Mary Woinarowicz, MA IIS Manager

Transcription

1 Mary Woinarowicz, MA IIS Manager

2

3 NDIIS Background Established in 1988 The North Dakota Department of Health (NDDoH) contracted with Noridian Mutual Insurance Company (NMIC), formally Blue Cross/Blue Shield of North Dakota (BCBSND), in 1996 to develop the current web-based system. In May 2013, the NDIIS went through a technical upgrade that moved the system to.net technology. ND Century Code requires North Dakota providers enter all childhood (under 18 years of age) immunizations into the NDIIS within 4 weeks of administration. There are 1,205,138 active client records in the NDIIS There are 11,505,080 dose records in the NDIIS

4 Interoperability Overview As of March 2016 the NDIIS is interoperable with 245 individual provider locations, the North Dakota Health Information Network (NDHIN) and the ND Department of Health disease surveillance system (MAVEN). 212 providers are connected to the NDIIS via the NDHIN 8 providers are submitting real-time, VXU only 31 providers are submitting flat files 206 are real-time, fully bi-directional

5 Interoperability Overview 80.0% % of doses added to NDIIS electronically 70.0% 60.0% 50.0% 40.0% % HL7 30.0% 20.0% 10.0% 0.0% Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q4 2015

6

7 Adult Provider Outreach North Dakota is an IIS Sentinel Site. In 2014 and 2015, Sentinel Sites received supplemental funding to increase Pandemic Preparedness and to increase IIS Functional Capacity. o Activities for additional cooperative agreements included outreach with adult immunization providers.

8 Adult Outreach continued The NDIIS is a lifespan system that includes infants, children, adolescents and adults. ND has a mandatory reporting requirement for childhood (18 and under) vaccinations, but does not have a requirement for reporting adult immunizations. Adults can opt-out of the NDIIS. Only 3 adults have opted out. Have seen a steady increase in adult participation in the NDIIS. Interoperability has helped by eliminating additional staff time for dual data entry.

9 Adult Participation Percent of adults 19 years of age and older with at least one adult dose of vaccine in the NDIIS 90% 80% 70% 63% 69% 73% 80% 85% 89% 60% 54% 50% 40% 30% 20% 10% 0%

10 Adult Immunization Rates 40.0% Percent of adults 60 years of age and older with at least one dose of zoster vaccine 35.0% 30.0% 25.0% 20.0% 15.0% ZOSTER 10.0% 5.0% 0.0% Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q4 2015

11 Adult Rates Continued 0.45 Percent of adults 65 years of age and older with at least one dose of PPV23 and PCV PCV13 PPV Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q4 2015

12 Targeted Providers In-patient hospitals Pharmacies Long Term Care Local Public Health Challenges: Only hospitals were eligible for Meaningful Use incentives. o Hoping recent changes to MU3 making long term care, pharmacies and public health eligible will motivate them to connect. Not all systems used by these providers are HL7 capable.

13 Flat File Specifications Developed specifications for submitting immunization data via flat file. Must send a client file and a vaccination file Files have required, required but may be empty and optional fields Code Set Dictionary defines all coded values Set a naming convention for each file type

14 Flat Files continued Files are securely transferred to the NDIIS secure FTP server NDIIS program: 1. receives flat files 2. converts flat file data into HL7 format Once in HL7 format, data is run through NDIIS messaging engine and is added to the NDIIS.

15

16 In-Patient Hospitals NDDoH heard from several hospitals that they were having issues with reimbursement for adult pneumococcal vaccines. Inpatients must have their pneumococcal vaccine prior to discharge. Without reliable documentation of having a dose, assume they don t and administer vaccine. Hospital not being reimbursed because patient already had the vaccine. Motivation to report to the NDIIS to have record of previous doses and reduce financial burden of not being reimbursed.

17 Hospitals continued Catholic Health Initiatives (CHI) network of 7 hospitals Not associated with a larger healthcare system Real time messaging, VXU only via NDHIN Submitting immunizations in production August other in-patient hospitals in queue to connect Primarily critical access hospitals not associated with larger healthcare system

18 Pharmacies Pharmacies account for only 8% of all adult doses reported to the NDIIS. Thrifty White Local chain of 31 pharmacies and is largest pharmacy reporter. o 4% of all adult doses o 51% of all pharmacy doses Began working with them on flat file submissions in September 2014 First files were submitted in February 2016

19 Pharmacies continued CVS There are 6 locations in ND. o ND is the only state in the US with a law that requires pharmacies to be locally owned. Have not reported any vaccine doses administered to the NDIIS. Began working on MOU and on-boarding in June 2014 MOU was finally signed in May 2015 Currently actively engaged in technical testing of realtime HL7 connection with NDIIS. In contact with two other local pharmacy chains to get them connected or submitting flat files

20 Long Term Care Represent less than 1% of all adult doses reported to NDIIS. Administer vaccinations, including influenza, to their residents. Goal is to conduct outreach with at least 75 long term care facilities around the state. Visits include education on adult vaccines, adult immunization rates (based on NDIIS data), NDIIS training and information on electronic data submissions. Provide flat file spec to all interested facilities. o o Currently have 2 facilities interested in submitting data electronically. NDIIS coordinator has also been in contact with EHR vendor used by high volume of long term care providers in North Dakota.

21 Local Public Health Represent 13% of adult doses reported to the NDIIS Currently have 15 of 54 individual local public health units submitting data to the NDIIS via HL7. 2 more will be connected in 2016 Administer high volume of immunizations, especially during flu season. Don t report all adult administered vaccines Takes a lot of staff time to report childhood immunizations (mandatory) that they only report adult doses when and if they have time Targeting 19 additional public health units to get them submitting data electronically Have technical resources available to help

22 Other Providers University Student Health Centers North Dakota has 2 major universities. Both have a student health clinic that provides immunizations to their students. University of North Dakota Real-time, fully bi-directional connection in production in April 2015 North Dakota State University Started on-boarding in March 2016

23

24 Disease Surveillance System MAVEN is the system used by the ND Department of Health, Division of Disease Control for reporting and investigation of reportable diseases in the state. This includes vaccine-preventable diseases (VPD). When investigating reports of VPDs, staff had to fill in the patient s vaccination history. Staff had to: o leave the MAVEN system, o log in to the NDIIS separately and search for the patient s immunization record and o manually extract history back in to MAVEN.

25 MAVEN connection continued NDDoH worked directly with MAVEN vendor, Consillience and NMIC interoperability technical resource on a connection between the NDIIS and MAVEN. SOAP connection Query/Response only Connection was in production in December Consillience built manual trigger in MAVEN that would send an HL7 query to the NDIIS. Also built a filter so that the trigger can only be initiated for VPDs.

26 MAVEN connection continued MAVEN case and NDIIS immunization records are matched based on first name, last name and birthdate. If a match is found, the NDIIS returns the patient s complete immunization history. MAVEN consumes the NDIIS response and stores the patient s vaccination history as part of the disease investigation documentation. Saves a significant amount of staff time during disease investigations and helps sync patient demographics between the two systems.

27 MAVEN connection continued In 2016, NDDoH teams plan to evaluate the success of the connection and the benefits and time savings to the department. Also plan to update the trigger filter to include immunizations for STD and HIV cases reported to MAVEN in order to: assess the HPV vaccination status for reported STD cases and assess if HIV cases have received all ACIP recommended vaccines.

28 Future Connections North Dakota Cancer Registry Currently working on an initial data match project with the Cancer Registry. Data match project will help identify possibility of continual data exchange between NDIIS and the Cancer Registry.

29 Contact Information Mary Woinarowicz IIS Manager