Presented by: Rebecca Coyle MSEd.
AIRA Executive Director
A Summary of the Methods, Successes and Challenges of
Pharmacy-IIS Interfaces
What is AIRA
•
AIRA is viewed by its members as the
centralized core of activity for IIS
development, standardization, and best
practices
• Provides knowledge sharing opportunities
and capacity building activities
• Promotes, advocates for, develops, and
disseminates IIS data exchange standards
consistent with national standards that
increase the visibility of IIS as public health
best practice models for interoperable and
integrated health management systems
Percentage of children aged <6 years participating* in an
Immunization Information System (IIS) – United States, five
cities+, and the District of Columbia, 2012
NYC
Philadelphia
DC
San Antonio
Chicago
Houston
≥95%
67%-94%
34%-66%
≤33%
No IIS
No data
National child participation: 86%
* Participation is defined as having two or more vaccinations recorded in the IIS
+Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas.
Percentage of adolescents aged 11 through 17 years participating*
in an Immunization Information System (IIS) – United States, five
cities+, and the District of Columbia, 2012
NYC
Philadelphia
DC
San Antonio
Chicago
Houston
≥95%
67%-94%
34%-66%
≤33%
No IIS
No data
National adolescent participation: 54%
* Participation is defined as having two or more vaccinations administered during adolescence recorded in the IIS
+Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas.
Percentage of adults aged ≥19 years participating* in an
Immunization Information System (IIS) – United States, five
cities+, and the District of Columbia, 2012
NYC
Philadelphia
DC
San Antonio
Chicago
Houston
≥95%
67%-94%
34%-66%
≤33%
No IIS
No data
National adult participation: 25%
* Participation is defined as having one or more vaccinations administered during adulthood recorded in the IIS
+Chicago, Illinois; Houston, Texas; New York, New York; Philadelphia, Pennsylvania; and San Antonio, Texas.
Methods
Phase 1: Online survey
issued to all State,
Territory, and Local IIS
CDC Awardee Projects
Phase 2: Interviews with
representatives from the
five largest pharmacy
chains actively interfacing
with IIS in multiple states
Survey Purpose
•
•
•
Examine what is being done to connect IIS
and Pharmacies and how it is being done.
Which pharmacies are providing
immunizations
Which pharmacies are reporting vaccinations
administered to the IIS, and
 Of those reporting, what is the nature and quality of
the data being received
•
•
Capture the successes and challenges of the
pharmacy-IIS reporting relationship and
What efforts are being made to increase the
number of pharmacies reporting to the IIS
Pharmacy Interview Purpose
•
•
Gain a better understanding of the
chain’s corporate approach to
vaccination and reporting
Provide balance and validation of
responses captured during the IIS
Survey phase
Map of IIS Survey Responses
Major Findings
•
Of the state and project areas
responding to the survey (n=45)
 Pharmacies are allowed to provide
•
vaccinations in 42 (93%) of the project
areas.
 Pharmacies report doses administered to IIS
in 36 (80%) jurisdictions and are required to
report in 22 (49%).
Pharmacists will generally administer whatever
vaccinations they are allowed to administer in
accordance with individual state laws
Types of Vaccinations Reported
by Frequency
Most Common Data Submission
Methods & Frequency
•
•
Flat files loaded manually (26%),
HL7 batch (25%) and
Manual data entry (23%)
•
For Electronic Interfaces:
•
 Weekly data feeds (42%)
 Daily feeds (28%)
Reporting Methods by Frequency
Reporting (cont.)
•
•
For pharmacies reporting
electronically (n = 64), a multi-site
feed including all sites/clinics in the
jurisdiction was by far the most
common practice (83%).
For manual submissions (n=22), data
entry is almost always performed at
the individual site/clinic level (82%).
Most Common Transport
Methods
•
•
FTP/SFTP (47%)
SOAP over HTTP(s) (24%)
Success



Partnerships with the
pharmacy community is
critical when recruiting &
interfacing with new
pharmacy partners
Significant increase in
adult immunization
records
Improved quality of adult
data
IIS



The improvement of
overall patient care
Role of pharmacies in
the patient care
continuum
System improvements
Pharmacy
Challenges – IIS Perspective
•
Data quality issues
• Lack of unique patient identifiers
• Variations in patient’s name
• Lack of patient address
• Inability to collect required data
elements
• Inability to generate a file format
supported by the IIS
Challenges – Pharmacy
Perspective
•
Restrictions on the type of files that IIS
are willing or able to accept (e.g.
pharmacy can generate a flat file but
state requires HL7 or vice versa)
• Limited staffing resources and
infrastructure on the IIS side can lead to
a lengthy onboarding process
• State variations in the IIS specifications
• IIS consent requirements mandated
through state/local law
Recommendations
Evaluate IIS reporting
specifications/recommendations on a more
global scale to standardize the reporting
process for external partners that span multiple
states/jurisdictions (specifically required fields,
reporting methods supported, reporting
timelines).
2. Assemble partners with the ability to influence
public health policy and pharmacy vaccination
practice to recommend standardization in laws
defining pharmacy vaccination programs,
mandatory reporting requirements, and
consent/disclosure limitations.
1.
Recommendations (cont.)
IIS should work with pharmacy reporting
partners to identify alternative reporting options
and/or establish feasible transition plans and
timelines to facilitate reporting until pharmacy
systems can report in the IIS’s preferred
reporting method. All efforts should be made to
avoid requiring pharmacies to perform
unnecessary duplicate data entry.
4. IIS not capable of supporting the most current
HL7 2.5 specification should establish timelines
for implementing the new standards and
communicate those timelines to the more
advanced pharmacy partners.
3.
Recommendations (cont.)
5.
6.
Consider moving to NDC as the
standard for vaccine type and
manufacturer reporting, or enhance
IIS to support NDC in addition to
CPT/CVX codes.
Include pharmacy partners in
immunization and IIS related
meetings and educational
opportunities whenever appropriate.
Recommendations (cont.)
Leverage partnerships to increase the
number of Pharmacy-IIS interfaces, evolve
reporting processes and improve patient
care.
8. Consider future study opportunities to
evaluate pharmacy data quality when
compared to other provider submissions,
investigate possibility of getting pharmacy
data through a centralized billing system,
and assess the feasibility of pharmacies
incorporating review of records in the IIS
into the routine vaccination workflow.
7.
AIRA Website Resources
www.immregistries.org
Danielle Reader-Jolley
Participating Immunization Information Systems
CVS
Kroger
Rite Aid
Safeway
Surescripts
Walgreens
Type of Data Exchange
Transport Modes by Frequency