The Data Exchange Process and Participants

Cecile Town

Objectives

• Assign roles and responsibilities at the Area level for immunization data exchange programmatic and technical support

• Define IIS/RPMS testing scenarios vs. production data exchange

• Communicate effectively with IIS staff and vendors about IHS data exchange capability

What’s an Immunization Information System ?

• Also known as Immunization Registries, Immunization Information Systems (IIS) are confidential, population-based, computerized information systems

• They collect vaccination data about all children within a geographic area (usually statewide)

• Some registries also collect vaccine data for adults.

The IHS Data Exchange Initiative

IHS contracted to develop RPMS-compatibleImmunization Data Exchange software

Benefits- Facilities continue to use the RPMS as their

primary information source- Eliminates the need for double data entry- Data can be pulled from the IIS directly into

individual RPMS records- Built to CDC standards

Software Used

• RPMS Immunization Module - BI

• IHS Immunization Data Exchange Software – BYIM – usually IIMM on RPMS Menu

• HL7 Communications Bridge – non IHS software

IHS Data Sharing Policy• Under HIPAA, sharing immunization data with

state registries is permitted• IHS issued a policy memo stating sharing

data with state registries is permitted and encouraged according to routine use

• Ultimately, participation is determined by the tribe

• SECURE TRANSACTIONS– Check with your ISSO

Why do IHS, Tribal and Urban providers participate in IIS?

Rationale for Data Exchange

States Need:• Timely information on patients seen at IHS

and tribal sites• Standardized exchange

Issues for Data Exchange

IHS Needs:• Timely information on patients seen at other

clinics• Standardized exchange

– 35 different states– Crossing of state lines

• Bi-directional exchange

Data Exchange with IIS

One-way - RPMS Export to IIS– ITU sends all patient immunizations to IIS and they

are de-duplicated and added– Site must look up patient records in the IIS

Two-way - RPMS Export/Import– ITU sends all patient immunizations, registry de-

duplicates & matches, sends back to facility to add to individual RPMS record

– Both processes are piloted tested with one site before going into production phase & roll-out to other sites

What we know • Majority of sites send

information to the IIS, direct data entry is method most frequently used

• In 2009, 88% of those doing direct data entry also performed double data entry. Of those, 40.9% indicate that this is a barrier to facility participation in IIS.

• Most ITU’s use look-up capability from the IIS.

• Although two-way interfaces account for only 10-11% of all participation, 94% of respondents feel it would be useful to have.

• MU attestation is interface based

What is to come?

Meaningful Use Stage 1 will drive new interfaces in

19

states!

IHS needs an increased support network for these interfaces

Stages of Data Exchange• Discover

– State & IHS initial Q & A• Plan

– Determine contacts, meetings• Develop

– Determine software specifications, transport methods

• Test – the “handshake”

Stages of Data Exchange• Certify

– Verify data quality, test phase• Install

– Kickoff meeting, train providers• Live

– production data exchange at pilots• Rollout

– data exchange implemented at additional facilities following successful pilot

Interface Project Management

Interfaces

• GOAL – share data between RPMS & IIS• What data? – Local immunization data• Which format? – HL7 2.4• How will the data get there? IIS dependent• Who will send data? – local provider• How often will they send data? – site

dependent• Who identifies and addresses issues?

Data Exchange: Who Does What?

National Data Exchange TeamTechnical/ProgrammingTom Love - BYIMNathan Bunker - Transport

Testers/Super UsersJohn Parker, RNScott Hamstra, MDMary Brickell

Programmatic Coordination/Partnering Cecile Town

BYIM Coordinates with Immunization Package Development: Amy Groom Ros SingletonMike Remillard

Who makes data exchange work?

• Clinical providers• IT Site Managers• Clinical Applications Coordinators• Area Immunization Coordinators• IT Site Analysts• OIT Helpdesk• State IIS personnel• State IIS vendors

Roles IIS/IHS

Role IHS IIS

Coordination/Facilitation Data Exchange Coordinator

IIS Manager

Technical – HL7 messaging

BYIM Programmer IIS Vendor

Technical – Transport Transport Consultant IIS Vendor

Troubleshooting Message Content

PHNs/Immunization Coordinators

IIS HL7 Specialist

Troubleshooting Transmission issues

Tiers 1 -3 – ALL IIS Vendor/HL7 Specialist

Interface Project Management

Area Teams

• Clinical Applications Coordinators• Immunization Coordinators• PHN Consultants • IT Site analysts• Meaningful Use Coordinators/Consultants

Technical Support Snapshot

• Immunization Program presenting an IT solution for RPMS providers

• Immunization Program advances interface nationally & actively partners with IIS community

• OIT funds support software development • Technical support & development are contracted• OIT Help Desk requests are routed to the Immunization

Program• Documentation, testing, training, installation and

troubleshooting --- National Data Exchange Team• Meaningful Use kicks off rapid growth of data exchange,

creating need for enhanced technical support

Consent Issues - FYI

• While software solutions exist, provider practices and requirements differ by Area, State

• Information security & consent differ • IHS policy memo & individual level

consent

Lessons Learned From the Field

• Software capabilities do not equal feasible practice

• IHS IT presence critical• Process must be assigned & ongoing• It’s a partnership – clinical & IT • Time spent on the front end will be time

saved on the back end

What could this slide look like for your Area?

• Facilitator, Data Exchange POCCecile Town – Cecile.Town@ihs.gov

• Contact for provider issuesScott Hamstra – scott.hamstra@ihs.gov

• Contact(s) for IT & software issuesJohn Parker – john.parker@ihs.govTom Love

• Contact for questions about MU attestationJoAnne Hawkins – joanne.hawkins@ihs.gov