Development and Support Proactive Immunization Assessment and Immunization Information Systems This educational activity was developed and supported by the American Pharmacists Association. Michael D. Hogue, Pharm.D., FAPhA, FNAP Samford University, Birmingham, Alabama mdhogue@samford.edu Accreditation Information Disclosures The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education (CPE). This live, knowledge-based activity for pharmacists is approved for 1.0 hour of CPE credit (0.1 CEUs). The ACPE Universal Activity Number is: #0202-0000-17-248-L06-P. To claim CPE credit, participants must enter the attendance code, and complete the evaluation on pharmacist.com (My Training) by November 11, 2017. Michael D. Hogue discloses that he is on the speaker s bureau for Pfizer, Inc., has received research funding from Merck & Co., Inc., and is a member of the vaccine advisory board of GlaxoSmithKline. APhA s editorial staff declare no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria. For a complete list of APhA staff disclosures, go to www.pharmacist.com/aphadisclosures. Conflicts of interest have been resolved through content review by Helen Sairany, PharmD, BCACP, Associate Director of Content Development at the American Pharmacists Association. 1
Acknowledgements Learning Objectives Portions of today s presentation were originally presented by David Kim, MD, CAPT, U.S. Public Health Service, Deputy Associate Director for Adult Immunization Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and Rebecca Coyle, Executive Director of American Immunization Registry Association. 1. Describe the purposes of Immunization Information Systems (IIS). 2. Identify the technology requirements for interoperability of IISs and pharmacy dispensing systems. 3. Discuss the current challenges with the use of IIS by pharmacies, pharmacists, and other providers in the immunization neighborhood, as well as possible solutions to those challenges. Which is NOT a recognized challenge to using IIS in pharmacies? Which of the following statements regarding interoperability of IIS is TRUE: a) Lack of training on IIS use b) Limited access to IIS by pharmacists c) Varying reporting requirements for the IIS by health care practitioners d) Although immunization documentation in IIS for adults is required, pediatric vaccine documentation may be incomplete a) IIS vendors are required to comply with HL7 (Health Level 7 International). b) IIS vendors are required to connect to pharmacy dispensing systems. c) Pharmacy dispensing systems are required to store immunization data in the same format as an IIS. d) IIS serves as a real-time two way communication bridge between inpatient and outpatient providers. 2
Which is a key parameter of Immunization Information Systems (IISs)? a) Cold chain integrity b) Data exchange c) Proper administration technique d) Patient education Background APhA Policy Gap Pharmacists are key to proactively fighting vaccine preventable illnesses. Provider access to vaccine histories is key to assessing a patients need for vaccinations as is the ability to document pharmacist administered vaccines. Current IISs allow for this, however pharmacist knowledge of and limited access to these IISs hinders their use as do limits to interoperability with EMRs and pharmacy management systems. Currently there is a lack of guidance on proper use of IISs, pharmacist access to IISs, interoperability with EMRs and pharmacy management systems, and ability to properly document pharmacist administered immunizations Adult Vaccination Rates Remain Poor Immunization Neighborhoods Vaccine Rate Tdap (Adults > 19 years of age) 20.1% Herpes Zoster (Adults > 60 years of age) 27.9% Pneumococcal Vaccine (Adults > 65 who have received both vaccines) 18.3% Influenza Vaccine (All Adults > 19 year of age) 43.2% Hepatitis B Vaccine (At-Risk Adults > 19 years of age) 24.5% HPVVaccine (Adults 19-26 years of age) 40.2% Female 8.2% Male School or Occupational Health Family Practice Patient Hospital Specialist Home Health MMWR. Feb 2016. 65(1).1-36. MMWR. 2017;66(27):728-733 Pharmacy 3
Immunization Neighborhoods Immunization Information Systems Family Practice School or Occupational Health Hospital Patient Specialist Home Health Pharmacy www.cdc.gov/vaccines/programs/iis/about.html IIS Capture the vaccination status of the population Recognized Challenges with IIS and Pharmacies Fragmentation or lack of state based registries, with many registries focusing on children and not adults. Lack of connection between existing IISs, pharmacy management systems, and EMRs, with software vendors struggling to achieve bidirectional communication. Access to IISs and EMRs by pharmacists is limited, allowing for limited ability to access immunization needs and properly document immunizations. Pharmacists may have a limited knowledge and/or training on IIS use. Varying reporting requirements for the IIS by health care practitioners. http://www.cdc.gov/vaccines/programs/iis/annual-report-iisar/rates-maps-table.html 2015 IISAR http://www.cdc.gov/vaccines/programs/iis/annual-report-iisar/rates-maps-table.html AIRA 2016 4
Getting to Solutions Association of Immunization Managers (AIM) identified success stories in State IIS working with Pharmacists in their publication. Challenges Pharmacists unaware of state registry Concern about patient privacy Manual data entry no time in pharmacy for this IIS is just another thing I have to do. Solutions States create educational program for pharmacists. States issue IIS usernames for individual pharmacists versus pharmacy States have systems which are interoperable and allow for electronic data interchange Demonstrate that IIS are more than just for storing IZ data. Immunization Programs Level of Engagement in Improving Immunization Rates by Partnering with Pharmacies, 2014. AIM. Available online. Association of Immunization Managers. Adult Immunization Resource Guide. Available at: https://c.ymcdn.com/sites/aim.site-ym.com/resource/collection/d15b51d0-f6e5-42ec-b0a0- F6C3150667A4/AIM_Adult_Resource_Guide_ONLINE_090716.pdf. IIS Proven to Improve Vaccination Strong evidence of effectiveness in increasing vaccination rates At point of clinical care consolidated vaccination history At population level surveillance and program operations Supports other evidence-based strategies to improve vaccine delivery Patient reminder and recall system Provider reminders Provider assessment and feedback Standing orders So Why Not a National Registry? Congress Rejected the idea in 1993. States rights Privacy concerns Compromise was pass through funding to states to create their own systems, primarily aimed at pediatrics. Today s Challenging Reality: Interoperability and connectivity of the existing systems. Community Preventive Services Task Force. The Guide to Community Preventive Services (The Community Guide) https://www.thecommunityguide.org/ 5
Standards for Immunization Practice Pediatric Immunization providers are required to document vaccines administered 1 Use of IIS is a part of standard of practice Adult Immunization providers should check IIS to determine if patient completed recommended vaccination series and reduce unnecessary vaccinations 2 Requirement for providers to use IIS varies by state IIS Image Pediatric providers Standard of practice, required of all vaccination providers Complete, accurate, timely Adult care providers Requirement for some, not others Unfamiliar, incomplete, inconsistent 1. National Immunization Program. Standards for Pediatric Immunization Practices. February 1996. https://www.hhs.gov/nvpo/nvac/reports-and-recommendations/the-standards-for-pediatric-immunizationpractice/index.html. 2. National Vaccine Advisory Committee. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice. Public Health Reports.129: March April 2014. IIS Vision IIS Environment Real-time, consolidated immunization data and services for all ages are available for authorized clinical, administrative, public health users, and consumers anytime and anywhere Drivers in Broader Environment in which IIS Operate IIS Stakeholders Increased Immunization Emphasis on Program Interoperability Growth EHR and Federal Vendors, Standardization Organizations Meaningful Funding HIEs, (e.g. CDC, Use and Sources SureScripts CMS, NVPO, MACRA Imz ONC) Providers Programs (e.g. AFIX, VFC) State Return on State Public Public Variation Investments Health (e.g. Health Surveillance, Researchers IIS WIC) Day Care Health Plans, IIS Data Facilities, Widespread ACOs, Demands Schools, Adoption MMCOs Universities of EHRs Consumers Vital Records Personal Health Records Access Health Information Exchange Networks Workforce 6
IIS Interface with Clinical Decision Support The right immunization at the right time Challenges Technical Systems set-up, maintenance, upgrades Data collection, sharing, exchange, reporting Systems capacity Less technical Policies and procedures for data collection, management Management of diverse functionality, maturity, data quality, adherence to standards On-boarding providers Staff turnover and competing priorities https://www.cdc.gov/vaccines/programs/iis/cdsi.html Interoperability Assessment and Certification Interjurisdictional Exchange: AIRA/ASTHO Community of Practice Last Updated: December 2, 2016 AIRA American Immunization Registry Association ASTHO Association of State and Territorial Health Officers 7
How Does Data Get Into an IIS? POLICIES How they affect data capture and data sharing IIS updates information & returns updated forecast to provider Provider sends query to IIS Provider administers vaccines & submits new information to IIS IIS sends patient history and forecast to provider Represents Bi-Directional Data Exchange Evolution of Interoperability Data Exchange INTEROPERABILITY 1990 s - Early 2000s Late 2000s 2010 2011-2014-ish 2016 IIS Readiness Provider Readiness Meaningful Use Pediatric Focus Who gives the most shots? Lifespan 8
Assuming state/jurisdiction law and policy permit reporting of adult immunizations to the IIS: Does your IIS currently accept reporting from adult immunization providers? Adults Does your IIS currently allow adult providers to access immunization histories in the IIS? Adults New York City Philadelphia New York City Philadelphia District of Columbia District of Columbia San Diego San Diego Houston Key: Houston Key: San Antonio Yes (60) San Antonio Yes (59) No (1) No (2) No IIS (1) No IIS (1) American Samoa Federated States of Micronesia Guam Mariana Islands Puerto Rico American Samoa Federated States of Micronesia Guam Mariana Islands Puerto Rico Does your IIS have the resources to enroll and support adult providers who want to report to the IIS? Adults Is your state/jurisdiction interested in working with medical associations and other partners to expand the number of providers that report adult immunizations to the IIS? Adults New York City Philadelphia New York City Philadelphia District of Columbia District of Columbia San Diego Key: Houston Key: Houston Yes & ready to do so (36) San Antonio Yes (53) San Antonio Yes, but lack resources to No (8) do so at this time (22) No IIS (1) Other (3) No IIS (1) American Samoa Federated States of Micronesia Guam Mariana Islands Puerto Rico American Samoa Federated States of Micronesia Guam Mariana Islands Puerto Rico 9
Why should pharmacist s care about IIS? Improves adult immunization rates. Improves patient care, solves a public health need. Demonstrates to other healthcare providers that pharmacists are team players, aimed at quality care and documentation. Places pharmacists in a leadership position within the public health community as effective partners in prevention. Reduces/Eliminates unnecessary or duplicate doses IIS Broad Information To Help Pharmacists Previous date of administration Timing of doses Vaccine type received Series completion or status How many doses already completed for series When next dose in series is due Missing doses based on CDC schedule Documented vaccine refusals Reason for refusal Date of refusal Previously identified contraindications Required Pharmacy Reporting to an IIS Policy Issues Going Forward for APhA San Diego Houston San Antonio Scientific Technologies Corporation, 2016 http://iispolicy.stchome.com/ New York City Philadelphia District of Columbia Puerto Rico Key: Yes, all ages Yes, children only Yes, includes look-up Not required How pharmacists, in all settings, can routinely assess and recommend vaccines in a proactive manner. Increasing access to pharmacist administered immunizations and training opportunities to allow more pharmacists to immunize. Allow full access by pharmacists to IISs, increase utilization of IISs, and increase interoperability of IISs, EMRs, and pharmacy management systems. Address data upload issues and ensure proper documentation of pharmacist administered immunizations in IISs. Address role of student pharmacists and technicians in immunization practices. 10
APhA Policy Development Process: Transforming Ideas in Action We d Like to Hear From You APhA APhA House of Members Delegates APhA State Staff Associations Public IDEA APhA- APPM/APRS/ASP Joint Policy Standing Committee IDEA APhA Board of Trustees IDEA Webinar APhA House of Delegates Policy Committee If you have perspectives you d like to share with the APhA Policy Committee and House of Delegates, please email your thoughts to hod@aphanet.org. APhA Board of Trustees ACTION APhA- APPM/APRS/ASP Joint Policy Standing Committee Implementation IDEAS APhA House of Delegates ADOPTED Policy Statements PROPOSED Policy Statements Webinar Which is NOT a recognized challenge to using IIS in pharmacies? Which is NOT a recognized challenge to using IIS in pharmacies? a) Lack of training on IIS use b) Limited access to IIS by pharmacists c) Varying reporting requirements for the IIS by health care practitioners d) Although immunization documentation in IIS for adults is required, pediatric vaccine documentation may be incomplete a) Lack of training on IIS use b) Limited access to IIS by pharmacists c) Varying reporting requirements for the IIS by health care practitioners d) Although immunization documentation in IIS for adults is required, pediatric vaccine documentation may be incomplete 11
Which of the following statements regarding interoperability of IIS is TRUE: Which of the following statements regarding interoperability of IIS is TRUE: a) IIS vendors are required to comply with HL7 (Health Level 7 International). b) IIS vendors are required to connect to pharmacy dispensing systems. c) Pharmacy dispensing systems are required to store immunization data in the same format as an IIS. d) IIS serves as a real-time two way communication bridge between inpatient and outpatient providers. a) IIS vendors are required to comply with HL7 (Health Level 7 International). b) IIS vendors are required to connect to pharmacy dispensing systems. c) Pharmacy dispensing systems are required to store immunization data in the same format as an IIS. d) IIS serves as a real-time two way communication bridge between inpatient and outpatient providers. Which is a key parameter of Immunization Information Systems (IISs)? Which is a key parameter of Immunization Information Systems (IISs)? a) Cold chain integrity b) Data exchange c) Proper administration technique d) Patient education a) Cold chain integrity b) Data exchange c) Proper administration technique d) Patient education 12
How to Claim CPE Credit 1. At the conclusion of this webinar, log in to pharmacist.com 2. Click LEARN, LIVE ACTIVITIES. Find the activity name, Proactive Immunization Assessment and Immunization Information Systems. 3. Click Claim Credit 4. Click Enroll Now 5. Enter attendance code: GKG6NH 6. Complete evaluation 7. Claim credit Your CPE must be filed by November 11, 2017, at 5 p.m. ET to receive credit. 13