IHS IIS Survey 2010 Provider Feedback About IIS

IHS IIS Survey 2010: Provider Feedback About IIS Participation in Various States Cecile Town, Cheyenne Jim, Amy Groom IHS Immunization Program Division of Epidemiology and Disease Prevention CDC NCIRD Immunization Services Division/Program Operations Branch

Background 2007 U. S. Census: – AI/AN alone or in combination with other races: 4, 429, 514 (1. 5% of U. S. population) Indian Health Service (IHS) system (34 states): – Federal health care provider for eligible AI/AN – Eligibility = member of a federally recognized tribe (560+) – Services via IHS, Tribal and Urban Indian (I/T/U) facilities – 1. 4 million AI/AN people access IHS-funded services

Indian Health Service Portland Billings Aberdeen Bemidji California Phoenix Tucson Alaska Nashville Navajo Albuquerque Oklahoma User Population: 1. 4 Million

The IHS Resource and Patient Management System • An Electronic Health Record (EHR) system developed and supported by IHS • Used by I/T/U facilities throughout the country • Includes an immunization component: – – – Tracking and forecasting of immunizations Immunization coverage reports Reminder/ recall letters Due lists Doses Administered Report

The IHS Data Exchange Initiative A bidirectional HL 7 batch interface between RPMS & SIIS using: • IHS data exchange software (BYIM) • HTTPS Bridge software Benefits of Interface: – Encourages IIS participation – Eliminates need for double data entry – Facilities can continue to use the RPMS as their primary information source – Data can be pulled from the IIS directly into individual RPMS records – The bridge software automates the exchange, saves time, provides interface continuity

IHS Data Exchange Survey Objectives • Characterize I/T/U provider participation in IIS • Identify perceived barriers to participation • Develop a tool for use in providing technical assistance and feedback to I/T/U’s • Track I/T/U participation with IIS over time

Methods, Year Three 2010 • 25 Questions & Likert scale, via Survey Monkey • Distributed by 12 Area Immunization Coordinators to the IHS National Immunization Reporting System (NIRS) • Also distributed to tribal and urban sites NOT reporting to NIRS

Limitations • Does not represent results from all ITU sites • Different samples • Responses are self reported

Responses # states # N % 2008 19 133 233 48. 5 2009 28 147 259 56. 8 2010 29 135 232 58. 2 90% return respondents from 2009 survey Excluded: Incompletes, duplicates, responses from non-immunizing facilities, facilities who did not receive the survey

Results 2008 2009 n % 2010 n % Shares info with IIS 78 113 69% 114 147 78% 109 130 84% One-way interface 24 78 31% 22 114 19% 29 109 27% Two-way interface 11 78 14% 16 114 14% 15 109 14%

Sending Information to IIS n= 109

Double Data Entry • Of 130 total respondents, 68 (52%) enter their data directly into the IIS. • Of those, 62 (48%) enter data into both RPMS and the IIS. “Entering immunizations into two systems is a barrier to our facility participating in the IIS. ” -N/A, no response -Neutral -Agree -Disagree 2009 4 ( 6%) 15 (25%) 25 (41%) 17 (28%) 2010 9 (15%) 15 (24%) 17 (27%) 21 (34%)* 8 commented that interface was still desired

Methods of Receiving Information from the IIS n = 129

ITU Perceptions, 2010 Agree Interest in IIS participation 85% IIS participation is important 90% Look-up capability is useful 97% Two-way interface would be useful 94%

IHS Data Exchange 2010 Two Way Exchange (9) AK ITU State, No Exchange (22) WA ME MT ND VT MN OR N Y WI ID MI SD IA IL NE CA KS PA PH OH IN MO VA KY OK NM DE SC AR MS San Diego County IIS MD NC TN AZ NJ D C WV UT CO RI CT WY NV MA NH AL States w/non. Federally Recognized Tribes or No Tribes GA TX LA FL One Way Exchange (4) 1/23/2022 Current IHS Immunization Data Exchange Operations

Total I/T/U facilities engaged in data exchange: 65 • • • AK – 15 AZ – 11 CA - 1 MN - 4 OR - 1 MT - 8 • • • UT - 1 WA – 10 WI - 5 WY- 1 ME – 4 (pending) SD – 4 (pending)

AK Why no data exchange in 22 states? Two Way Exchange (9) ITU State, No Exchange (22) WA ME MT ND VT MN OR N Y WI ID MI SD PA IA IL NE OH IN CA KS MO N J MD D C WV UT CO RI CT WY NV MA N H VA KY DE NC TN AZ OK NM SC AR MS San Diego County IIS AL GA TX LA FL State w/non. Federally Recognized Tribes or No Tribes (16) One Way Exchange (4) 1/23/2022 Current IHS Immunization Data Exchange Operations

Interface Feasibility in I/T/U States Interface Transport HL 7 Capable* (5) AK Urban facility is non-RPMS (1) Development /No IIS* (12) Challenges (5) WA ME MT ND VT MN OR N Y WI ID MI SD PA IA IL NE OH IN CA KS MO N J MD D C WV UT CO RI CT WY NV MA N H VA KY DE NC TN AZ San Diego County IIS OK NM SC AR MS AL GA TX LA FL 1/23/2022 *Source: 2008 CDC Immunization Information Systems Annual Report

H 1 N 1 Reporting • 95% respondents reported H 1 N 1 vaccinations to the state – 52% entered the information into the IIS – 26% completed a state reporting form – 13% reported via data exchange • 56% found the reporting process efficient

Conclusions • Most (84%) sites send information to the IIS • Direct data entry is method most frequently used • In 2010, 91% of those doing direct data entry also performed double data entry • Most sites use IIS look-up capability; this number has increased from 2008 – 2010 • Regardless of method of IIS participation, 99% of respondents feel look-up is useful

Conclusions • Two-way interfaces account for only 14% of all participation, but 94% of respondents feel one would be useful. • Of 11 potential interfaces, 5 have potential transport issues • HL 7 is one factor in interface implementation • Transport is another important consideration not yet addressed by a standard

Acknowledgements • Cheyenne Jim, CDC contractor • Amy Groom, CDC • IHS Area Immunization Coordinators

Immunization Registry Minimum Functional Standards, CDC • Standard #1 • Electronically store data on all NVAC-approved core • data elements • Standard #5 • Protect the confidentiality of health care information • Standard #6 • Ensure the security of health care information • Standard #7 • Exchange immunization records using Health Level • Seven (HL 7) standards

Next Steps: Five HL 7 Capable States, 11 Facilities • • • ID - Fort Hall, Kootenai, Nimipuu KS - Haskell, White Cloud LA - Chitimacha, Coushatta, Jena Band of Choctaw, Tunica-Biloxi NC - Eastern Band of Cherokee RI - Narragansett Indian Tribe