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GCN : March 2014
children whose families have opted not to have them immunized. For example, Kurilo said, in a pertussis (whooping cough) outbreak, officials can generate a list of students who are not up to date with the pertussis-containing vac- cine. Schools can also issue reminders to students alerting them that their immuni- zations are due or past due. Plus, schools can get a list of exempt students and de- cide to send them home for their protec- tion, she added. HIGH VALUE ON DATA So far, 90 percent of Oregon s immuniza- tion data comes directly from about 1,200 providers hospitals, private physician practices, specialty clinics and pharmacies through an electronic data exchange with their electronic health records or other systems. Ten percent of records are manually entered, Kurilo said. Before Oregon can "onboard" or accept an electronic data feed from a new pro- vider into ALERT IIS, the provider must adhere to certain data specifications. Two state staffers test the data content and for- mat to ensure it meets a certain level of quality before it can be shared. The data is transmitted in either real time or in daily or weekly batches. In addition to primary source data, the state also gets secondary source data from Medicaid, large health plans or other or- ganizations that may not have provided a vaccine shot, but can supply claims data about a particular shot to backfill any miss- ing information. With thousands of reports transmitted almost hourly, Kurilo said the system uses very sophisticated algorithms to provide "probabilistic" matching that can merge reports from various sources for the same patient or even multiple reports of the same immunizations for one patient. The state has extensive standard- ized data quality protocols on existing data, and it maintains close relationships with providers to make sure they adhere to high-quality data standards, she said. State staffers also review records that may need a little more scrutiny. Once these records are approved, they go live in the data- base for providers to access. ANALYTICS PAYS OFF Oregon is continuing to add adult immu- nization records to the registry, and this expansion will help the state better ana- lyze flu vaccine uptake, enabling analysts to compare statistics with reported influ- enza cases or flu-like cases across the state in real time, Kurilo said. And with pharmacies playing a greater role in immunizations, Oregon plans to use analytics to not only see how well the system is capturing such records, but also how pharmacists are using the registry to provide shots. "We ve had a few high-profile cases of pharmacists immunizing for pneumococ- cal right after the patient received his pneumococcal at his provider s office be- cause the patient didn t remember and the pharmacy didn t check," Kurilo said. "We want to make sure that everyone is lever- aging this consolidated record particular- ly as patients are more and more mobile and getting their vaccinations in different locations." Kurilo, who is the immediate past presi- dent of the American Immunization Reg- istry Association said as these systems continue to evolve they can serve as a model for how other health care agencies can better collaborate, use advanced tech- nology, improve service and save money. She said an early study estimated that for every dollar spent on registries, the health care system saved about $7 in terms of a provider s time, resources and efforts. However, Kurilo added there hasn t been a good cost-effectiveness study since then. "What we hear anecdotally from pro- viders is that [these registries are] incred- ibly efficient for them, so, to some extent, these systems have really sold them- selves." • GCN MARCH 2014 • GCN.COM 27 Barcoding accelerates Nationally, states are eyeing the integration of two-dimensional barcoding to label and track vaccines. According to the Centers for Disease Control and Prevention, which funded a recent two-year pilot, a 2D bar code could contain vaccine product identi cation information, the lot number and expiration date. By scanning this information directly into a registry, states can quickly, accurately and automatically analyze speci c vaccines that have been distributed to providers. Not only could this reduce administrative errors, such as incorrect, expired or recalled vaccines, but of cials could identify patients who may have been vaccinated with a product that had a problem. "It's important for patient safety if there was ever an issue with an additive or something in the vaccine and we need to know who had this particular lot of the vaccine," said Gary Wheeler, Hewlett-Packard's immunization services portfolio executive. SHUTTERSTOCK