1. Interoperability of Immunization Information Systems and Electronic Health Records – A Federal Perspective
National Immunization Conference Online
Gary A. Urquhart, MPH
Chief, Immunization Information Systems Support Branch
Immunization Services Division
National Center for Immunization and Respiratory Diseases
March 28, 2012

2. Discussion Points Interoperability Dependencies
Status on Selected IIS Performance As of December 2010
CDC Initiatives to Improve Interoperability
National HIT Initiatives that address Interoperability

3. Status on Selected IIS Performance As of December 2010

4. Percentage of children aged < 6 years participating in a grantee immunization information system – United States, and six cities, 2010
0% or No Report (2)
< 60% (8)
60-79% (8)
> 80% (38)
Chicago, IL (< 60%)
District of Columbia (> 80%)
Houston, TX (< 60%)
New York City, NY (> 80%)
Philadelphia, PA (> 80%)
San Antonio, TX (60%–79%)
National Participation: 81% (excluding Territories)
Source: Immunization Information System Annual Report

6. Compliance with HL 7 Messaging Standards in a grantee Immunization Information System – United States, and six cities, 2010
No IIS or No Report (1)
Grantee Uses State IIS (2)
No HL7 Compliance (10)
Partial HL7 Compliance (2)
Full HL7 Compliance (41)
Source: Immunization Information System Annual Report

7. CDC Initiatives to Improve Interoperability

8. CDC Immunization Program Grantees Selected to Receive Funding for the EHR-IIS Enhanced Interoperability Cooperative Agreements As of December 2011 WA MT ND OR MN VT RI ID SD WI NY MA CT MI WY
New York City, NY IA NJ NE
Philadelphia, PA UT MD CO wv
District of Columbia KS MO NC AZ NM MS AL
HITECH\ARRA 317 Funding
PPHF Funding TX HI AL

9. Compliance with HL 7 Messaging Standards or Expect to Become Compliant Because of HITECH or PPHF Funding
No IIS or No Report (1)
Grantee Uses State IIS (2)
No HL7 Compliance (1)
HITECH Grantee – Will be HL7 Compliant (5)
Full HL7 Compliance (41)
PPHF Grantee – Will be HL7 Compliant (5)

10. EHR- IIS Interoperability Outcomes from HITECH\ARRA 317 Funded Activities
Almost 29,000 practice sites with an EHR have been identified by HITECH\ARRA 317 grantees. These sites serve almost 6 million children <6 years of age.
About 3,000 practice sites with EHRs in 17 states and 3 cities have been selected for interoperability enhancements to enable real-time exchange of immunization data. About 2.4 million children < 6 years of age will benefit.
HL7 enhancement best practices will be developed to sustain activities in practices and IISs.

11. Survey of VFC Sites on EHR Capacity and Planning to Participate in CMS Meaningful Use - October 2011
The CDC conducted an electronic survey of VFC provider sites using a convenience sample from 35 Immunization Program grantees in October 2011 and concluded that of about 4,200 VFC practice sites surveyed:
81% of responding VFC practice sites stated that they submitted immunization data to their state or local IIS.
57% of respondents used some form of EHR system with practice use ranging from <1% to 54% by grantee;
About 40% of respondents reported that one or more provider in their practice had registered for the CMS MU incentive program;
About 66% of respondents reported that their practice would submit immunization data to their state/local IIS to fulfill the PH objective for MU.

12. % VFC Provider Site Survey Participation
% of VFC Practice Sites Participating in VFC Site Survey – October 2011 ME MT ND MN OR ID WI RI SD MA WY
NY City IA
Chicago
Philadelphia NE NJ NV OH IL DE DC CA CO MO VA KS NC HI NM GA AL TX LA
San Antonio
Houston
% VFC Provider Site Survey Participation
Grantee did not participate (21)
0.1% % (20)
20.2% % (15)
Average % VFC practice site participation from 35 grantees: 16%

13. EHR- IIS Interoperability Outcomes
Enhancements may assist practices in receiving Meaningful Use incentives.
Enhancing EHR-IIS interoperability will improve data quality challenges by addressing:
Accuracy
Timeliness
Completeness

14. National HIT Initiatives that address Interoperability

15. Electronic Health Records Initiative
On April 27, 2004, in his State of the Union address, President Bush called for “…the majority of Americans to have interoperable electronic health records within 10 years.”
Establishes the position of National Coordinator for Health Information Technology.
Develops a strategic plans with goals that include:
Introduction of information tools into clinical practice;
Electronically connecting clinicians to other clinicians;
Using information tools to personalize care delivery; and
Advancing surveillance and reporting for population health improvement.

16. Electronic Health Record Status, 2007
DesRoches et al published “Electronic Health Records in Ambulatory Care – A National Survey of Physicians” in NEJM in July 2008 and concluded that of about 1,800 physicians surveyed:
EHRs were more prevalent with younger physicians; larger practices; and in the western United States.
< 20% of the physicians responding to the survey had a fully functional or basic EHR.
Barriers to adoption of EHRs included: cost; ability to meet practice needs; ROI; and application life cycle.
Facilitators to adoption of EHRs included: incentives for purchase; payment for use; and liability protection.

17. Health Information Technology for Economic and Clinical Health Act (HITECH)
President Obama’s administration introduced the HITECH Act to support the adoption and use of Electronic Health Records (EHRs)
The purpose of HITECH is to achieve significant improvements in care through meaningful use of EHRs by health care providers.
Established incentive payments to eligible professionals and hospitals to promote the adoption and meaningful use of interoperable HIT and qualified electronic health records (EHRs)

18. Adoption of Electronic Health Record Systems by Office-based Physicians: United States, 2011
The CDC NCHS published a mail survey entitled “Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives Among Office-based Physician Practices: United States, 2001–2011” in November 2011 and concluded that of about 10,000 physicians surveyed:
57% used an some form of EHR system with use by state ranging from 40% to 84%;
About 34% were reported the use of a basic EHR that met MU criteria for a certified EHR product;
About 52% of physicians intended to apply for MU incentives.
Source: Centers for Disease Control and Prevention (CDC) (2011). NCHS Data Brief: Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives Among Office-based Physician Practices: United States, 2001–2011, No. 79

19. National HIT Initiative Outcomes
National HIT Initiatives have facilitated EHR-IIS interoperability by:
Promoting the development and use of certified EHR systems that use national standards for interoperability with IIS and other healthcare systems
Incentivizing clinical practice interoperability to improve overall patient care.
Promoting consumer e-health that empowers patients to use and understand their own health care.

20. Contact Information
Gary A. Urquhart, MPH
Chief, Immunization Information Systems Support Branch
Immunization Services Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
1600 Clifton Road N.E., MS A-19
Atlanta, Georgia 30333
USA
Telephone:
Web: