Evaluating IIS Address Data Quality following HL7 Implementation by a Retail Pharmacy Chain. Kevin Dombkowski, DrPH, MS April 6, 2016

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1 Evaluating IIS Address Data Quality following HL7 Implementation by a Retail Pharmacy Chain Kevin Dombkowski, DrPH, MS April 6, 2016

2 Historically, reminder / recall efforts have been hampered by outdated or missing contact information Background

3 Expensive: mailing / postage follow-up for undeliverable notices Notifications must be delivered in order to be effective Background

4 Background Since 2012, the Michigan Care Improvement Registry (MCIR) is receiving HL7 VXU messages directly from EHRs now >2,200 sites All HL7 messages include a street address Typical medical practice work flows include verification of contact information with each patient visit

5 Background State law requires reporting of all immunizations administered to MCIR for persons <21 years No requirement to report for adults However, MCIR is authorized accept data for all age groups

6 Questions To what extent can HL7 messaging improve the quality of contact information among adults in MCIR? What are the potential implications for successful MCIR-based reminder / recall among adults?

7 Objective To assess the extent to which the quality of contact information reported following HL7 differs in terms of: completeness changes Evaluate the demographic characteristics of persons receiving doses: age geographic location [see Session 7, Track B]

8 Methods Vaccination records reported by all Walgreens pharmacies in Michigan, flu season

9 Walgreens Pharmacies

10 Methods HL7 (VXU) reporting by Walgreens commenced in October 2013 Pre-HL7 reporting was electronic batch file transfer Information was matched with subjects historical contact information in MCIR: street address telephone number

11 Methods Comparison of HL7 address information to historical MCIR data was classified as: Same identical values Changed a new physical location Updated same location, refined information (e.g., ZIP+4) New person previously not in MCIR

12 Methods Comparison of HL7 telephone information to historical MCIR data was classified as: Same identical values Changed a different phone number Updated same number, added information New person s phone number was not previously in MCIR Deleted number removed from MCIR

13 Results Overall, 215,766 persons received vaccinations at Walgreens in Michigan during the flu season: 107,788 pre-hl7 107,978 post-hl7

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16 100% Walgreens Immunization Patients Flu Season 96% 92% 80% 60% Percent 40% 20% 4% 8% 0% Kids <18 Adults 18 Pre-HL7 (n= 107,788) Post-HL7 (n= 107,978)

17 100% Walgreens Immunization Patients Current Address vs. Historical Flu Season 80% 60% Percent 49% 40% 30% 20% 0% 15% 6% <1% Same Change Update New Uncertain Pre-HL7 (n= 107,788) Post-HL7 (n= 107,978)

18 100% Walgreens Immunization Patients Current Address vs. Historical Flu Season 80% 60% Percent 49% 46% 40% 32% 30% 20% 15% 16% 0% 6% 5% <1% <1% Same Change Update New Uncertain Pre-HL7 (n= 107,788) Post-HL7 (n= 107,978)

19 Walgreens Patients Percent New Persons By Age Group 100% 80% Percent New Addresses 60% 40% 30% 44% 44% 39% 33% 28% 23% 25% 30% 20% 0% < Age Pre-HL7 (n = 32,399) Post-HL7 (n = 49,791)

20 Walgreens Patients Percent New Persons By Age Group 100% 80% Percent New Addresses 60% 40% 30% 38% 56% 44% 44% 59% 39% 54% 33% 49% 28% 44% 23% 37% 25% 40% 30% 43% 20% 0% < Age Pre-HL7 (n = 32,399) Post-HL7 (n = 49,791)

21 100% Walgreens Immunization Patients Current Phone Number vs. Historical Flu Season 80% Percent 60% 40% 54% 30% 20% 0% 6% 8% 1% <1% 1% Same Change Update New Uncertain Deleted Added Pre-HL7 (n= 107,788) Post-HL7 (n= 107,978)

22 100% Walgreens Immunization Patients Current Phone Number vs. Historical Flu Season 80% Percent 60% 54% 46% 43% 40% 30% 20% 0% 10% 6% 8% <1% 1% <1% 0% 0% 1% 1% Same Change Update New Uncertain Deleted Added Pre-HL7 (n= 107,788) Post-HL7 (n= 107,978)

23 Changes by Location Most sites (n=117) reported an increased number of persons post-hl7 Most sites (n=197) reported >90% adults Increases were observed at locations across the state

24 Post HL7 Top 25 Walgreens Sites

25 Conclusions Walgreens pharmacies submit a large number of doses to MCIR during the flu season Doses were submitted primarily for adults Nearly half of persons post-hl7 were new to MCIR

26 Implications Although not required by law, a huge amount of information is being reported electronically for adults The HL7 dividend practices that must report doses for kids have no barrier to also reporting for adults, i.e., a tiny marginal cost More complete denominator More complete vaccination history More accurate contact information

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28 Benefits: Pandemic Preparedness More complete and accurate contact information Minimize issues where Sent Delivered

29 100% Doses Reported to MCIR Adults 3,500,000 80% 3,000,000 2,500,000 Doses Reported to MCIR 60% 40% 2,000,000 1,500,000 1,000,000 Total Number of Doses 20% 500,000 0% 2010 (n= 2,062,675) 2011 (n= 1,672,921) 2012 (n= 2,067,804) 2013 (n= 2,360,657) 2014 (n= 2,767,003) HL7 EXT Keyboard Total Number of Doses 2015 (n= 3,228,128) 0

30 100% Doses Reported to MCIR Adults 3,500,000 80% 3,000,000 2,500,000 Doses Reported to MCIR 60% 40% 2,000,000 1,500,000 1,000,000 Total Number of Doses 20% 500,000 0% 2010 (n= 2,062,675) 2011 (n= 1,672,921) 2012 (n= 2,067,804) 2013 (n= 2,360,657) 2014 (n= 2,767,003) HL7 EXT Keyboard Total Number of Doses 2015 (n= 3,228,128) 0

31 Retail Pharmacies Reporting HL7 Retail pharmacy reporting via HL7 to MCIR: Walgreens (2013) CVS (2014) Meijer (2014) Walmart (2105) Sam s Club (2015) Over 700 retail pharmacy chain sites

32 Derek Van Hannah Jary Collaborators Michigan Department of Health and Human Services / MCIR team

33 Kevin Dombkowski, DrPH, MS Research Associate Professor University of Michigan, Division of General Pediatrics Child Health Evaluation and Research (CHEAR) Unit (734)