Reducing Vaccine Preventable Disease through Immunization Registries

The case study highlights the collaboration between the state's immunization registry and the state's Regional Extension Center (REC). These two entities have been working together to ensure providers can satisfy the public health requirements for Meaningful Use Stage 1.

The Michigan Department of Community Health (MDCH) Division of Immunization sponsors the Michigan Care Improvement Registry (MCIR). MCIR was created in 1998 as the Michigan Childhood Immunization Registry to collect reliable immunization information and make it accessible to authorized users online. In 2006, because of the passage of Public Act 911, the Michigan Childhood Immunization Registry was expanded to include adults and was renamed the Michigan Care Improvement Registry. MCIR benefits health care organizations, schools, licensed childcare programs, and Michigan's citizens by consolidating immunization information from multiple providers. This reduces vaccine-preventable diseases, over-vaccination, and allows providers to see up-to-date patient immunization history

The mission of Michigan's Health Information Technology (IT) Regional Extension Center (REC) (M-CEITA) is to provide education, outreach, and technical assistance to improve the quality and value of health care delivery in the state of Michigan and to assist in achieving meaningful use Stage 1. M-CEITA recognizes providers often face challenges when integrating an Electronic Health Record (EHR) system into their practice. Most providers are not experts in system selection, clinical IT integration, or contract negotiation and need an ally to assist them in the achievement of meaningful use stage 1. M-CEITA offers the resources and expertise providers need to select an EHR, implement it efficiently, and attest for the EHR Incentive Program. The M-CEITA Program is facilitated by Altarum Institute, a nonprofit health systems research and consulting company based in Ann Arbor, MI. M-CEITA is staffed regionally throughout Michigan, ensuring an understanding of and connection to local health care markets.

“We wanted to collaborate within the department [MDCH], so that providers don't need to go to three different places to test for the three measures. We wanted it to be convenient.” –MCIR

For a number of years, Michigan has had a health IT commission in place charged with facilitating and promoting the design, implementation, operation, and maintenance of an interoperable health care information infrastructure in the state as well as advance the adoption of health information technologies throughout the state's health care system. The health IT Commission has come to play a unique role in ensuring that all American Recovery and Reinvestment Act (ARRA) funded health IT programs in Michigan are operating transparently and in the best interest of the public. Much of the work of the health IT Commission in 2011 has focused on calling for information from and providing feedback to the ARRA health IT initiatives in Michigan.

The health IT commission has monthly meetings that are open to the public, and had been following the progress of the HITECH Act for over a year before it was passed. The MDCH, MCIR and M-CEITA have both been involved in this commission and because of this prior collaboration, MCIR, MDCH, and M-CEITA were able to hit the ground running to address the public health meaningful use measures once the HITECH Act passed and once the final rule was published. The health IT commission has continued to work to ensure the same messages for public health reporting are included in the State Medicaid Health IT Plan (SMHP); M-CEITA and MiHIN's work on meaningful use; and MCIR's work on immunization reporting.

Meaningful Use Stage 1 requires eligible providers to select one of two public health measures: syndromic surveillance reporting or immunization reporting2, and test their ability to submit this data electronically from their EHR to their state public health department. MDCH has set up a public health meaningful use website that serves as a “one-stop shop” for providers to register to test their ability to electronically submit data for any of the three public health measures to the appropriate system within MDCH.

• Electronic lab reporting (ELR) is submitted to the Michigan Disease Surveillance System (MDSS); syndromic surveillance data is submitted to the Michigan Syndromic Surveillance System (MSSS).
• Immunization data is submitted to MCIR.

Funds to set up the website came from Michigan's SMHP plan. The Michigan HIE cooperative agreement and a CDC IIS-EHR interoperability grant also set aside funds for interface development and public health systems. The SMHP and HIE cooperative agreement plans both used the same language in regards to public health systems to ensure that a seamless infrastructure could be created.

The one-stop registration website provides links to “Specification Guides” for each type of submission. These Guides outline the technical specifications needed to submit test messages to MDSS, MSSS and MCIR systems. After a provider has reviewed the appropriate Guide and is ready test, they complete and submit a “Meaningful Use Questionnaire” that alerts MDCH the provider is ready to send a test message.

After the Questionnaire is submitted, MDCH contacts the provider with further details on the test process for the selected measure. The specific versions of HL7 supported by the relevant system are detailed in the corresponding Guide.

• MCIR is currently supporting HL7 versions: 2.5.1, 2.3.1
• MDSS is currently supporting HL7 versions: 2.5.1, 2.3.1
• MSSS is currently supporting HL7 versions: 2.5.1, 2.3.1

The MDCH test registration website provides one avenue in to all three systems (MDSS, MSSS, and MICR), allowing for an efficient, streamlined testing registration process, and easing the burden to providers.

The MDCH also created a secure website which allows providers to submit a test message. Those providers choosing to submit immunization data are able to cut and paste their message, which is then validated by the MCIR system. Once the provider submits a successful test message, they receive a confirmation letter from MDCH. Currently, all the providers who have tested for ELR and syndromic surveillance have submitted their information in real time, so they have not needed to cut and paste messages, though MDCH is prepared to provide this capability as well, whenever it is needed. Once the provider submits a successful test message, they receive a confirmation letter from MDCH.

Because many providers have already been reporting immunization information to MCIR, albeit through other mechanisms, the vast majority of providers have selected this measure to test. Because of the high number of providers selecting this measure,M-CEITA has been working closely with MCIR to ensure providers are able to successfully submit a test message through the MDCH testing website. Their efforts have been successful, as approximately 2, 167 providers have already tested immunization data submission.

“We have to work together because we serve the same clients. We both have a hand in making them successful in this process.” –M-CEITA

M-CEITA and MCIR have been working hand-in-hand to educate vendors and providers about the steps needed for immunization reporting. For example:

• M-CEITA has worked with MCIR to ensure that the M-CEITA specialists working with providers are able to give these providers the correct information and messages about immunization reporting.
• The two entities have worked to ensure vendors have the correct information. In some instances, vendors have told providers MDCH is not ready to accept test messages and the provider should claim exclusion, which is incorrect.
• MCIR and M-CEITA have worked to inform each other when a misunderstanding occurs, and then work to address it with the vendor and the provider.
• M-CEITA and MCIR both noted the importance of keeping the other in the loop to ensure that the correct messages about immunization reporting are conveyed to provider and vendor communities.

Furthermore, MCIR provides M-CEITA with periodic updates that include:

• Which products providers have used to complete testing. M-CEITA, in turn, is able to pass this information on to their members, which serves as another way to combat misunderstandings and incorrect information that may be floating around the communities.
• M-CEITA also provides MCIR with reports including which providers are ready for testing, and any challenges they may be encountering.

“Overall, education, having the right message, and getting it out to the provider and vendor community are the most important.” –MCIR

`Overall, M-CEITA and MCIR have found building strong relationships with the vendor and provider communities is key to ensuring the successful achievement of meaningful use stage 1. Additionally, M-CEITA and MCIR's strong relationship have allowed them to formulate united messages to promote EHR adoption and use.

1. Public Act 91 of 2006
2. Note that eligible hospitals can also select to submit electronic lab reports to satisfy this requirement.