Regional Immunization Summit October 23, 2015 LY N N T R E F R E N I M M U N I Z AT I O N B R A N C H C H I E F C D P H E

Transcription

1 Regional Immunization Summit October 23, 2015 LY N N T R E F R E N I M M U N I Z AT I O N B R A N C H C H I E F C D P H E

2 Colorado Immunization Branch (CIB) Goal: Improve immunization rates in Colorado Activities & Initiatives Provide Funding Core funding given to all LPHA Special projects funded for LPHA that apply Colorado Immunization Information System (CIIS) Work Directed by Legislation SB 222 HB 1288 Work Guided by Advisory Committees Vaccine Advisory Committee of Colorado (VACC) School Immunization Task Force (SIT) Other Activities

3 Funding Provided Activities funded for all LPHA include immunization clinics, education, reminder/recall, best practices Special project funding 7/15 6/16 Health Care Worker / Influenza 15 LPHA funded to help facilities required to report HCW rates of flu vaccination HPV 26 LPHA funded to improve HPV vaccination rates RACK Rates Assessment in Child Care & Kindergarten 28 LPHA funded to help child care and kindergarten staff assess immunization rates and compliance

4 Healthcare Worker Influenza Requirement Approved February 15, 2012; developed with extensive stakeholder input All facilities licensed by CDPHE must report number of employees who received an influenza vaccine Target is 90% If target is met, facility is exempt from requirement to create a policy, but must report annually If target is not met, facility directed to complete activities based on facility type ** Does not include outpatient physician clinics, dental offices, chiropractic offices or LPHAs,

5 CIIS 4.65 million patients 1.69 mil patients mil patients 19+ 1,477 patients opted out 50 million immunization services 261K avg administered immunizations/month Increase by 0.25%/month 307K avg/month by ,200+ providers submitting data (75% electronically) 171 current interfaces; 741 clinics 65 interfaces in process 520 providers on waiting list (43% FP, 12% Int. Med, 10% OB/GYN and 10% peds) QI project to reduce interface development time in coordination with CORHIO

6 CIIS Enhancements CIIS Resource Center Borrowed Doses functionality: Users will be forced to account for doses administered where funding source and patient eligibility do not match. Inventory Adjustments: Add/Subtract + Reason (no longer have to enter negative numbers) Auto-complete functionality for vaccine ordering (much like the Google search bar) Inventory reconciliation changes, including having only one open reconciliation per inventory location

7 Legislation SB Establish a vaccine access taskforce Improve access to childhood vaccines by leveraging public/private partnerships to provide affordable, sustainable, and geographically diverse solutions that address vaccination barriers across Colorado HB Pertains to exemptions to immunization requirements for children attending school Requires schools & child care centers to release UTD rates upon request, directs CDPHE to create an educational module, directs the BOH to make rules about the frequency of exemptions, joint data sharing policies

8 HB / BOH changes Frequency of Nonmedical Exemptions For young children, exemption submission at 2 months, 4 months, 6 months, 12 months and 18 months Kindergarten 12 th grade Annual submission to align with school s enrollment/registration One form submitted for all vaccines exempted from Recommendation from PBE Stakeholder process with majority support No change for colleges & universities No change for medical exemptions

9 New Process for Exemptions Centralize collection through CDPHE website Offered as a service; can not require without legislative change Online nonmedical exemption form Download medical exemption form/return with signatures If no computer access - Forms will be mailed/faxed Multiple languages Transfer to Colorado Immunization Information System Documented similar to immunizations received School/childcare associated with record CIIS Opt-out still applies Exemption documented internally Parent or Department sends exemption info to school/childcare **Not officially part of BOH rules

10 Educational Module Outline Epidemiology Overview of vaccine preventable diseases (VPD) How immunizations have reduced incidence of VPDs Colorado Immunization Rates How Vaccines Work (video) Vaccines Recommended For Children Individual modules for each vaccine Why Immunize? Childhood Immunization Schedule Why Immunizations Are Given When They Are Risks and Benefits of Vaccines Common Side Effects Basic Comfort Measures Vaccine Safety Vaccine ingredients Food and Drug Administration role Advisory Committee on Immunization Practices (ACIP) role Vaccine Information Statements Vaccine Adverse Event Reporting System (VAERS) Vaccine Safety Datalink (VSD) Colorado School Immunization Requirements Exemptions

11 Insert overview and instructions. Section 1: Licensed Childcare Facility Information Statistical Reporting of Immunization Data Childcare Facility Name: Childcare Facility Code: Childcare Facility Physical Address: County: Type of Licensed Child Care Facility: Child Care Center School-Age Child Care Center Preschool Day Camp Resident Camp Day Treatment Center Family Child Care Home Foster Care Home Head Start Program Name of the person completing this report: Title: Phone number: By December 1 of each year schools will report total numbers, by antigen, via an online form Do you or someone at your childcare facility have access to view immunization records in the Colorado Immunization Information System (CIIS)? Yes No If No, and you would like more information, please go to: Does Kindergarten your childcare facility enter student reported immunization records into total a data system? numbers Yes No and separately to If yes, which data system? XXXX XXXXX XXXX comply with annual Other, please CDC specify: survey Section 2: Immunization and Exemption Data for Childcare Facility Students TOTAL NUMBER OF STUDENTS ENROLLED: VACCINE NUMBER UP TO DATE Students who have all required vaccines NUMBER OF MEDICAL EXEMPTIONS NUMBER OF RELIGIOUS EXEMPTIONS NUMBER OF PERSONAL EXEMPTIONS NUMBER IN PROCESS Students who have a plan in place to get all required vaccines NUMBER NOT UP TO DATE Students who have some but not all required vaccines, are not In Process, or have not claimed an Exemption NUMBER WITH NO IMMUNIZATION RECORDS TOTALS For each row, total should equal total number of all enrolled students In Compliance Not In Compliance Hep B DTaP Polio PCV13 MMR Varicella TOTALs

12 Advisory Committees VACC Established in 2007, Re-structured in 2013 National Governor s Association (NGA) School Immunization Taskforce (SIT) Established to provide stakeholder input to the rules for school immunizations Meets annually to consider and propose changes Ad-hoc work groups formed as needed

13 Other Activities Meningococcal Vaccine Letter received from legislators asking CIB to consider a MCV4 requirement for school Presented to VACC and SIT, will convene broader stakeholder group SB222 Work Group Vaccine access in Colorado VaxCare Pilot Physician Mentoring Resource HUB

14 Thank You LY N N T R E F R E N LY N N. T R E F R E S TAT E. C O. U S

15 The Vaccine Advisory Committee for Colorado and The Immunization Policy Roundtable Matthew F. Daley, M.D. Institute for Health Research, Kaiser Permanente Colorado Department of Pediatrics, University of Colorado School of Medicine October 23, Colorado Immunization Summit Immunization Policy Panel

16 Disclosures Dr. Daley reports no relevant financial interests and no conflicts of interest regarding the content presented in this talk

17 Outline What does policy change look like? Vaccine Advisory Committee for Colorado Recent Immunization Policy Roundtable Discussion

18 Policy Change Can Take Many Forms Legislative: changes to CO state law Change the process by which parents claim a non-medical exemption from school immunization requirements Rule-making: state Board of Health rules Whether or not meningococcal conjugate vaccine should be required for school Specify the frequency with which parents need to claim nonmedical exemption Interpretive: state interpretation of federal FERPA legislation Programmatic: CIIS (CO Immunization Information System) processes Publicize attributes of EHRs that interface well with CIIS

19 Many States Have Vaccine Advisory Committees 2011 national survey: 64% of states had vaccine advisory committees Designed to assist state immunization programs in decision-making Issues considered included: School and childcare vaccination requirements Immunization information systems Vaccination of health care workers Implementation of new vaccine requirements Ref: Dolan V et al, J Public Health Manag Pract, 2013.

20 Vaccine Advisory Committee for Colorado (VACC) Established 2007 with broad mandate: examine barriers to immunization, identify pockets of need, recommend strategies Restructured in 2013 with narrower focus: to provide advice and guidance on vaccine-related matters to Colorado Department of Public Health and Environment (CDPHE), particularly in support of the Immunization Section at CDPHE Members: local and state public health, public health law, family medicine, pediatrics

21 Roundtable Discussion on Promising Immunization Practices Hosted by CO Governor s Office (Kyle Brown), August 2015 Organized by the National Governors Association Participants included: Local and state public health Local and regional immunization stakeholders Colorado-based immunization delivery experts Several invited national immunization delivery experts

22 Important Context for What Follows Summarize some of the policy considerations that were discussed What follows does not represent a policy agenda or a state legislative agenda Evidence base lacking for many appealing policy changes More ideas than we have time to discuss here

23 Policy Considerations Fell Into Four Broad Domains Immunization registries (information systems) and other data collection tools Rules governing school and child care immunization requirements and exemptions Compliance with, and enforcement of, existing school and child care immunization requirements Other policy considerations

24 Data Sharing Between Schools and CIIS Utilize the Department of Education October 1 st count of students to link each student, in each school, with CIIS, to assess immunization status Opportunities: Public health collects immunization records for students, not schools Public health generates school immunization rates, exemption rates Fosters collaboration between schools and public health Challenges: Could be challenged on educational privacy grounds (FERPA) May require legislation Current information collected on students not sufficient to match to CIIS Does not apply to licensed child care facilities

25 Require Exemption Reporting to CDPHE Rather than to Schools Grant CDPHE authority to collect exemption data; require parents to report exemptions to CDPHE Opportunities: CDPHE would have accurate and timely exemption data (outbreaks) Information would be recorded in CIIS; increases data accuracy in CIIS Reduces burden on schools May reduce burden on parents (24-7 access to on-line tool) Challenges: Requires legislation Parents can opt out of CIIS, resulting in incomplete data in CIIS for providers, schools, public health Resources needed at CDPHE to manage

26 Increase Exemption Effort Charge exemption fee to fund state or local public health processing of exemption funds Require education prior to claiming exemption Require parents to explain why they are not vaccinating Require provider signature prior to claiming an exemption Implement informed refusal by including additional information on exemption form Health plans charge higher premiums for unvaccinated patients

27 Increasing Exemption Effort, cont. Opportunities: Equal effort to exempt or to immunize Ensure that only those with true convictions against immunization claim an exemption Challenges: Could foster antagonism rather than collaboration with parents who choose not to vaccinate With exception of informed refusal, all would require legislation Significant push-back from those with opposition to school immunization requirements

28 Compliance and Enforcement of Immunization Requirements Grant explicit authority to CDPHE to enforce compliance with requirements Opportunities: Empowers public health to motivate schools to comply Create consequences for inaction, such as reduction in school funding Effort could be targeted at schools with large numbers of students out of compliance with requirements Challenges: Requires legislation May be hard to muster support from schools, Dept. of Education, Board of Education Identifying the appropriate consequences for lack of compliance Need to be careful not to penalize schools with low income children who may lack access to timely immunization

29 Publicize School Immunization, Exemption, and Compliance Rates Opportunities: Will hold schools publicly accountable Will promote school efforts to ensure compliance Will provide transparency to parents when choosing schools Could be linked to educational ranking sites Challenges: Will need resources to notify schools that they are out of compliance Schools may challenge the accuracy of data Schools may request updates to the data mid-year

30 More Effective Messaging to the Public Regarding Vaccine Safety Implement public education campaign, with tailoring to specific demographic or geographic areas of interest Opportunities: Education campaign that resonates with targeted population Could be synchronized with provider training Could result in opinion change Challenges: A tailored campaign would likely be expensive and time-consuming to implement; research needed up-front Could spends lots of money and time but have no impact on the public s perception of vaccines

31 Colorado Children s Immunization Coalition s Public Policy Agenda Immunization Summit, Grand Junction CO Stephanie Wasserman, MSPH, Executive Director October 23 rd, 2015

32 Educating Healthcare Professionals Advocating for Public Policy Raising Awareness & Conducting Outreach Campaigns Providing Free and Low-Cost Immunization Services Building a Statewide Coalition & Collaborative Partnerships

33 Inform and advance legislative or regulatory policies to promote improved access, delivery and demand for childhood vaccinations Provide educational opportunities to legislators and staff Outreach and stakeholder engagement as an independent organization

34 August: CCIC Policy committee makes recommendations based on strategic plan September: CCIC board approved policy recommendations October-December: Policy priorities are communicated to coalition members and partners January-May: Colorado General Assembly Legislative Session January-December: Administrative Rulemaking, Outreach, Stakeholder Engagement, Action Alerts etc

35 POLICY ISSUE PRIORITY NO. 1 Colorado Immunization Information System (CIIS): Enhanced Utilization CCIC Position: CCIC supports inclusion of complete and accurate lifelong immunization data in CIIS, integration of CIIS with schools (which include licensed child care facilities) and use of CIIS in clinical and public health decision making.

36 Support resources to address provider wait-list Support resources for school functionality Support resources to on-board all immunization providers Explore use of 90/10 Incentive dollars from HCPF Support reminder/recall efforts using CIIS data Incentivize Medicaid, VFC and CHP+ providers to participate in CIIS.

37 CCIC Position: CCIC supports increased school entry law enforcement and compliance, and increased participation of State and Local Public Health in school entry law enforcement, compliance, and collection of data.

38 Partner with researchers to conduct parent and childcare attitudes and beliefs survey Host Immunization Data Advisory Council to create and share local data tools for targeted intervention Outreach to parents on making informed daycare and school choices based on high immunization coverage rates

39 CCIC Position : Evidence shows that non-medical exemptions result in higher risk of vaccine preventable disease to both the children who take an exemption and to others in the community. Non-medical exemptions should require equal effort compared to obtaining immunizations (required renewals at regular intervals) and should be based on informed refusal. CCIC supports the Board of Health rules adopted in 2015 concerning non-medical exemptions.

40 Support the continuing implementation of HB and BOH rules Promote ImmunizeforGood.com parent outreach campaign Share CDPHE s online education module and other resources Support CIIS upgrades that allow for electronic collection of exemption data

41 CCIC Position: Protecting children from vaccine-preventable diseases is a child safety issue. Younger children are particularly vulnerable to contracting highly contagious diseases such as pertussis (whooping cough), measles, mumps, varicella (chickenpox), and influenza. To prevent the transmission of disease to children enrolled in child care, CCIC supports immunization requirements for all child care workers and child care health consultants in accordance with the Advisory Committee on Immunization Practices (ACIP) recommendations.

42 Continue to engage with Department of Human Services on Health and Safety Rules Package Work with partner organization such as the Denver Preschool Program and the Colorado Preschool Program on including staff immunizations in provider agreements

43 CCIC Position: CCIC supports affordable and accessible immunizations in accordance with ACIP recommendations for all Coloradans.

44 Participate in SB Vaccine Access Taskforce: Evaluating several private sector solutions designed to remove or alleviate some of the most common barriers in vaccination service delivery. VaxCare Pilot Creating Provider Resource Hub Launching mentoring program

45 #6 Safety Net: Incentivize Participation in Vaccines for Children (VFC) #7 Increased Immunization Funding and Reimbursement #8 Healthcare Workers: Require ACIP-recommended vaccinations #9 Ensure life-long immunization: Support resources to ensure life-long immunization for ACIP-recommended vaccinations #10 K-12 Teachers and Other School and District Employees: Require ACIP-recommended vaccinations

46

47

48