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GCN : March 2014
In the early 1990s, state public health agencies and several major cities began planning and developing large databases of immunization records to help health care providers track vac- cines administered to children. With these databases, providers were able to access consolidated records of patients to make sure they were current with vaccina- tions they needed. Today, these agencies are in- creasingly turning to more ad- vanced analytics to better exploit the millions of records they've collected in immunization regis- tries - or immunization informa- tion systems (IIS). With these features, public health officials are gaining great- er insight into public health care trends that could improve treat- ment outcomes and lower costs. Analytics, for example, can help health care agencies spot areas with lower up-to-date vaccina- tion rates or enable providers to better manage vaccine invento- ries in real time. National attention on analytics has emerged only in the last three years or so even though many im- munization registries have been around for a decade plus, said Gary Wheeler, Hewlett-Packard's immunization services portfo- lio executive. That's because the initial focus was on building sys- tems with good, quality data sets - and that was critical. "Because if you do analytics on inaccurate data, you're not going to get the outcomes that you want," he said. IMPROVING POPULATION HEALTH In the late 1990s, HP helped the state of Wisconsin develop the underlying technology for its im- munization registry. This system has since been shared with 19 other states, including Oregon, which migrated in 2010 from its then 14-year-old homegrown system. Oregon's system contains about 48 million records cover- ing about 5.3 million patients (in- cluding those of former state resi- dents), according to Mary Beth Kurilo, director of the Oregon ALERT Immunization Informa- tion System (IIS), which is part of the state's Public Health Division. Authorized providers in Or- egon have Web-based access to immunization records of nearly 100 percent of babies, adoles- cents and teenagers up to 18 years old and currently about 70 percent of the adult population. These records include patients with private insurance, Medicaid and Medicare. The ALERT IIS runs on an Or- acle platform with transactional and data mart databases sup- ported by HP, Kurilo said. Analyt- ics is performed on the data mart, which is a replicated data set. From the start, Oregon had an- alysts to research and spot trends through the registry. But these days, analysts have more tools at their fingertips. Kurilo said they use Oracle PL/SQL to extract data from backend tables and an- alyze it through various analytic tools - including SAS, IBM SPSS and others - to run ad hoc and canned reports. For example, health officials can assess the impact of new vac- cines coming to market or the ef- fect of drug shortages. Analytics can also help drug suppliers keep track of vaccine stocks and better estimate their future needs, par- ticularly for influenza. And local clinics can use the system to find out how many of their patients are up to date on their shots - and send reminders to those who aren't. With this capability, the state can even support school districts in handling vaccine exemptions, CASE STUDY HEALTH IT Public health o cials are applying analytics to immunization registries to gain deeper insights into trends that could improve treatment outcomes and lower costs States dig deep into electronic health records BY DIBYA SARKAR 26 GCN MARCH 2014 • GCN.COM