Bilateral Communication With the New York Citywide Immunization

Bilateral Communication With the New York Citywide Immunization Registry Angel Aponte Computer Specialist (Software) Contact: aaponte@health. nyc. gov

Outline • New York Citywide Immunization Registry (CIR) introduction • Open Source technologies used at CIR • CIR electronic data exchange – Immunization reporting – Immunization information sharing – Decision support for immunization schedule • Current methods • Emerging solutions

New York Citywide Immunization Registry • Immunization Information System for the New York City area • Implemented in 1997 • NYC has mandatory reporting of vaccinations of children 0 -18 years of age – Birth to < 8 years old since January 1, 1997 – Birth to < 19 years old since August 18, 2005 • Over 3. 4 million records with over 36 million immunizations • >90% of pediatric providers in NYC participate in CIR • Population-based

Open Source Technologies Used at CIR • Red Hat Enterprise Linux (RHEL) 5 operating system • Apache Web Server, Tomcat Application Server, and Axis for Web Services/SOAP/XMLP • My. SQL database • Java, C/C++ (gcc), Python, Perl, Eclipse for development • nagios service outage alerting system • Security: iptables firewall, nmap port scanner, wireshark packet sniffer

CIR Application Logical Architecture

Current Methods of Reporting • Web File Repository (WFR) for batch electronic submission, data quality feedback, and retrieval • Reporting: – Paper: 27, 130 forms per month are key entered an electronic file is created and submitted through WFR – Electronic file: Facilities also perform extracts from their information systems and submit a text file to CIR – Web: Online Registry for additions of current and historical immunizations in real-time

CIR Reporting Volume Immunizations added to CIR for children < 8 years

Shift to electronic methods of reporting

Current Methods of Data Access • Batch data exchange interface • Online Registry for viewing immunization history and immunization schedule recommendations • Issue immunization records in response to requests via phone, fax, mail

Current Methods of Data Access FY 2008 Method of access % Online Registry 72% Electronic file extract in batch 26% Phone, fax, mail 2% Total 100%

Online Registry use: 2004 -to date

Emerging Data Exchange: Real-Time EHR Integration With CIR • Provide current information to doctors through their healthcare facility’s electronic system • Provide decision support services • Enable real-time reporting from doctor’s system • Can also be used by other CIR partners – New York State – Other immunization registries (e. g. ~47, 000 patients < 19 years old with a New Jersey address reported to NYC CIR) – Immunization clinics – Regional Health Information Organizations (RHIOs)

CIR Web Service Logical Architecture

Conclusions • CIR is a successful system in NYC that uses Open Source technologies • CIR Web application currently provides real -time reporting and access to immunization histories and decision support • CIR Web Services will provide these immunization information services to providers with EHRs and other partners • Existing batch data exchange mechanisms will be maintained as a fallback solution