Program Operations
Service Delivery - Assess Kids under Medicaid
Key results of GPRA project to date:
ALERT data revealed barriers in administrative systems that contribute to late starts:
Proved to be powerful evidence to convince policymakers, OMAP Medical Directors, and health plans
#1 policy recommendation by advisory group
Incentive for plans to submit data to ALERT
OMAP now uses ALERT data to publish
HEDIS rates for all Medicaid MCOs

19. Registry Impact on Program Operations
Service Delivery – Assess MCO rates (HEDIS)
This plan immediately took action to improve regional participation in ALERT

20. Registry Impact on Program Operations
Service Delivery – Schools and Child Care
ALERT produces immunization status for childcare providers based on enrollment rosters.
School access to ALERT from Oregon’s largest district serving 85K kids in Portland:
District found additional records in ALERT for 33%-49% of kids at risk for school exclusion.
ALERT and the school district won the “Innovative Partnership” Award from the Oregon Partnership to Immunize Children (OPIC).

21. Registry Impact on Program Operations
Disease Surveillance
ALERT participates in a CDC study to:
Link registries with disease surveillance to help evaluate the efficacy of PCV 7 in children
Supports prevention and control efforts for:
Perinatal Hep B - track series completion
Hep A - identify clinics needing follow-up, plan interventions

22. Registry Impact on Program Operations
Hepatitis A project:
Communicable disease specialists asked ALERT to help with the following questions:
Have providers been giving Hep A doses according to the year 2000 ACIP schedule?
What age groups are being immunized?
What clinics have incorporated Hep A into their practices?

23. Distribution of Oregon Children born 1983 to 1998 with Hep A Dose 1 reported to ALERT (n=91096)
Hep A immunization rate in Oregon is ~25% for kids ages 2-5
Pre-school
Adolescents
Oregon is a state that has periodic resurgence of Hep A.
Imm rates are still very low (about 10%).
Used ALERT to assess what children, ages 2-18, are getting immunized.
CD specialists have noted that year 2000 has the lowest incidence ever recorded.
Oregon is anticipating that we are soon to go into a disease cycle.
Edis and CDs will look to ALERT to see who is vaccinated, from what regions, and what docs are giving the vaccine.

24. Registry Impact on Program Operations
Help identify clinics for education and follow up

25. Registry Impact on Program Operations
Monitor schedule changes –
Thimerosal and Hep B Birth Dose
0-56 days
Mid- 1999
0-5 days after birth

26. Registry Impact on Program Operations
Birth Cohort = 46K
76% of the kids born in 2000 have at least PCV 1
Monitor the impact of changes to the childhood vaccine schedule
Prevnar has been very well accepted by private providers in Oregon.
Clinicians are making a clear choice to administer this vaccine.
Most doses on record are given to children <1 year of age, but the uptake for all kids <2 is quite good.
63% of children born in Sept 2000 have had PCV1, based on birth cert records and imms in ALERT.
Prevnar harmonizes well with the well-child visits at 2, 4, and 6 months of age.

27. Good ways to get involved
Registry Impact on Program Operations
Conclusion:
Registries are valuable tools to enhance immunization services. Programs can reduce the “learning curve” and take advantage of lessons learned:
AIRA (American Immunization Registry Association) - network of registry managers, developers, staff and supporters. Created to advance the important work of registries.
PROW (Programmatic Registry Operations Workgroup) - AIRA/CDC. Identify and share registry best practices that support immunization program goals.
Good ways to get involved
Thank
you !