Using Registry Data in Daily Program Operations: The Washington, D.C. Experience

1
Using Registry Data inDaily Program
OperationsThe Washington, D.C. Experience

• Karyn L. Berry, MD, MPH
• March 23, 2005
• 39th National Immunization Conference
• Washington, DC

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Washington, DC Overview

• District of Columbia City-state
• Self-governing
• Congressional budget approval oversight
• Non-voting congressional representation
• Overall population 572,059 residents
• African-American 60.0 343,321
• White 30.8 176,101
• Hispanic 7.9 44,953
• Asian/PI 2.7 15,537
• 112,000 (20) of residents are Children (2002)

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DC Immunization Registry

• Overview
• 1992 - Began with Immunization
• 2000 - Linked to DC Birth Registry
• 2000 - Became internet-based
• October 2001 - Added Medicaid EPSDT Program
• Age-less System tracks records birth to death
• Records accessed more than
• 2.5 million times since system
• began tracking in May 1996

• Contains 366,479 Individuals
• Records
• 4,015,843 million Immunizations
• 2,247 exemptions
• 64,236 histories of Varicella

data from March 1, 2005
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DC Registry Daily Work

• Importance of integrating the Immunization
  Registry with Immunization Program Functions
• Cost savings in using data multiple times
• Decreased staff time in completing assignments
• Increased unification of program components
  Team Approach
• Guidance for Integrating Immunization Program
  Operations Manual (IPOM)

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DC Registry Vaccine Management

• Capture VFC Eligibility Status for each dose of
  vaccine
• Capture VFC PIN of Provider giving vaccine
• Capture lot number and manufacturer for tracking
• Project Vaccine Needs
• Generate Doses Administered Reports
• by Patient Age
• for Specific Time Periods
• by VFC-eligibility

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DC Registry Provider QA

• Web-based Lists of patients for Reminder (Due)
  Notices and Recall (Overdue)
• Monthly reports to Medicaid, Medicaid MCOs, WIC,
  Schools
• Web-based export of Registry data to CASA
• Registry reports on immunization levels beyond
  CASA
• Other Age Groups 0-4-year-olds, school-age
• Track incorrectly administered doses and other
  vaccine rules (4-day grace period)
• Display record with vaccine assessment (incorrect
  doses marked)

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DC Immunization Registry Record
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DC Registry Service Delivery

• Linked to WIC Program
• WIC Enrollment tracked in Registry (monthly
  update)
• Key WIC Sites linked to Registry (view only)
• Monthly Immunization Level reports generated for
  each WIC site (17 sites)
• Monthly reminder/recall lists generated for each
  site (also available on web)
• Linked to Child Care and Head Start Programs
• Enrollment tracked in Registry (yearly update)
• Immunization level reports and reminder/recall
  lists for each site (also available on web)

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DC Registry Consumer Information

• Prints official immunization records for clients
• Incorporates Broadcast Fax System
• Send out health alerts/advisories to community
  providers
• Send out alerts for upcoming Immunization Clinics

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DC Registry Surveillance

• Disease investigators access Registry as Users
  over internet
• Generate individual immunization histories on
  clients
• Generate reports on students enrolled in specific
  school, child-care, Head Start center
• Track Perinatal Hepatitis B cases
• Identify vaccine provider if follow-up required
• Track vaccine lot numbers in case of recall
• Track vaccine adverse events

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DC Registry Assessment

• All Assessment activities done solely through
  Registry
• Child-care facilities (comprehensive)
• Head Start facilities (comprehensive)
• Public, Charter, Parochial, Private Schools
  (comprehensive)
• WIC
• Specific populations (physician/clinic, adults,
  STD/HIV, corrections)
• All varicella histories and exemptions (religious
  and medical) are entered into Registry and
  counted in Forecasting Algorithm
• Utilization of Registry for DC Public School
  Immunization Initiative
• Monthly and on-line reports of immunization
  levels
• Monthly and on-line lists non-compliant students

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DC Registry School Enrollment

• 2003 enrollment 65,099
• ES (101) 39,161
• MS (11) 4,638
• JHS (9) 5,111
• SHS (20) 12,311
• Special ed schools (20) 1,058

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School Demographics Diversity

• Student population by race/ethnicity
• African-Americans 84.4
• Hispanics 9.4
• Whites 4.6
• Asian Americans 1.6
• Other 0.5
• 112 different home languages representing 138
  different nationalities
• 60.8 of DCPS students receive free or reduced
  price meal support

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School Immunization Survey

• By law- DCPS requires all children (pre-school
  thru 12th grade) to be immunized
• Yearly enrollment and immunization check of all
  students
• Can be excluded from school
• Required immunizations
• ACIP schedule for DTaP, polio, HIB, Hepatitis B,
  MMR, Varicella, Td
• Doses must be appropriately spaced given at
  appropriate ages
• June 2001 Survey demonstrated 40 compliance
  with required immunizations for DCPS students
• Almost 40,000 students required immunizations/data

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Immunization Requirements
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DC Registry School Results

• Compliance rates increased from 40 at the end of
  school year SY 2000-01 to greater than 94 by mid
  SY 2004-05
• Improvements in public school immunization
  compliance were demonstrated equally across the
  community
• Current immunization levels (DCPS 94.38) place
  DC in the upper echelon of system compliance
  nationwide
• Data is collected, analyzed and reported on in 1
  system The DC Immunization Registry

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DC Schools See the Success!
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Key Working Partnerships

• DC Immunization Program
• Technical expertise
• Tool Registry
• Data entry, analysis distribution
• School Health Services
• Record collection
• Contact with school principals parents
• DCPS
• Enrollment data
• Enforcement of immunization laws

• DC Medicaid Admin
• Enrollment data
• MCO accountability
• Medicaid MCOs
• Member follow-up
• Provider communication
• Providers
• Patient access
• Implementing ACIP schedule
• Community partners
• Outreach follow-up activities
• Parents

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Value of the DC Registry

• On-going healthcare tracking system established
• Reduced over/under immunization due to lost
  records
• Improved Provider immunization practices
• Decreased Provider labor to locate patient
  records
• Decreased labor required to assess immunizations
  and prepare reports (e.g., school forms, HEDIS,
  surveys, CASA)
• Improved School immunization rates

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Future of the DC Registry

• Mandatory reporting by Providers
• Expand system usage to more Providers and Groups
• Expand linkages with other Systems
• Child Care
• WIC
• Lead Screening

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Acknowledgements

• District of Columbia Department of Health
• Primary Care Prevention and Planning
  Administration
• Maternal and Family Health Administration
• Health Promotion Administration
• Childrens Hospital Medical Center
• Childrens School Services
• District of Columbia Public Schools
• DC Medicaid Administration and Managed Care
  Organizations
• DC Immunization Coalition
• World Vision DC
• Pharmaceutical Companies Aventis, Merck,
  GlaxoSmithKline and Wyeth

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Contact Information

• Immunization Program
• Rosie McLaren, PHA
• Phone [phone] x24
• Email rosie.mclaren_at_dc.gov
• Registry/Tracking System
• C Thomas, RN
• Phone [phone] x11
• Email cthomas_at_trey-industries.com