Post on 23-Jan-2016
description
Contra Costa County Health Services, California 1
Implementation of Adult and Implementation of Adult and Adolescent ScheduleAdolescent Schedule
Contra Costa County Health Services
Siu Wing Tong, Ph.D.
Information Systems Division
Contra Costa County Health Services, California 2
What is CCAIR?What is CCAIR?
Contra Costa Automated Immunization Registry is a centralized data repository designed to accept and consolidate all immunization history records from multiple providers
Prototype developed in 1995
Contra Costa County Health Services, California 3
What is CCAIR?, Cont’dWhat is CCAIR?, Cont’d
CA DHS (partial) funding started in January 1996
Remaining funding picked up by County
In-kind supportsPiloted in Contra Costa Public Health in
1996
Contra Costa County Health Services, California 4
What is CCAIR?, Cont’dWhat is CCAIR?, Cont’d
Selected by CA DHS in 1999 after HumanSoft collapse for replication elsewhere in the state
Selected by Nevada State Health Division in 1999
Contra Costa County Health Services, California 5
What Happened To CCAIR?What Happened To CCAIR?
Turned over a copy of web-enabled source code to CA DHS in 2001– After the 2nd IRC held in Little Rock, AK– CA DHS now maintains their CAIR version
3.x
Contra Costa County Health Services, California 6
What Happened To CCAIR?, Cont’dWhat Happened To CCAIR?, Cont’d
Contra Costa Health Services retained client/server copy of source code
Continue to operate as standalone registry
Contra Costa County Health Services, California 7
dot-NET Conversiondot-NET Conversion
Porting of client-server version to Microsoft dot-NET– Started in November 2001
Finished the first prototype before the 3rd IRC in PA in October 2002
Prototype presented at 3rd IRC
Contra Costa County Health Services, California 8
Scheduling in CCAIRScheduling in CCAIR
Modeled after ACIP recommendationsTable-driven logic for next due date
recommendationsValidate/invalidate shots given based
on minimum age & intervals
Contra Costa County Health Services, California 9
Scheduling in CCAIR, Cont’dScheduling in CCAIR, Cont’d
Help text to show ACIP recommendations
“WHY button” text to explain CCAIR internal logic
Contra Costa County Health Services, California 10
Why A&A?Why A&A?
CCAIR for children has been in Contra Costa County for years, covering primarily children 0 to 5 years of age
Mature and in use since 1996Desire to expand
Contra Costa County Health Services, California 11
Why Now?Why Now?
CCAIR is linked into Patient Care Information System, our County’s Electronic Health Record project, which is intended for all ages
New vaccines expected for older patients
Contra Costa County Health Services, California 12
A&A In CCAIRA&A In CCAIR
Finished implementation of some adolescent schedule by 1998– HBV 2-dose formulation– VZV adolescent schedule after age
13Started selected implementation of a
subset of A&A in 2003 after dot-NET rewrite
Contra Costa County Health Services, California 13
Current ScopeCurrent Scope
Which subset of ACIP A&A schedule for this current first phase– Influenza– 3-dose adolescent DTP (or Td)– Td (Tetanus Diphtheria) boosters– Pneumococcal polysaccharide
Contra Costa County Health Services, California 14
Goals & ChallengesGoals & Challenges
Follow ACIP A&A scheduleSelect a subset to implement in the initial
attemptMaintain current table-driven architecture
– Ease of maintenanceLeverage existing mechanisms
– VZV, HBV-2dose, Rotavirus
Contra Costa County Health Services, California 15
Goals & Challenges, Cont’dGoals & Challenges, Cont’d
Discover new mechanisms needed– Repeating doses, age dependency,
disease dependency, seasonal natureLink up with other tracking systems
– Asthma, Prenatal/OB
Contra Costa County Health Services, California 16
How Does It Work Now?How Does It Work Now?
One single table for all schedules of vaccine groups of interest
One record for each recommended dose
Lots of parameters in each dose record storing min/max age, intervals, conditional skips and many others
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How Does It Work Now?, Cont’dHow Does It Work Now?, Cont’d
Match one shot with one schedule record
The last unused or unassigned schedule record will be used for calculation of next-due-date recommendation.
Contra Costa County Health Services, California 18
What’s Needed?What’s Needed?
Apply new table parameter valuesChange conditional skip to relativeAdd new “repeating” parameterCreate multiple age ranges of
recommendationAdd new “seasonal” parameter
Contra Costa County Health Services, California 19
Our FindingsOur Findings
Td 3-dose series– May use existing DTP 5-shot series– Need new skip condition that is relative to
a previous dose, not to a particular, fixed dose number
– Cannot easily specify the recommended vaccine codes from DTP to Td etc.
Contra Costa County Health Services, California 20
Our Findings, Cont’dOur Findings, Cont’d
Td Boosters– Need new “repeating” parameter– User may specify a shot as booster shot– Put “repeating” scheduling record (for
booster) at the end of the series
Contra Costa County Health Services, California 21
Our Findings, Cont’dOur Findings, Cont’d
Influenza– Need new “repeating” parameter– Need new “seasonal” parameter
To specify the starting of the season
– Need two records in schedule tableThe second one being “repeating”
Contra Costa County Health Services, California 22
Our Findings, Cont’dOur Findings, Cont’d
Pneumococcal Polysaccharide– Separate group from PNU conjugate– Avoid recommending both PNUps
and PNUcon– Disease history or medical conditions
To store or not to store
Contra Costa County Health Services, California 23
Our ExperiencesOur Experiences
More difficult to maintain totally table-driven algorithm
Complexity of scheduleDependency on sensitive disease
history & medical conditions– How best to obtain information– To store or not to store in registry
Contra Costa County Health Services, California 24
ContributorsContributors
Erika H. JenssenCarol FitzgeraldAtes TemeltasSiu Wing Tong
Contra Costa County Health Services, California 25
Contact UsContact Us
Siu Wing Tong, Ph.D.
Information Technology Supervisor
Contra Costa County Health Services
595 Center Ave, Suite 200
Martinez, CA 94553
swtong@hsd.co.contra-costa.ca.us