1. 39th National Immunization Conference
Using Registry Data in Daily Program Operations: The Washington, D.C. Experience
Karyn L. Berry, MD, MPH
March 23, 2005
39th National Immunization Conference
Washington, DC

2. Washington, DC Overview
District of Columbia: “City-state”
Self-governing
Congressional budget approval & oversight
Non-voting congressional representation
Overall population: 572,059 residents
African-American: % ,321
White: % ,101
Hispanic % ,953
Asian/PI % ,537
112,000 (20%) of residents are Children (2002)

3. DC Immunization Registry
Overview
Began with Immunization
Linked to DC Birth Registry
Became internet-based
October Added Medicaid EPSDT Program
“Age-less” System: tracks records birth to death
Records accessed more than
2.5 million times since system
began tracking in May 1996
Contains 366,479 Individual’s
Records
4,015,843 million Immunizations
2,247 exemptions
64,236 histories of Varicella
data from March 1, 2005

4. DC Registry & Daily Work
Importance of integrating the Immunization Registry with Immunization Program Functions
Cost savings in using data multiple times
Decreased staff time in completing assignments
Increased unification of program components: Team Approach
Guidance for Integrating: Immunization Program Operations Manual (IPOM)

5. DC Registry & Vaccine Management
Capture VFC Eligibility Status for each dose of vaccine
Capture VFC PIN of Provider giving vaccine
Capture lot number and manufacturer for tracking
Project Vaccine Needs
Generate Doses Administered Reports
by Patient Age
for Specific Time Periods
by VFC-eligibility

6. DC Registry & Provider QA
Web-based Lists of patients for Reminder (“Due”) Notices and Recall (“Overdue”)
Monthly reports to Medicaid, Medicaid MCOs, WIC, Schools…
Web-based export of Registry data to CASA
Registry reports on immunization levels beyond CASA
Other Age Groups: 0-4-year-olds, school-age
Track incorrectly administered doses and other vaccine rules (4-day grace period)
Display record with vaccine assessment (incorrect doses marked)

7. DC Immunization Registry Record

8. DC Registry & Service Delivery
Linked to WIC Program
WIC Enrollment tracked in Registry (monthly update)
Key WIC Sites linked to Registry (view only)
Monthly Immunization Level reports generated for each WIC site (17 sites)
Monthly reminder/recall lists generated for each site (also available on web)
Linked to Child Care and Head Start Programs
Enrollment tracked in Registry (yearly update)
Immunization level reports and reminder/recall lists for each site (also available on web)

9. DC Registry & Consumer Information
Prints official immunization records for clients
Incorporates Broadcast Fax System
Send out health alerts/advisories to community providers
Send out alerts for upcoming Immunization Clinics

10. DC Registry & Surveillance
Disease investigators access Registry as “Users” over internet
Generate individual immunization histories on clients
Generate reports on students enrolled in specific school, child-care, Head Start center
Track Perinatal Hepatitis B cases
Identify vaccine provider if follow-up required
Track vaccine lot numbers in case of recall
Track vaccine adverse events

11. DC Registry & Assessment
All Assessment activities done solely through Registry
Child-care facilities (comprehensive)
Head Start facilities (comprehensive)
Public, Charter, Parochial, Private Schools (comprehensive)
WIC
Specific populations (physician/clinic, adults, STD/HIV, corrections)
All varicella histories and exemptions (religious and medical) are entered into Registry and counted in Forecasting Algorithm
Utilization of Registry for DC Public School Immunization Initiative
Monthly and on-line reports of immunization levels
Monthly and on-line lists non-compliant students

12. DC Registry & School: Enrollment
ES (101): 39,161
MS (11): 4,638
JHS (9): 5,111
SHS (20): 12,311
Special ed schools (20+): 1,058

13. School Demographics & Diversity
Student population by race/ethnicity:
African-Americans: 84.4%
Hispanics: 9.4%
Whites: 4.6%
Asian Americans: 1.6%
Other: %
112 different home languages representing 138 different nationalities
60.8% of DCPS students receive free or reduced price meal support

14. School Immunization Survey
By law- DCPS requires all children (pre-school thru 12th grade) to be immunized
Yearly enrollment and immunization check of all students
Can be excluded from school
Required immunizations:
ACIP schedule for: DTaP, polio, HIB, Hepatitis B, MMR, Varicella, Td
Doses must be appropriately spaced & given at appropriate ages
June 2001: Survey demonstrated 40% compliance with required immunizations for DCPS students
Almost 40,000 students required immunizations/data

15. Immunization Requirements

16. DC Registry & School: Results
Compliance rates increased from 40% at the end of school year SY to greater than 94% by mid SY
Improvements in public school immunization compliance were demonstrated equally across the community
Current immunization levels (DCPS = 94.38%) place DC in the upper echelon of system compliance nationwide
Data is collected, analyzed and reported on in 1 system: The DC Immunization Registry

17. DC Schools: See the Success!

18. Key Working Partnerships
DC Immunization Program
Technical expertise
Tool: Registry
Data entry, analysis & distribution
School Health Services
Record collection
Contact with school principals & parents
DCPS
Enrollment data
Enforcement of immunization laws
DC Medicaid Admin
Enrollment data
MCO accountability
Medicaid MCO’s
Member follow-up
Provider communication
Providers
Patient access
Implementing ACIP schedule
Community partners
Outreach & follow-up activities
Parents

19. Value of the DC Registry
On-going healthcare tracking system established
Reduced over/under immunization due to lost records
Improved Provider immunization practices
Decreased Provider labor to locate patient records
Decreased labor required to assess immunizations and prepare reports (e.g., school forms, HEDIS, surveys, CASA)
Improved School immunization rates

20. Future of the DC Registry
Mandatory reporting by Providers
Expand system usage to more Providers and Groups
Expand linkages with other Systems
Child Care
WIC
Lead Screening

21. Acknowledgements District of Columbia Department of Health
Primary Care Prevention and Planning Administration
Maternal and Family Health Administration
Health Promotion Administration
Children’s Hospital Medical Center
Children’s School Services
District of Columbia Public Schools
DC Medicaid Administration and Managed Care Organizations
DC Immunization Coalition
World Vision DC
Pharmaceutical Companies – Aventis, Merck, GlaxoSmithKline and Wyeth

22. Contact Information
Immunization Program
Rosie McLaren, PHA
Phone: (202) x24
Registry/Tracking System
C Thomas, RN
Phone: (202) x11