1. MSIPC Fundamentals: Interaction between IPs and Local and State Health Departments Joyce Lai, MPH– Michigan Department of Community Health Noreen Mollon, MS– Michigan Department of Community Health October 29, 2014 www.michigan.gov/hai

2. Outline  MDCH Organization  Communicable Disease Surveillance  Reportable Diseases  Michigan Surveillance Data Systems  MDSS  MSSS  Sentinel Surveillance for ILI  SHARP  Outbreak Response  Surveillance and Reporting  Prevention Initiatives  Other MDCH Entities that frequently interact with IPs

3. MDCH Mission Statement  MDCH will protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations

4. MDCH Organization Operations Administration Medical Services Administration Behavioral Health & Developmental Disabilities Administration Office of Inspector General Offices of Services To the Aging Chief Operating Officer DIRECTOR Public Health Administration

5. MDCH Organization Public Health Administration Bureau of Local Health & Administrative Services Bureau of Family, Maternal And Child Health Bureau of Disease Control, Prevention, and Epidemiology Bureau of Laboratories Division of Health Wellness And Disease Control Office of Public Health Preparedness

6. MDCH Organization Bureau of Disease Control, Prevention, and Epidemiology Division of Genomics, Perinatal Health, and Chronic Disease Division of Immunization Division of Environmental Health Division of Communicable Disease Surveillance Section

7. Communicable Disease Surveillance  Communicable disease reporting is required by Michigan law:  Michigan Public Health Act No. 368 Communicable Disease Rules: R 325.171-3, 333.5111  Rule revision allows the State the right to periodically update the list of reportable diseases  This reporting is expressly allowed under HIPAA Hepatitis C Virus Neisseria meningitidisHistoplasma capsulatum Bordetella pertussis

8. Why Communicable Disease Surveillance is Important  To identify outbreaks  To assure treatment, preventive treatment and/or education  To evaluate prevention and control programs  To help target prevention resources  To facilitate epidemiologic research  To assist national and global surveillance efforts Salmonella sp. Influenza Virus Chlamydia trachomatisMycobacterium tuberculosis

9. Public Health Depends on Collaboration Healthcare Providers Clinical Laboratories Local Health Department State Health Department Centers for Disease Control and Prevention Isolates and specimens sent to State Lab for additional testing

10. Communicable Disease Reporting Entities  Physicians*  Laboratories*  Hospital ICP  Private citizens  School systems*  Pharmacists  Veterinarians  Medical Examiners  Hospitals*  Child care facilities  Long-term care facilities*  Pre-hospital emergency services  Police  Fire  EMS * Required to report

11. Communicable Disease “Brick Book”  The current 2014 version (electric crimson), provides a good summary of the communicable disease rules, requirements, and responsibilities

12. Michigan Reportable Diseases  ~90 disease/conditions are reportable in Michigan  Also reportable are ‘unusual occurrences’, outbreaks and epidemics of any disease or condition (including healthcare-associated infections)  Specific reporting rules and definitions can be found at www.michigan.gov/cdinfo www.michigan.gov/cdinfo

13. Case Rules and Definitions  Example of Streptococcus pneumoniae reporting algorithm

14. Case Rules and Definitions  Acute / Chronic Hepatitis C Reporting Flowchart

15. Timeliness and Completeness of Communicable Disease Reports  In general, all reportable diseases are required to be reported within 24 hours of confirmation  Report contents  Demographic info – name, date of birth, sex, race  Contact info – address, phone number  Disease details – onset date, lab results  Surveillance is only as good as the data received  The timeliness and effectiveness of public health responses are dependent on prompt and accurate surveillance reporting

16. Authority of State and Local HDs  Michigan is a “home rule” state, meaning local HDs have autonomy within their jurisdiction  The MDCH operates independently from the local HDs  The primary role of the MDCH in communicable disease control is to provide:  expert consultation  reference level diagnostics laboratory services  childhood vaccines  support local HDs upon their request  Maintenance and administration of the MDSS  All communicable disease reports should be reported to your local HDs

17. Map of Michigan Local HDs

18. Public Health Investigative Authority  State and local HD personnel are authorized to investigate reported diseases, including:  Contacting health providers  Conducting additional case-finding  Conducting epidemiological studies  Conducting specimen collection  Gathering information on medical history, lab results, diagnostic procedures, treatment, and health outcomes  The MDCH works collaboratively with the local HDs and participates in investigations when requested

19. Confidentiality, HIPAA, and PHI  Disclosure of protected health information (PHI) to health authorities without individual consent or authorization is permitted when disclosure is required by law or is authorized by law for a public health purpose (www.hhs.gov/ocr/hipaa/)www.hhs.gov/ocr/hipaa/  All information provided to public health authorities is kept confidential

20. Helpful Links  www.michigan.gov/mdch www.michigan.gov/mdch  Click on ‘Providers’ and then ‘Chronic and Communicable Diseases’  www.michigan.gov/hivstd - HIV/STD/Viral Hepatitis www.michigan.gov/hivstd  www.michigan.gov/cdinfo - Communicable Disease resources, forms, links, reports, and publications www.michigan.gov/cdinfo  www.michigan.gov/mdss - Michigan Disease Surveillance System (MDSS) www.michigan.gov/mdss  www.michigan.gov/hai- Healthcare-Associated Infection Surveillance & Prevention www.michigan.gov/hai-

21. Michigan Surveillance Systems  Michigan Disease Surveillance System (MDSS)  Michigan (Emergency Department) Syndromic Surveillance System (MSSS)  Sentinel Surveillance for Influenza-Like Illness

22. Disease Detection/Reporting Timeline Exposure Symptom Onset Seeking of Medical Care Diagnosis Reported to Local HD Reported to State HD ED Syndromic Surveillance Michigan Disease Surveillance System Time

23. Michigan Disease Surveillance System  Web-based communicable disease surveillance system  Disease can be reported 24/7 from your computer  Used to facilitate coordination between local, State, and federal public health agencies  Streamlines disease reporting; more efficient and closer to real-time  Allows for more timely public health interventions  Reduces delays in public health follow-up by grouping disease based on county of patient residence

24.  Data in the MDSS can be accessed and edited by multiple parties which facilitates the sharing of information without requiring multiple phone calls  Allows for instantaneous retrieval of summary reports  MDCH Weekly Surveillance Report (www.michigan.gov/cdinfo)www.michigan.gov/cdinfo  Data sent to CDC National Notifiable Disease Surveillance System (NNDSS – www.cdc.gov/nndss) for Morbidity and Mortality Weekly Reports (MMWR – www.cdc.gov/mmwr)www.cdc.gov/nndsswww.cdc.gov/mmwr Michigan Disease Surveillance System

25. MDSS Reporting Pathways CommunityPhysiciansInfection Preventionists Hospital Labs Local Health Department Case Follow-up Local Surveillance Electronic Reports MDCH Statewide Surveillance Weekly Surveillance Reports (WSR) CDC National Notifiable Disease Surveillance System (NNDSS) Morbidity and Mortality Weekly Report (MMWR) MDSS

26. Adding/Editing Cases in MDSS

27. Searching Records in MDSS

28. Pulling MDSS Data

30. MDSS Statistics YearReferrals Individual Case ReportsTransactions Unique User Log Ins 200783,87677,686400,000---- 2008136,057104,616429,848783 2009160,326119,843618,731893 2010158,225113,765697,258906 2011213,639159,185803,092982 2012211,150146,0691,018,3041,126 2013185,362126,8121,059,0231,155

31. MDSS Electronic Reporting LABORATORY20062007200820092010201120122013 MDCH REGIONAL LAB - LANSING16,4077,03913,58920,72316,24518,56722,30520,905 DETROIT MEDICAL CENTER LAB1,1678,6528,7588,8829,81610,1478,9817523 MDCH REGIONAL LAB - DETROIT1,2061,3232,0401,5961,6621,71436912 ARUP LABORATORIES2,1003,6562,6783,3143,4983,2095,6805621 GARCIA LABORATORIES-- 483-- 8 HURLEY HOSPITAL LAB (3/09)-- 3,0243,7925,0314,4482874 MAYO CLINICAL LABS (8/09) 1,5486,6683,9854,3173375 LABCORP (9/09) 1,2263,3754,2254,9575149 MDCH REGIONAL LAB – OAKLAND (9/09) 863 MDCH REGIONAL LAB - OAKLAND CO LAB - PONTIAC2,8232,5522,1882106 MDCH REGIONAL LAB - OAKLAND CO LAB - SOUTHFIELD425676552758 MDCH REGIONAL LAB - KALAMAZOO3401,359127123 MDCH REGIONAL LAB - UPPER PENINSULA57000 MDCH REGIONAL LAB - KENT COUNTY4121,757268204 MDCH REGIONAL LAB - SAGINAW COUNTY3081,6323,1892288 SPARROW LABS (2/11)1,7352,2812161 SPARROW LABS – ST LAWRENCE LAB (2/11)2,1042,7122965 QUEST DIAGNOSTIC – AUBURN HILLS (8/11)4,96912,51016420 McLAREN OAKLAND HOSPITAL 16 McLAREN CENTRAL MI HOSPITAL 5 McLAREN MACOMB HOSPITAL 27 McLAREN FLINT HOSPITAL 27 McLAREN BAY HOSPITAL 26 McLAREN GREATER LANSING HOSPITAL 7 Total20,88020,67027,54841,17649,42163,66274,88472600

32. More Info on the MDSS  Contact:  Your Local Health Department Communicable Disease Program  Your Regional Epidemiologist  Edward Hartwick, MS, MDSS Coordinator  HartwickE@michigan.gov HartwickE@michigan.gov http://www.michigan.gov/mdss (517) 335-8165

33. Michigan (Emergency Department) Syndromic Surveillance (MSSS)  A surveillance system that detects and tracks the chief complaints of ED patients throughout the state  Chief complaints are classified into syndromic categories that could indicate a possible public health emergency  Web-based application displays the data in real-time  Alerts are automatically sent when rates of a given syndrome are detected to be higher than the predicted norm

34. MSSS  # of facilities: 95  # of users: 173  # of referrals per day, Statewide: 12,343  # of referrals per day, per facility: 130

35. MSSS Data  Each message sent to the MSSS consists of:  Demographics: date of birth, sex  Residence: home zip code  Visit Info: date, time, class (e.g. urgent care, ER)  Chief Complaint

36. MSSS Chief Complaints  Chief complaints are classified into the following syndromes:  Hemorrhagic  Botulinic  Neurological  Other  Default  Gastrointestinal  Constitutional  Respiratory  Rash

37. MSSS Classification Examples Chief ComplaintSyndrome “slurred speech”Botulinic “general weakness”Constitutional “stomach pain”Gastrointestinal “difficulty breathing”Respiratory “nose bleed”Hemorrhagic “headache”Neurological “hives and itching”Rash “right foot injury”Other “med refill”Default

38. MSSS Alerts  A detection algorithm monitors the data hourly  An e-mail alert is sent to State and regional epidemiologists if an aberration is detected  If the actual value of a syndrome exceeds the predicted value for a given syndrome in a geographic area  Users can view the data in charts, graphs, or maps

39. Use of MSS Data  Early detection of outbreaks  Enhanced surveillance during high-profile events:  World Series  Super Bowl  MLB All-Star Game  Final Four  Detroit Auto Show  Seasonal influenza monitoring  Situational awareness

40. Sentinel Provider Surveillance for Influenza-Like Illness (ILI)  Michigan component of the CDC U.S. Outpatient Influenza-like Illness Surveillance Network  Influenza sentinel reports provide data on over 12,000 outpatient office visits per week and are an important part of influenza surveillance in Michigan  Contact Stefanie DeVita at 517-335-9104 or DevitaS1@michigan.gov for more information DevitaS1@michigan.gov

41. Michigan Influenza Sentinel Hospital Network  MDCH is working to establish a network of sentinel hospitals that report influenza-associated hospitalizations  Hospitals that agree to participate would be asked to provide:  Weekly report consisting of the number of influenza- associated hospitalizations in each of five age categories  Total number of admissions during that time frame  Contact: Sally Bidol (bidols@michigan.gov)bidols@michigan.gov

42. www.michigan.gov/hai Surveillance for Healthcare-Associated and Resistant Pathogens (SHARP) Unit  Objectives of the SHARP Unit:  Coordinate activities related to HAI surveillance and prevention in Michigan  Improve surveillance and detection of antimicrobial- resistant pathogens and HAIs  Identify and respond to disease outbreaks  Use collected data to monitor trends  Educate healthcare providers, state and local public health partners, and the public on HAIs

43. SHARP Activities  Outbreak Response  Surveillance and Reporting  MDRO Prevention Initiatives  Consulting/Education Staphylococcus aureus Clostridium difficileKlebsiella pneumoniae www.michigan.gov/hai

44.  The MDCH SHARP staff are available to offer our services and expertise in healthcare-associated outbreak investigations  MDCH can help facilities coordinate molecular testing with the MDCH Bureau of Laboratories to identify genetic-relatedness between patient isolates (at no cost) Outbreak Response Acinetobacter baumannii www.michigan.gov/hai

45. Surveillance and Reporting  Vancomycin-Intermediate Staphylococcus aureus (VISA) and Vancomycin-Resistant Staphylococcus aureus (VRSA) are required to be reported according to the communicable disease rules  Unusual occurrences and outbreaks of HAIs are also mandated by law to be reported  However, individual HAIs (like a CLABSI), are not required to be reported to state or local health departments www.michigan.gov/hai

46.  33 states have laws requiring HAIs to be reported to state health departments, the majority of which publically release hospital HAI rates (http://www.jstor.org/stable/10.1086/663204)http://www.jstor.org/stable/10.1086/663204 Surveillance and Reporting www.michigan.gov/hai

47.  In Michigan, hospitals can voluntarily report HAIs to MDCH SHARP via the National Healthcare Safety Network (NHSN)  NHSN is a web-based surveillance program designed by CDC:  Uses standardized HAI surveillance definitions  Users can enter and analyze HAI data  The data sent to SHARP from Michigan hospitals are de-identified and the numbers aggregated for the purposes of producing state-wide HAI surveillance reports Surveillance and Reporting www.michigan.gov/hai

48.  HAIs tracked by MDCH SHARP surveillance: Central Line-Associated Blood Stream Infection (CLABSI) Surgical Site Infection (SSI) Catheter-Associated Urinary Tract Infection (CAUTI) Ventilator-Associated Pneumonia (VAP) Clostridium difficile LabID surveillance MRSA LabID surveillance Antimicrobial resistance in select pathogens Surveillance and Reporting www.michigan.gov/hai

49. Staphylococcus aureus Subclavian central venous line Mechanical ventilator Surgical incision showing signs of infection Clostridium difficile Foley catheter insertion kit SSI CLABSI VAP CAUTI CDI LabID MRSA LabID HAI Surveillance

50. SHARP Surveillance  Currently there are 97 Michigan hospitals sharing HAI data with SHARP, with all 97 hospitals releasing their data to the Michigan Health and Hospital Association MHA Keystone Center, and 14 hospitals releasing their NICU data to the Vermont Oxford Network (updated 9-17-14). www.michigan.gov/hai

51. SHARP Reports  SHARP releases state-wide HAI reports quarterly, semiannually, and annually which are posted at www.michigan.gov/hai www.michigan.gov/hai  All hospital data are de-identified and aggregated  Individual hospital data is not made public  SHARP also compiles hospital specific HAI reports which are only shared with those individual hospitals www.michigan.gov/hai

52. SHARP HAI Data www.michigan.gov/hai

53. SHARP HAI Data www.michigan.gov/hai

54. SHARP HAI Data www.michigan.gov/hai

55. SHARP HAI Data www.michigan.gov/hai

56. SHARP HAI Data www.michigan.gov/hai Standardized Infection Ratios (SIR) Type of Infection Number of Hospitals Procedures Done Device Days or Patient Days Observed 1 Predicted 2 MI SIR 3 MI p-value 4 MI 95% CI 5 CAUTI 6 87N/A100,676 DD274219.24971.2500.00041.108, 1.404 CLABSI 7 84N/A91,900 DD86192.92660.446<0.00010.359, 0.561 CLABSI ICU 8 84N/A82,973 DD77170.48660.452<0.00010.359, 0.561 CLABSI NICU 9 17N/A8,927922.44000.4010.00160.196, 0.736 SSI 10 8113,514N/A239309.54300.772↓<0.00010.679, 0.875 SSI COLO 11 802400N/A117143.92600.813↓0.02370.675, 0.971 SSI HYST 12 742162N/A4840.74301.1780.25950.878, 1.549 MRSA Bac LabID 13 85N/A1,189,685 PD7989.43670.8830.26850.704, 1.095 C.diff LabID 14 85N/A1,109,626 PD834926.21020.9000.00220.841, 0.963 Michigan Data US Data 1 Observed: Number of infections (CAUTI, CLABSIs or SSIs) reported during the time frame. 2 Predicted: The number of CAUTIs or CLABSIs predicted based on the type of hospital unit(s) under surveillance, or the number of SSIs predicted based upon 2009 national SSI rates by procedure type. 3 SIR: Standardized Infection Ratio: Ratio of observed events compared to the number of predicted events, accounting for unit type or procedure. An SIR of 1 can be interpreted as having the same number of events that were predicted. An SIR that is between 0 and 1 represents fewer events than predicted, while an SIR of greater than 1 represents more events than expected. 4 P-value: An SIR p-value of <0.05 is considered significantly different than expected. It can be either significantly worse (if the SIR is greater than 1 and the p-value is <0.05) or significantly better (if the SIR is less than 1 and the p-value is <0.05). 5 95% CI: 95% confidence interval around the SIR estimate. A 95% CI indicates that 95% of the time, the actual SIR will fall within this interval. 6 CAUTI: Catheter-Associated Urinary Tract Infection. CAUTIs are defined using symptomatic urinary tract infection (SUTI) criteria or Asymptomatic Bacteremic UTI (ABUTI) criteria. UTIs must be catheter-associated (i.e. patient had an indwelling urinary catheter at the time of or within 48 hours before onset of the event). 7 CLABSI: Central Line-Associated Blood Stream Infection. CLABSIs are laboratory-confirmed bloodstream infections (LCBI) that are not secondary to a community-acquired infection, or an HAI meeting CDC/NHSN criteria at another body site. BSIs must be central line associated (i.e., a central line or umbilical catheter was in place at the time of, or within 48 hours before, onset of the event). 8 CLABSI ICU: CLABSIs from ICU locations only 9 CLABSI NICU: CLABSIs from NICU locations only 10 SSI: Surgical Site Infection. Includes any superficial incisional, deep incisional, or organ/space SSI. 11 SSI COLO: Inpatient Colon surgeries 12 SSI HYST: Inpatient Abdominal Hysterectomies 13 MRSA Bacteremia LabID: Inpatient facility-wide MRSA bacteremia Laboratory-identified Event 14 Clostridium difficile LabID: Inpatient facility-wide Clostridium difficile Laboratory-identified Event ↓ or  Indicates statistically significantly lower or higher than previous quarter (respectively). Green Text or Red Text indicates significantly fewer or greater infections than expected.

57. SHARP HAI Data www.michigan.gov/hai

58. SHARP HAI Data www.michigan.gov/hai

59. SHARP HAI Data www.michigan.gov/hai

60. SHARP HAI Data www.michigan.gov/hai

61. SHARP HAI Data www.michigan.gov/hai

62. SHARP HAI Data www.michigan.gov/hai

63. SHARP HAI Data www.michigan.gov/hai

64. MDRO Prevention Initiatives  SHARP also has started two prevention initiatives aimed to reduce the incidence and prevalence of MDROs in healthcare facilities in Michigan:  Clostridium difficile (CDI) surveillance and prevention initiative  Carbapenem-Resistant Enterobacteriaceae (CRE) surveillance and prevention initiative Enterobacter cloacae Citrobacter freundii Klebsiella pneumoniaeEscherichia coli Staphylococcus aureus

65.  SHARP recruited facilities into the two initiatives  Both will measure the baseline prevalence and incidence of their respective organisms  Then there will be a period of measurement during which facilities are encouraged to begin implementing infection prevention interventions to reduce the transmission of these organisms MDRO Prevention Initiatives Planning Stage Baseline Stage Intervention Stage www.michigan.gov/hai

66. Education and Consulting  Another primary focus of the SHARP unit is increasing awareness of HAIs, answering FAQs, and disseminating best-practice and evidence-based recommendations and guidelines  Examples of entities/persons that ask for our guidance:  IPs  Local HDs  Healthcare workers  Schools  Gyms  Correctional Facilities  Students  Public www.michigan.gov/hai

67. Special Collaboration  SHARP collaborates with the MDCH Viral Hepatitis Unit:  Investigating potentially healthcare-related viral hepatitis infections (e.g. David Kwiatkowski)  Works jointly on injection safety-related educational campaigns (e.g. One and Only campaign)  Contact information  (517)335-8165  www.michigan.gov/hivstd (click on the hepatitis link)www.michigan.gov/hivstd www.michigan.gov/hai

68. SHARP Unit Contacts (517) 335-8165 www.michigan.gov/hai www.michigan.gov/hai o Jennie Finks, DVM, MVPH – HAI Coordinator and Unit Manager finksj@michigan.gov o Jennifer Beggs, MPH – Infectious Disease and Preparedness Epidemiologist beggsj@michigan.gov o Allison Murad, MPH – National Healthcare Safety Network (NHSN) Epidemiologist murada@michigan.gov murada@michigan.gov o Noreen Mollon, MS – Infection Prevention Consultant mollonn@michigan.gov o Gail Denkins, RN – CDI Prevention Initiative Coordinator denkinsg@michigan.gov o Brenda Brennan, MSPH – CRE Prevention Initiative Coordinator brennanb@michigan.gov www.michigan.gov/hai

69. Other MDCH Entities that Interact with IPs  Bureau of Labs (BOL)  Office of Public Health Preparedness (OPHP)  Licensing and Regulatory Affairs (LARA)  Michigan Occupational Safety and Health Administration (MIOSHA)  Healthcare Facility Engineering  Michigan Care Improvement Registry (MCIR)

70. MDCH Bureau of Labs (BOL)  Main Phone: (517) 335-8063  Tours available quarterly, to schedule call (517) 335-9654

71. MDCH BOL Testing www.michigan.gov/mdchlab www.michigan.gov/mdchlab List of Tests performed By MDCH BOL Forms required to Request testing

72. Regional Reference Labs  Report Suspected Bioterrorism:  Lansing: (517) 335-8063  Kalamazoo: (269) 373-5360  Grand Rapids: (616) 632-7210  Saginaw: (989) 758-3825  Oakland County: (248) 858-1310

73. Office of Public Health Preparedness (OPHP)  Purpose of OPHP is to establish strategic leadership, direction, assessment, and coordination of activities to ensure statewide readiness and interagency collaboration to respond to public health emergencies.

74. Michigan Emergency Management System President of US Governor Michigan State Police State Director of Emergency Management DHS / FEMA Emergency Management Division (EMD) MDCH EMD District Coordinators Local Health Departments Local Emergency Management Health Preparedness Regions All emergencies and disasters are local www.fema.gov/nims

75. Emergency Preparedness Collaboration Utilities Transportation Emergency Management Fire & Rescue Public Health Hospitals EMS Law Enforcement Public Works Industry / Private Sector www.fema.gov/nims

76. Emergency Preparedness Training MI-TRAIN (http://mi.train.org)http://mi.train.org

77. Emergency Preparedness Communication  Statewide communication capabilities:  Michigan Statewide Comprehensive Interoperable Communication Plan  Public Health Safety Communication System (800Mhz radios)  Health Alert Network (HAN)

78. MI HAN (https://michiganhan.org)https://michiganhan.org

79. Emergency Preparedness Regions  8 Michigan Emergency Preparedness Regions:  Modeled after State Police Regions  Encompass 45 Local HD Emergency Preparedness Centers  Each Region contains: Medical Director Hospital Bioterrorism Coordinator Epidemiologist

81. Strategic National Stockpile  Able to distribute large quantities of pharmaceuticals and medical supplies during an emergency  Local HDs and hospitals are prepared to receive MISNS assets  MISNS is capable of delivering assets via ground or air transport

82. OPHP Contacts  Linda Scott – Hospital Preparedness Coordinator  (517) 335-8150  scottl12@michigan.gov scottl12@michigan.gov  Mary Macqueen – Public Health Preparedness Coordinator  (517) 335-8150  macqueenm@michigan.gov macqueenm@michigan.gov

83. MIOSHA – Michigan Occupational Safety and Health Administration  MIOSHA operates under Licensing and Regulatory Affairs (LARA)  For healthcare inquiries contact MSIPC’s MIOSHA liaison Eric Zaban:  (517) 882-1022  For general consultation and/or training contact:  (517) 322-1809  www.michigan.gov/miosha www.michigan.gov/miosha

84. LARA- Health Facilities Engineering  Provide enforcement and interpretation of the minimum healthcare facility design standards to reduce the risk of transmission  Kasra Zarbinian  (517) 241-3422  www.michigan.gov/hfes www.michigan.gov/hfes

85. Michigan Care Improvement Registry (MCIR) www.mcir.org www.mcir.org  Web-based system created in 1998 to collect children’s immunization information  Expanded in 2006 to include adults (lifespan registry)  Consolidates immunization information from multiple data sources and provides immediate, real- time, patient immunization history  Assists with all-hazard preparedness by tracking vaccines and medications during a public health emergency

86. MCIR Activity  9 million records  Over 83 million shot records  29,000 registered users  5,500 active provider sites

87. The Benefits of MCIR  High healthcare provider participation (90%)  Reports indicate ‘pockets of need’  Flexibility, allowing linkages with other public health systems  Types of information available in MCIR:  Patient Immunization status at time of visit  Reminders/recall letters  Coverage level reports  High risk influenza  Newborn screening  Lead results  Early hearing detection and intervention (EHDI)

88. Immunization Information  Annual Fall Conferences – www.michigan.gov/immunizewww.michigan.gov/immunize  AIM Kits – www.aimtoolkit.orgwww.aimtoolkit.org  Influenza information “FluBytes”– www.michigan.gov/fluwww.michigan.gov/flu  Quarterly Newsletters – send an e-mail with SUBSCRIBE in the subject line to franklinr@michigan.govfranklinr@michigan.gov  Beatrice Salada, State MCIR Coordinator  saladab@michigan.gov saladab@michigan.gov  www.mcir.org www.mcir.org

89. Thanks!  Questions or comments?  Joyce Lai  (734) 727-7204  LaiJ@michigan.gov LaiJ@michigan.gov  Noreen Mollon  (517) 335-6582  MollonN@michigan.gov MollonN@michigan.gov