1. Laura Heermann Langford, RN, PhD
Connect: Registry to Private Provider USIIS & Intermountain Health Care: A Partnership with an HL7 Backbone
Joseph L. Nay, BS
Utah Department of Health
David J. Richards, BS
Laura Heermann Langford, RN, PhD
Intermountain Health Care
Salt Lake City, Utah
Copyright 2002 D.J. Richards, Intermountain Health Care
Copyright 2002 D.J. Richards, Intermountain Health Care

2. Copyright 2002 D.J. Richards, Intermountain Health Care
Why Health Plans?
HEDIS
Vested interest in Immunization Rates
Historical Data
Advanced health record management
Copyright 2002 D.J. Richards, Intermountain Health Care

3. What IHC required of USIIS…
HL7 back-end interface
Phase 1: ADT messages
Copyright 2002 D.J. Richards, Intermountain Health Care

4. Copyright 2002 D.J. Richards, Intermountain Health Care
Real Time ADT messages
Copyright 2002 D.J. Richards, Intermountain Health Care

5. What IHC required of USIIS…
HL7 back-end interface
Phase 1: ADT messages
Phase 3: Vaccines messages
Copyright 2002 D.J. Richards, Intermountain Health Care

6. VXU Real Time vaccine message
Copyright 2002 D.J. Richards, Intermountain Health Care

7. VXU Nightly Batch Updates
Copyright 2002 D.J. Richards, Intermountain Health Care

8. What IHC required of USIIS…
HL7 back-end interface
Phase 1: ADT messages
Phase 3: Vaccines messages
Application Performance
Copyright 2002 D.J. Richards, Intermountain Health Care

9. Copyright 2002 D.J. Richards, Intermountain Health Care
Where we were and are…
Copyright 2002 D.J. Richards, Intermountain Health Care

10. What IHC required of USIIS…
HL7 back-end interface
Phase 1: ADT messages
Phase 3: Vaccines messages
Application Performance
Service Level Agreement
Security Measures
Copyright 2002 D.J. Richards, Intermountain Health Care

11. What did IHC do for USIIS?
~ 60% of private health data
Quality of data (Saturation Rate Increase of 14.3%)
Copyright 2002 D.J. Richards, Intermountain Health Care

12. Copyright 2002 D.J. Richards, Intermountain Health Care
USIIS Saturation Rate Percentage of children in USIIS with 2 or more vaccines
IHC Data Load Aug. 2001
Copyright 2002 D.J. Richards, Intermountain Health Care

13. What did IHC do for USIIS?
~ 60% of private health data
Quality of data (Penetration Rate Increase of 14.3%)
46 private health clinics
Enhanced Enrollment
Copyright 2002 D.J. Richards, Intermountain Health Care

14. Enrollment Rates This includes all IHC clinics
Copyright 2002 D.J. Richards, Intermountain Health Care

15. What did IHC do for USIIS?
~ 60% of private health data
Quality of data (Penetration Rate Increase of 14.3%)
46 private health clinics
Enhanced Enrollment
Image of registry as valid resource of information
Quality of testing application
$$$$$$-Money
Copyright 2002 D.J. Richards, Intermountain Health Care

16. Copyright 2002 D.J. Richards, Intermountain Health Care
Why did IHC want USIIS?
HL7 interface available
Support for real time data transfer
Willingness to work with IHC and seamless integration of systems
Copyright 2002 D.J. Richards, Intermountain Health Care

17. Copyright 2002 D.J. Richards, Intermountain Health Care
Why did IHC want USIIS?
Missed opportunities
Need for reminders
Multiple sites of care
Burdensome documentation/charting
Difficulty keeping current with Recommendations
Time consuming, incomplete methods for determining immunization rates and creating reports
Introduce each reason separately without detail.
Say each reason as it comes up on the screen.
Copyright 2002 D.J. Richards, Intermountain Health Care
Copyright 2002 D.J. Richards, Intermountain Health Care

18. Copyright 2002 D.J. Richards, Intermountain Health Care
Missed Opportunities
Problem:
Children are seen in the clinic for reasons other than a preventive care visit and their immunizations are overlooked
USIIS Solution:
Forecast report shows shots
That are complete
Due or overdue
Can be printed the day prior to visit
Easy look up for other family
members present
Problem:
Easy for provider and parent to “not remember” immunizations when immunizations aren’t the reason for the clinic visit.
Previous attempts/solutions that didn’t work? (ask Tamara, will time allow?)
Solution:
Forecast (which shows due date and status – complete, current, due, overdue, immune – for each vaccine type or series) is viewed prior to every child’s appointment – whether the appointment is a Well or Sick visit.
*Put in new slide showing Forecast Rpt example? (If looking for more time)
Copyright 2002 D.J. Richards, Intermountain Health Care
Copyright 2002 D.J. Richards, Intermountain Health Care

19. Copyright 2002 D.J. Richards, Intermountain Health Care
Need for Reminders
Problem:
No efficient method for identifying patients not up to date with immunizations
USIIS Solution:
Allows the state, clinic or IHC to create lists of children not up to date
Copyright 2002 D.J. Richards, Intermountain Health Care
Copyright 2002 D.J. Richards, Intermountain Health Care

20. Copyright 2002 D.J. Richards, Intermountain Health Care
Multiple Sites of Care
Problem:
Full record not present when child seen
Shots given to patient outside primary clinic
(hospital, shot van, public health clinics).
USIIS Solution:
Information from various sources
Hep B given at hospital automatically entered (7-14 days post birth)
Copyright 2002 D.J. Richards, Intermountain Health Care

21. Burdensome Documentation/Charting
Problem:
Documentation requires 4-6 separate entries by nurse to chart a given immunization
USIIS Solution:
Nurse documents only once per shot and prints reports accordingly
Don’t need to put on slide but remember to mention the 4-6 sites are between mediums, computer, chart, other “sheets” around the clinic for ordering etc.
Copyright 2002 D.J. Richards, Intermountain Health Care
Copyright 2002 D.J. Richards, Intermountain Health Care

22. Difficulty keeping current with Recommendations
Problem:
ACIP/AAP recommendations change every 6-12 months without notification of update.
Clinic can be following outdated recommendations
USIIS Solution:
USIIS contracts with a firm to keep logic updated as per the latest CDC guidelines
Tamara emphasized to me how difficult it was to communicate the changes to all clinicians. First a small group would only hear about them at monthly meetings, then word would have to be communicated numerous clinics, and there was no good medium to do so. People don’t keep up in reading newsletters, etc The time between the CDC change and the actual impl. In routine pt care could be considerable
Copyright 2002 D.J. Richards, Intermountain Health Care
Copyright 2002 D.J. Richards, Intermountain Health Care

23. Copyright 2002 D.J. Richards, Intermountain Health Care
Time consuming, incomplete methods for determining immunization rates and creating reports
Problem:
Reports all had to be filled out by hand using billing databases or by going through patient charts
HEDIS®
School Entry Reports
Immunization History
VFC Report
CASA Reports
Copyright 2002 D.J. Richards, Intermountain Health Care

24. Copyright 2002 D.J. Richards, Intermountain Health Care
Time consuming, incomplete methods for determining immunization rates and creating reports
USIIS Solution:
Health Plans have access to USIIS for HEDIS® reporting
A built-in CASA report
VFC reports automatically tallied and sent electronically to VFC Program
School report and patient specific reports available
Copyright 2002 D.J. Richards, Intermountain Health Care

25. Results From Using WebKIDS at IHC
Users do not want to return to their old process
End users have accepted WebKIDS reports
Users found WebKIDS to be time-saving and efficient
Copyright 2002 D.J. Richards, Intermountain Health Care

26. Time savings at IHC using USIIS
Process
Pre-USIIS
Post-USIIS
Time Saved
Vaccine Administration per patient
11:21
8:04
3:17
Determine patient’s need for immunization
1:38
0:10
1:28
Create new Individual Immunization Record
10:02
1:29
8:33
Create new School Report
5:47
2:22
3:25
Look-up/Edit history of contraindications/exemptions
3:33
1:01
2:32
Record reaction to immunization
1:46
0:49
0:57
Copyright 2002 D.J. Richards, Intermountain Health Care

27. Increased Immunization Rates at IHC (1999 – 2000)
The most dramatic one-year increase to date
HEDIS® measurement for commercial members increased from 64.7% to 76.2%
Absolute increase of 11.5 percentage points
HEDIS® measurement for Medicaid members increased from 66.4% to 76.9%
Absolute increase of 10.5 percentage points
Copyright 2002 D.J. Richards, Intermountain Health Care