O N E R O O T, M A N Y R O U T E S Impact of User-Based System Design on Immunization Delivery

Transcription

1 O N E R O O T, M A N Y R O U T E S Impact of User-Based System Design on Delivery CPHA 2016 Health Protection June 14, 2016 Authors Rosalie Tuchscherer, Saskatchewan Ministry of Health Jill Reedijk, British Columbia Centre for Disease Control Karen Hay, Ontario Ministry of Health and Long Term Care Carol Kurbis, Manitoba Health Josée Dubuque, Ministère de la Santé et des Services sociaux du Québec Maureen Perrin, Panorama Coordination Office Jong Jung, Panorama Coordination Office

2 Roadmap 1. Describe key aspects of publicly funded immunization programs & policies across jurisdictions using Panorama 2. Analyze common root the Panorama application Entering data: Describe major immunization works as influenced by jurisdictional requirements Using data: Describe impact of automating schedules in a decision support tool as a cornerstone of immunization delivery 3. Discuss lessons learned from to inform immunization interoperability 2

3 Programs & Policies 3

4 s in Canada 1 National Guidelines for Informs P/T Programs Implemented in 1 System 6 Jurisdictions YK BC SK MB ON QC 4 Key characteristics of immunization programs are determined and funded by jurisdictions

5 Delivery Panorama as Provincial Registry Delivery (% PH / Family Doc) BCY TBD 65/35 MB Yes 50/50* ON Yes (In Progress) 15/85 QC Yes (legislative requirement) 80/20 SK Yes 99/1 Panorama has two main functions that drive how it is used: 1. Point of Service Clinical practice and college guidelines are evolving and vary across each jurisdiction 2. Registry / surveillance Need population-level data for public health and programming (funding) needs 5

6 Age-based Population Captured in Panorama Infants and Children (e.g. 0-6) School-Aged (up to depending on jurisdiction) Adults BC Y MB ON QC Majority of imms provided by public health are entered Some Physician imms are entered One BC HA uses another system BC First Nations adopting Panorama 6 to 19 yrs 1 BC health authority only enters HPV school imms into Panorama No Influenza administered in mass clinics are entered into Panorama All All All All All All All of School Pupils Act (ISPA) immunizations for clients age 4-6 are entered into Panorama as they are considered school aged. Other immunizations for this age group and immunizations from the age 0-3 group are entered into Panorama per PHU discretion. All ISPA immunizations for clients age 7-17 are entered into Panorama. Other immunizations for this age group are entered into Panorama per PHU discretion. Only those provided by Public Health or associated with an adverse event No Influenza administered in mass clinics are entered into Panorama All immunizations (including travel) for the age 18+ group are entered into Panorama per PHU discretion. s collected by PHUs for clients who are now 18+ but who were school aged remain in the system. ing towards All s, All Ontarians in 2020 All with at least one immunization* All with at least one immunization* All with at least one immunization* 6 SK In SK, publicly funded immunizations administered/offered by Public Health Nurses are recorded in Panorama. ALL for SK under all 3 categories as well All public health delivered immunizations, except for adult influenza

7 Canada s Provincial and Territorial Routine (and Catchup) Vaccination Programs for Infants and Children (as of Jan 2016) with Calculations Legend Vaccine Given Vaccine Not Given Not Publicly Funded VACCINE PROVINCIAL & TERRITORIAL VACCINATION SCHEDULES 7 Abbreviations Description Point in Time of IMMS BC & YT SK MB ON QC DTaP-IPV-Hib DTaP-HB-IPV-Hib DTaP-IPV or Tdap- IPV a Tdap HB Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus Influenzae type B vaccine Diphtheria, Tetanus, acellular Pertussis, Hepatitis B, Inactivated Polio Virus, Haemophilus Influenzae type B vaccine Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus vaccine, or Tetanus, diphtheria (reduced toxoid), acellular pertussis (reduced toxoid), Inactivated Polio Virus vaccine Tetanus, diphtheria (reduced toxoid), acellular pertussis (reduced toxoid) vaccine Hepatitis B vaccine 2 mos 4 mos 6 mos 18 mos 2 mos 4 mos 6 mos 18 mos 4 6 yrs Grade 8 Grade yrs Grade 8 or 9 3 rd year of high school HB provided in infancy (2-Dose) Grade 6 (2-Dose) Grade 7 (2-Dose) Grade 4 MMR Measles, Mumps, Rubella vaccine 12 mos Var Varicella vaccine 12 mos 15 mos Catch Up 2 nd Dose Grade 6 2nd Dose between Age 4 6 yrs (as of Apr 2016) MMR-Var Measles, Mumps, Rubella, Varicella vaccine 12 mos 18 mos 2 nd Dose at Age 4-6 Men-C-C Meningococcal conjugate (Strain C) vaccine 2 mos 12 mos Grade 6 To Be Provided 3 rd year of high school Men-C-ACYW-135 Meningococcal conjugate (Strains A, C, Y, W135) vaccine Grade 6 Grade 7 Pneu-C-13 Pneumococcal conjugate (13-valent) vaccine 2 mos 4 mos 12 mos Inf Influenza vaccine 6mos to..23 mos..59 mos..end Rota Rotavirus vaccine 2 mos 4 mos HPV Human Papillomavirus vaccine (2-Dose) Grade 6 e 2016/17 catch-up for boys in grade 7-9 (2-Dose) Grade 8 e (2-Dose) Grade 4 e Add boys In 09/2016 While each Province/Territory may have differing immunization schedules, children are still protected against VPDs

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9 Approach - Data In 2. Compare a Common (Recording IMMS Administration) 1. Compare Methods of Getting Data into the System SYSTEM 3. Compare Outputs of a Decision Support Tool (Forecaster) for a Use Case Scenario DATA 9

10 1. Method of Data Entry into the System for Publically Funded IMMS SYSTEM M A S S I M M S BCY SK MB ON QC D I R E C T E N T R Y POS / HISTORICAL THROUGH UI 10 See Appendix A for Detailed Notes Comments I M M S U P L O A D

11 2. Compare a Common (Record an Administered IMMS) : Record an Administered Set Client into Record Consent Select Immunizing Agent(s) Save BCY MB ON QC SK Review Forecaster Record Special Consideration Update Info Related to IMMS Admin. 11 The order of the steps may slightly differ between jurisdictions, but all jurisdictions execute the processes above.

12 3. Forecaster Digging Deeper Review Forecaster Core Business Rules Used (to Determine What IMMS Clients are Due For) Legend Yes No History Risk Factors Special Considerations Age (Date of Birth) Gender BCY Validate and invalidate imms; interaction rules; minimal intervals Yukon RF used to apply Yukon-specific forecaster rules to client records Exemptions and contraindications used for refusals and medical conditions For age specific vaccines/programs or eligibility dates HPV SK HPV MB ON HPV QC 12

13 3. Variability Between Jurisdictional IMMS Schedules Comparing Outputs High Degree of Variability Low Degree of Variability At the End of the Day See Appendix B for Notes on Calculations While the schedules may vary across Canada, disease protection is achieved.

14 Digging Deeper 14 Forecaster is rules-based decision support to assist clinicians with recommending immunizations based on history Calculates future doses based on rules and interactions Uses the least number of pokes to be protected Tool changed practice and legislation and standardized practice - by highlighting assumptions and contradictions

15 Automating Schedule: Forecast Functionality 15

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17 Shared Public Health Information System User Based Design Effective and efficient immunization programs benefit from user-driven design at the jurisdictional level Common root supports: supports unique jurisdictional needs provides mutual benefit of investment and shared learning drives progress towards ultimate goal of semantic interoperability and equitable protection of Canadian population 17

18 Process of managing a common tool allows for discussion of business requirements and common benefits where possible (e.g. mass immunization functionality) Forum to address impact of changes to programs and share any concerns or efficiencies in implementation Opportunity to influence others Impact of revisions from national guidelines Develop immunization standards for EMR applications across provinces/territories Integrate with apps (Immunize CA) Request standardized codes from vendors 18

19 Are We Doing Enough? Canadian Pediatric Society (CPS) A Status Report on Canadian Public Policy and Child and Youth Health 2016 Province / Territory 2012 Status 2016 Status Recommended Actions BC Excellent Good Implement a central immunization e- registry Y Fair Excellent Meets all CPS recommendations SK Good Excellent Meets all CPS recommendations MB Fair Excellent Meets all CPS recommendations ON Excellent Good Implement a central immunization e- registry QC Good Excellent Meets all CPS recommendations 19

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21 Appendices 21

22 Appendix A. Method of Data Entry into the System for Publicly Funded IMMS Jurisdiction Instructions BCY Direct entry - POS or historical (though UI) Self-explanatory! Data entry for point of service or historical imms through the UI Public Health point of service through the UI Others historical through the UI Mass Imms Imms Upload Other Does your jurisdiction use the mass imms functionality (e.g. assess coverage for a cohort) One health authority in 2015/16; most will use in 2016/17 Does your jurisdiction use the imms upload or messaging to import cohorts from other systems? Yes by some Upload/entry that doesn t fit in the previous 3 categories; e.g. non-ph users like Immunize CA or similar interface N/A SK Point of Service through the Panorama UI Mass Imms to be deployed fall 2016 Imms Upload is currently not used by Users; however, Imms Upload is used for tes/training data Entry is only done through the Panorama UI 22 MB ON QC Yes Yes Interface to Manitoba client registry. Use client upload to get school information for mass imms. Interfaces to Claims Processing System (physician billing) and Drug Programs Information Network (Pharmacy dispensing system Feb 2016) Paper forms submitted for non-publicly funded immunization (but most also captured as dispensed from DPIN). Yes Yes No Ontario uses STIX for student uploads (client demographic information) and have begun using PHIX in some PHUs for immunization upload and validation. Sources for PHIX include PHU websites for the public to report immunization information, day cares, EMRs, etc. Yes Not now No Data Upload for around 100 databases (I-CLSC,V09 et V06). These tools were developed by Québec team

23 Appendix B (1). Excerpt of Canada s Provincial and Territorial Routine (and Catchup) Vaccination Programs for Infants and Children (as of Jan 2016) with Calculations Legend Vaccine Given Vaccine Not Given Publically Not Funded 23 VACCINE PROVINCIAL & TERRITORIAL VACCINATION SCHEDULES I. Weighted Similarity Score (Greens over Abbreviations Point in Time of IMMS BC & YT SK MB ON QC Orange) DTaP-IPV-Hib DTaP-HB-IPV-Hib J. Score for "Full Difference" K. Adjusted Sim. Score ( I - J ) L. Adjusted Denominator (100% - J) 2 mos 60% 20% 40% 80% 50.0% 4 mos 60% 20% 40% 80% 50% 6 mos 80% 20% 60% 80% 75% 18 mos 80% 20% 60% 80% 75% 2 mos 100% 50% 50% 50% 100% 4 mos 100% 50% 50% 50% 100% 6 mos 50% 50% 0% 50% 0% 18 mos 50% 50% 0% 50% 0% M. Adjusted Score N. Weighted Similarity Average (Average M) O. Variability (1 - N) (0%: No Diff) (100%:Full Diff) 63% 38% 50% 50% DTaP-IPV or Tdap-IPV a 4 6 yrs 100% 20% 80% 80% 100% 100% 0% Tdap HB Grade 8 20% 20% 0% 80% 0% Grade 9 20% 20% 0% 80% 0% yrs Grade 8 or 9 40% 20% 20% 80% 25% 3 rd year of high school 20% 20% 0% 80% 0% HB provided in infancy 40% 20% 20% 80% 25% (2-Dose) Grade 6 40% 20% 20% 80% 25% (2-Dose) Grade 7 20% 20% 0% 80% 0% (2-Dose) Grade 4 20% 20% 20% 80% 25% 6% 94% 19% 81% MMR 12 mos 100% 33% 67% 67% 100% 100% 0% Var 12 mos 25% 25% 0% 75% 0% 15 mos 25% 25% 0% 75% 0% Catch Up 2 nd Dose Grade 6 25% 25% 0% 75% 0% 2nd Dose between Age 4 6 yrs (as of Apr 2016) 25% 25% 0% 75% 0% MMR-Var 12 mos 40% 20% 20% 80% 25% 18 mos 40% 20% 20% 80% 25% 2 nd Dose at Age % 20% 40% 80% 50% Men-C-C 2 mos 20% 20% 0% 80% 0% 12 mos 100% 20% 80% 80% 100% Grade 6 To Be Provided 60% 20% 40% 80% 50% 3 rd year of high school 20% 20% 0% 80% 0% Men-C-ACYW-135 Grade 6 50% 50% 0% 50% 0% Grade 7 50% 50% 0% 50% 0% Pneu-C-13 2 mos 100% 20% 80% 80% 100% 4 mos 100% 20% 80% 80% 100% 12 mos 100% 20% 80% 80% 100% Inf 6mos to 100% 20% 80% 80% 100%..23 mos 100% 20% 80% 80% 100%..59 mos 80% 20% 60% 80% 75%..end 60% 20% 40% 80% 50% Rota 2 mos 100% 20% 80% 80% 100% 4 mos 100% 20% 80% 80% 100% 2016/17 catchup for boys in 60% 20% 40% 80% 50% HPV (2-Dose) Grade 6 e grade 7-9 (2-Dose) Grade 8 e 20% 20% 0% 80% 0% (2-Dose) Grade 4 e Add boys In 09/ % 20% 0% 80% 0% 0% 100% 33% 67% 37% 63% 0% 100% 100% 0% 81% 19% 100% 0% 17% 83%

24 Appendix B (2). Calculations Explained Legend Vaccine Given Vaccine Not Given Publically Not Funded Five Steps to Quantify Schedule Variability Vaccine Given or Not? Calculate Similarity Normalize Scale Calculate Average for each Vaccine Reverse Scale for Variability Determine, row by row, which vaccines are administered at what time points for each jurisdiction. Calculate similarity scores for each time points Normalize scale (0% fully different) (100% fully similar) Average the scores for each Vaccine Reserve Scale (0% = Fully Similar) (100% = Fully Different) VACCINE PROVINCIAL & TERRITORIAL VACCINATION SCHEDULES I. Weighted Abbreviations Point in Time BC & YT SK MB ON QC Similarity Score (Greens over Orange) J. Score for "Full Difference" K. Adjusted Sim. Score ( I - J ) L. Adjusted Denominator (100% - J) M. Adjusted Score DTaP-IPV-Hib 2 mos 60% 20% 40% 80% 50% N. O. Weighted Variability Similarity (1 - N) Average (0%: No Diff) (Average M) (100%:Full Diff) 4 mos 60% 20% 40% 80% 50% 6 mos 80% 20% 60% 80% 75% 18 mos 80% 20% 60% 80% 75% 63% 38% 24