The Michigan Care Improvement Registry MCIR

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The Michigan Care Improvement Registry (MCIR)

• Kyle Enger, MPH
• engerk_at_michigan.gov
• March 2009

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MCIRs reason for being

• 1. Improve immunization practice
• Clinicians can access complete child immunization
  records
• Automatic assessment of children
• Remind families that they need immunizations
• Account for immunizations given
• Clinicians LHDs save time and
• More people get immunized
• 2. Provide information for public health
  research
• Basic assessments
• Advanced analysis

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Data source MCIR(Michigan Care Improvement
Registry)

• Operational since 1998 (but has older data)
• Web-based application
• Birth-to-death immunization registry
• lt 20 y age restriction removed June 2006
• 95 of providers participate
• Mostly pediatricians family practice
• Good coverage nearly everywhere
• Detroit, Oakland, and Wayne are improving
• Some border counties have lower coverage

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MCIR Regions

• Many MCIR functions are handled at the regional
  level
• Provider recruitment
• Provider training
• LHD data requests
• Bug reporting
• Help desk
• Advisory boards

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MCIR activity

• 4.7 million person records (MI pop 10 million)
• Over 57 million immunizations recorded
• 13,000 user logins to MCIR every day
• 2,334 provider sites submitted data in 2007
• 50 of all MDCH web traffic
• Over 35,000 registered users

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MCIR is currently linked with

• Vital Records
• Childhood Lead Poisoning Prevention Program
• WIC
• Medicaid
• Department of Education

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Collection of Immunization Data

• Direct data entry into MCIR, via web interface
• Health care providers
• Local health depts.
• Schools, daycares
• Transfer from electronic medical records
• Transfer from billing systems
• Paper scan forms

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Mcir.org
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MCIR demo
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Sample paper iz. recordfrom MCIR
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Current Immunization Profile for 19 - 35 Month
Old Children
Based on MCIR Data
Keweenaw
Keweenaw
Houghton
Houghton
Otonagon
Otonagon
Baraga
Baraga
Luce
Luce
Gogebic
Marquette
Gogebic
Marquette
Alger
Chippewa
Alger
Chippewa
Schoolcraft
Schoolcraft
Iron
Iron
Mackinac
Mackinac
Dickinson
Dickinson
Delta
Delta
Cheboygan
Cheboygan
Emmet
Emmet
Menominee
Menominee
Presque Isle
Presque Isle
Charlevoix
Charlevoix
Alpena
Montmorency
Montmorency
Otsego
Antrim
Otsego
Antrim
0 - 29
Alpena
Leelanau
Leelanau
Grand
Crawford
Grand
Crawford
Oscoda
Alcona
Kalkaska
Oscoda
Alcona
Benzie
Kalkaska
Traverse
Benzie
Traverse
Manistee
Wexford
Iosco
Missaukee
Manistee
Wexford
Ogemaw
Iosco
Missaukee
Roscommon
Roscommon
30 - 49
Ogemaw
Arenac
Arenac
Gladwin
Gladwin
Mason
Lake
Osceola
Clare
Mason
Lake
Osceola
Clare
Huron
Huron
Midland
Oceana
Newaygo
Mecosta
Isabella
Midland
Bay
Oceana
Newaygo
Mecosta
Isabella
50 - 59
Bay
Tuscola
Sanilac
Tuscola
Sanilac
Montcalm
Gratiot
Saginaw
Montcalm
Muskegon
Gratiot
Saginaw
Muskegon
Lapeer
Kent
Lapeer
Kent
Genesee
60 - 69
St. Clair
Genesee
Shiawassee
Clinton
Ionia
Ottawa
St. Clair
Shiawassee
Clinton
Ionia
Ottawa
Macomb
Macomb
Allegan
Barry
Eaton
Ingham
Livingston
Oakland
Allegan
Barry
Eaton
Ingham
Livingston
Oakland
70 - 79
Van
Buren
Calhoun
Jackson
Washtenaw
Wayne
Detroit
Kalamazoo
Detroit
Kalamazoo
Calhoun
Jackson
Washtenaw
Wayne
Van
Buren
Monroe
Berrien
Lenawee
Cass
Hillsdale
St. Joseph
Branch
Monroe
Berrien
Lenawee
Cass
Hillsdale
St. Joseph
Branch
80 - 89
August 2008
January 2001
431331
90 - 100
431330
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MCIR vs. NIS, 19-35m
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MCIR vs. NIS, teens
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Td Tdap iz.
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PCV7 shortage
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Exemptions by antigen
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Time-to-immunization
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Examples of data in MCIR

• Birth date
• County of residence
• Patient address
• Gender
• Name (parent patient)
• Characteristics of health care provider
• School district

• Vaccine type
• Date vaccine given
• Vaccine funding source
• Which health care provider gave the vaccine
• Vaccines waived
• Overall immunization status

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Ways to access MCIR data

• Immediately
• Publicly available data (mcir.org/mcirdata.html)
• Fairly quick
• Request deidentified or HIPAA-limited dataset
• potterr1_at_michigan.gov, engerk_at_michigan.gov
• Might require IRB approval or data use agreement
• MDCH IRB data use agreement required
• Request identifiable data from MDCH
• Direct access to data
• MDCH data warehouse (contains most important
  fields)
• Oracle database (contains everything)

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Mcir.org/mcirdata.html
You can access MCIR data resources online via
this webpage (mcir.org/mcirdata.html). Some
resources require Michigan Health Alert Network
(HAN) access. They can also be provided upon
request.
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MCIR research policy

• Please inform MCIR about any research you do,
  even if it only uses deidentified data
• Immunization providers have broad access to MCIR
  data via its web interface
• This is for patient care purposes ONLY
• It DOES NOT allow research using MCIR data
• Seek MDCH IRB approval data use agreement
• MCIR may decline requests for data
• Limited resources 1 FTE assigned to MCIR
  research
• No formal research policy document exists (yet)

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MCIR data are good, NOT perfect

• MCIR only contains what people report
• Not all clinicians participate (completely)
• MCIR only contains MI info (exceptions exist)
• Border counties tend to have lower coverage
• Adolescent and adult data are incomplete
• Data on 20 year olds allowed in June 2006
• Clinicians still getting used to using MCIR for
  adults
• MCIR isnt notified when people leave MI
• These people look incomplete to us, and inflate
  denominators
• 25 more 11-18 year olds in MCIR than US census
  estimates
• Data are sometimes wrong
• Duplicate records, typos, omissions, mistakes,
  etc.

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MCIR research collaborations

• Research on reminder/recall methods
• Kevin Dombkowski, UM Pediatrics
• UM epi student intern projects
• Andrea Weston, hepatitis A uptake in 1 year olds
• Erin Rees, characteristics of LHDs assoc. with
  iz. coverage
• Numerous projects with CDC
• Uptake of influenza, Tdap, MCV4
• PCV7 Hib shortages, etc.
• Association of waiver clusters with pertussis
  clusters
• Saad Omer, Johns Hopkins
• NIS-Registry study (National Immunization Survey)
• Use MCIR data to check reliability of NIS results
• HPV4 uptake (brand-new collaboration)
• Divya Patel, UM Ob. Gyn.

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Questions?

• Kyle Enger
• engerk_at_michigan.gov
• http//mcir.org