MSIPC Fundamentals: Interaction
between IPs and Local and State
Health Departments
www.michigan.gov/hai
October 21, 2015
Joyce Lai, MPH– Michigan Department of Health and Human Services
Noreen Mollon, MS CIC– Michigan Department of Health and Human Services
Outline
 MDHHS Organization
 Communicable Disease Surveillance
 Reportable Diseases
 Michigan Surveillance Data Systems
 MDSS
 MSSS
 Sentinel Surveillance for ILI
 SHARP
 Outbreak Response
 Surveillance and Reporting
 Prevention Initiatives
 Other MDHHS Entities that frequently interact with IPs
MDHHS Vision Statement
 MDHHS will promote better health outcomes,
reduce health risks and support stable and safe
families while encouraging self-sufficiency
MDHHS Organization
DIRECTOR
Chief Operating
Officer
Office of
Inspector General
Aging and Adult Services
Financial
Operations
External Relations
And Communications
Medical Services
Administration
Behavioral Health &
Developmental
Disabilities
Administration
Population Health
and Community Services
MDHHS Organization
Population Health and Community Services
Administration
Bureau of Local Health
& Administrative Services
Bureau of Disease Control,
Prevention, and Epidemiology
Bureau of Laboratories
Bureau of Family, Maternal
And Child Health
Bureau of EMS, Trauma and
Preparedness (formerly OPHP)
Bureau of Community Services
MDHHS Organization
Bureau of Disease Control,
Prevention, and Epidemiology
Division of Genomics, Perinatal
Health, and Chronic Disease
Division of Environmental Health
Division of Communicable Disease
Division of Immunization
Surveillance Section
Surveillance of Healthcare-Associated
and Resistant Pathogens (SHARP) Unit
Regional Epidemiology
Unit
Communicable Disease Surveillance
 Communicable disease reporting is required
by Michigan law:
 Michigan Public Health Act No. 368 Communicable Disease Rules:
R 325.171-3, 333.5111
 Rule revision allows the State the right to periodically update the list
of reportable diseases
 This reporting is expressly allowed under HIPAA
Hepatitis C Virus
Neisseria meningitidis
Histoplasma capsulatum
Bordetella pertussis
Why Communicable Disease
Surveillance is Important
 To identify outbreaks
 To assure treatment, preventive treatment and/or




education
To evaluate prevention and control programs
To help target prevention resources
To facilitate epidemiologic research
To assist national and global surveillance efforts
Chlamydia trachomatis
Influenza Virus
Mycobacterium tuberculosis
Salmonella sp.
Public Health Depends on Collaboration
Healthcare
Providers
Clinical
Laboratories
Local Health
Department
State Health
Department
Centers for Disease
Control and Prevention
Isolates and specimens
sent to State Lab for
additional testing
Communicable Disease Reporting
Entities
 Physicians*
 Laboratories*
 Hospital ICP
 Private citizens
 School systems*
 Pharmacists
 Veterinarians
 Medical Examiners
*Required to report




Hospitals*
Child care facilities
Long-term care
facilities*
Pre-hospital
emergency services
 Police
 Fire
 EMS
Communicable Disease “Brick
Book”
 The current 2015 version
provides a good summary of
the communicable disease
rules, requirements, and
responsibilities
Michigan Reportable Diseases
 ~90 disease/conditions are
reportable in Michigan
 Also reportable are ‘unusual
occurrences’, outbreaks and
epidemics of any disease or
condition (including
healthcare-associated
infections)
 Specific reporting rules and
definitions can be found at
www.michigan.gov/cdinfo
 List available by condition or
by pathogen
Case Rules and Definitions
 Example of
Streptococcus
pneumoniae
reporting
algorithm
Case Rules and Definitions
 Acute /
Chronic
Hepatitis C
Reporting
Flowchart
Timeliness and Completeness of
Communicable Disease Reports
 In general, all reportable diseases are required to be
reported within 24 hours of confirmation
 Report contents
 Demographic info – name, date of birth, sex, race
 Contact info – address, phone number
 Disease details – onset date, lab results
 Surveillance is only as good as the data received
 The timeliness and effectiveness of public health
responses are dependent on prompt and accurate
surveillance reporting
Authority of State and Local HDs
 Michigan is a “home rule” state, meaning local HDs have
autonomy within their jurisdiction
 The MDHHS operates independently from the local HDs
 The primary role of the MDHHS in communicable
disease control is to provide:
 expert consultation
 reference level diagnostics laboratory services
 childhood vaccines
 support local HDs upon their request
 Maintenance and administration of the MDSS
 All communicable disease reports should be
reported to your local HDs
Map of Michigan Local HDs
Public Health Investigative Authority
 State and local HD personnel are authorized to
investigate reported diseases, including:
 Contacting health providers
 Conducting additional case-finding
 Conducting epidemiological studies
 Conducting specimen collection
 Gathering information on medical history, lab results,
diagnostic procedures, treatment, and health outcomes
 The MDHHS works collaboratively with the local HDs
and participates in investigations when requested
Confidentiality, HIPAA, and PHI
 Disclosure of protected health information (PHI) to
health authorities without individual consent or
authorization is permitted when disclosure is required
by law or is authorized by law for a public health
purpose (www.hhs.gov/ocr/hipaa/)
 All information provided to public health authorities
is kept confidential
Helpful Links
 www.michigan.gov/mdhhs
 Click on ‘Providers’ and then ‘Chronic and
Communicable Diseases’
 www.michigan.gov/hivstd - HIV/STD/Viral Hepatitis
 www.michigan.gov/cdinfo - Communicable Disease
resources, forms, links, reports, and publications
 www.michigan.gov/mdss - Michigan Disease
Surveillance System (MDSS)
 www.michigan.gov/hai- Healthcare-Associated
Infection Surveillance & Prevention
Michigan Surveillance Systems
 Michigan Disease Surveillance System (MDSS)
 Michigan (Emergency Department) Syndromic
Surveillance System (MSSS)
 Sentinel Surveillance for Influenza-Like Illness
Disease Detection/Reporting Timeline
Exposure
Symptom
Onset
Seeking of
Medical Care
Reported
to Local HD
Reported
to State HD
Diagnosis
Time
ED Syndromic
Surveillance
Michigan Disease
Surveillance System
Michigan Disease
Surveillance System
 Web-based communicable disease surveillance system
 Disease can be reported 24/7 from your computer
 Used to facilitate coordination between local, State, and
federal public health agencies
 Streamlines disease reporting; more efficient and closer to
real-time
 Allows for more timely public health interventions
 Reduces delays in public health follow-up by grouping
disease based on county of patient residence
Michigan Disease
Surveillance System
 Data in the MDSS can be accessed and edited by multiple
parties which facilitates the sharing of information
without requiring multiple phone calls
 Allows for instantaneous retrieval of summary reports
 MDHHS Weekly Surveillance Report
(www.michigan.gov/cdinfo)
 Data sent to CDC National Notifiable Disease Surveillance
System (NNDSS – www.cdc.gov/nndss) for Morbidity and
Mortality Weekly Reports (MMWR – www.cdc.gov/mmwr)
MDSS Reporting Pathways
Community
Physicians
Infection
Preventionists
Hospital Labs
Local Health Department
MDSS
CDC
•
•
National Notifiable
Disease Surveillance
System (NNDSS)
Morbidity and Mortality
Weekly Report (MMWR)
• Case Follow-up
• Local Surveillance
• Electronic Reports
MDHHS
• Statewide Surveillance
• Weekly Surveillance Reports (WSR)
Adding/Editing Cases in MDSS
Searching Records in MDSS
Pulling MDSS Data
Pulling MDSS Data
MDSS Statistics
Individual
Case Reports
Transactions
Unique User
Log Ins
Year
Referrals
2007
83,876
77,686
400,000
----
2008
136,057
104,616
429,848
783
2009
160,326
119,843
618,731
893
2010
158,225
113,765
697,258
906
2011
213,639
159,185
803,092
982
2012
211,150
146,069
1,018,304
1,126
2013
185,362
126,812
1,059,023
1,155
2014
174,237
134,896
1,245,493
1,218
MDSS System Use Statistics
More Info on the MDSS
 Contact:
 Your Local Health Department Communicable
Disease Program
Your Regional Epidemiologist
Edward Hartwick, MS, MDSS Coordinator

HartwickE@michigan.gov
http://www.michigan.gov/mdss
(517) 335-8165
Michigan (Emergency Department)
Syndromic Surveillance (MSSS)
 A surveillance system that detects and tracks the chief
complaints of ED patients throughout the state
 Chief complaints are classified into syndromic
categories that could indicate a possible public health
emergency
 Web-based application displays the data in real-time
 Alerts are automatically sent when rates of a given
syndrome are detected to be higher than the predicted
norm
MSSS
 # of facilities: 95
 # of users: 173
 # of referrals per day,
Statewide: 12,343
 # of referrals per day,
facility: 130
per
MSSS Data
 Each message sent to the MSSS consists of:
 Demographics: date of birth, sex
 Residence: home zip code
 Visit Info: date, time, class (e.g. urgent care, ER)
 Chief Complaint
MSSS Chief Complaints
 Chief complaints are classified into the following
syndromes:
 Gastrointestinal
 Hemorrhagic
 Constitutional
 Botulinic
 Respiratory
 Neurological
 Rash
 Other
 Default
MSSS Classification Examples
Chief Complaint
“slurred speech”
“general weakness”
“stomach pain”
“difficulty breathing”
“nose bleed”
“headache”
“hives and itching”
“right foot injury”
“med refill”
Syndrome
Botulinic
Constitutional
Gastrointestinal
Respiratory
Hemorrhagic
Neurological
Rash
Other
Default
MSSS Alerts
 A detection algorithm monitors the data hourly
 An e-mail alert is sent to State and regional
epidemiologists if an aberration is detected
 If the actual value of a syndrome exceeds the predicted
value for a given syndrome in a geographic area
 Users can view the data in charts, graphs, or maps
Use of MSS Data
 Early detection of outbreaks
 Enhanced surveillance during high-profile events:
 World Series
 Super Bowl
 MLB All-Star Game
 Final Four
 Detroit Auto Show
 Seasonal influenza monitoring
 Situational awareness
Sentinel Provider Surveillance for
Influenza-Like Illness (ILI)
 Michigan component of the CDC U.S. Outpatient
Influenza-like Illness Surveillance Network
 Influenza sentinel reports provide data on over 12,000
outpatient office visits per week and are an important
part of influenza surveillance in Michigan
 Contact Stefanie Cole at 517-335-9104 or
DevitaS1@michigan.gov for more information
Michigan Influenza Sentinel
Hospital Network
 MDHHS is working to establish a network of sentinel
hospitals that report influenza-associated
hospitalizations
 Hospitals that agree to participate would be asked to
provide:
 Weekly report consisting of the number of influenza-
associated hospitalizations in each of five age categories
 Total number of admissions during that time frame
 Contact:

Seth Eckel (EckelS1@michigan.gov) 517-335-1194
Surveillance for Healthcare-Associated
and Resistant Pathogens (SHARP) Unit
 Objectives of the SHARP Unit:
 Coordinate activities related to HAI surveillance and
prevention in Michigan
 Improve surveillance and detection of antimicrobialresistant pathogens and HAIs
 Identify and respond to disease outbreaks
 Use collected data to monitor trends
 Educate healthcare providers, state and
local public health partners, and the
public on HAIs
www.michigan.gov/hai
SHARP Activities
www.michigan.gov/hai
 Outbreak Response
 Surveillance and Reporting
 CRE Surveillance and Prevention Initiative
 Consulting/Education
Staphylococcus aureus
Klebsiella pneumoniae
Clostridium difficile
Outbreak Response
www.michigan.gov/hai
 The MDHHS SHARP staff are available to offer our
services and expertise in healthcare-associated
outbreak investigations
Acinetobacter baumannii
 MDHHS can help facilities coordinate molecular
testing with the MDHHS Bureau of Laboratories to
identify genetic-relatedness between patient isolates
(at no cost)
Recent Outbreaks
Investigated by SHARP










www.michigan.gov/hai
Mycobacterium chelonae associated with tattoos
Community-onset, invasive MSSA infections
Ventilator-associated Stenotrophomonas maltophila
Clostridium difficile in a long-term care facility
Serratia marcescens SSIs post-cardiac surgery
Pseudomonas aeruginosa SSIs post-cardiac surgery
Pseudomonas aeruginosa respiratory infections associated with
contaminated transesophageal echocardiogram (TEE) gel
Healthcare-associated Hepatitis C Virus (HCV) related to drug diversion
Multidrug-resistant Pseudomonas aeruginosa urinary tract infections
associated with cystoscopy procedures in an outpatient urology clinic
First New Delhi Metallo-beta-lactamase-1 (NDM-1) detected in
Escherichia coli (CRE)
www.michigan.gov/hai
Surveillance and Reporting
 Vancomycin-Intermediate Staphylococcus aureus (VISA)
and Vancomycin-Resistant Staphylococcus aureus
(VRSA) are required to be reported according to the
communicable disease rules
 Unusual occurrences and outbreaks of HAIs are also
mandated by law to be reported
 However, individual HAIs (like a CLABSI), are not
required to be reported to state or local health
departments
www.michigan.gov/hai
Surveillance
and
Reporting
 33 states have laws requiring HAIs to be reported to state
health departments, the majority of which publically release
hospital HAI rates
(http://www.jstor.org/stable/10.1086/663204)
Surveillance and Reporting
www.michigan.gov/hai
 In Michigan, hospitals can voluntarily report HAIs to
MDHHS SHARP via the National Healthcare Safety
Network (NHSN)
 NHSN is a web-based surveillance program designed by
CDC:
 Uses standardized HAI surveillance definitions
 Users can enter and analyze HAI data
 The data sent to SHARP from Michigan hospitals are de-
identified and the numbers aggregated for the purposes
of producing state-wide HAI surveillance reports
Surveillance and Reporting
www.michigan.gov/hai
 HAIs tracked by MDHHS SHARP surveillance:
• Central Line-Associated Blood Stream Infection
(CLABSI)
• Surgical Site Infection (SSI)
• Catheter-Associated Urinary Tract Infection (CAUTI)
• Ventilator-Associated Events (VAE)
• Clostridium difficile LabID surveillance
• MRSA LabID surveillance
• Antimicrobial resistance in select pathogens
HAI Surveillance
SSI
CLABSI
Surgical incision showing signs of infection
Subclavian central venous line
VAP
CAUTI
Foley catheter insertion kit
Mechanical ventilator
CDI LabID
MRSA LabID
Staphylococcus aureus
Clostridium difficile
SHARP Surveillance
www.michigan.gov/hai
 Currently there are 104 Michigan hospitals
sharing HAI data with SHARP, with all 104
hospitals releasing their data to the
Michigan Health and Hospital Association
(MHA) Keystone Center, and 14 hospitals
releasing their NICU data to the Vermont
Oxford Network (10/7/15).
SHARP Surveillance




86 of 109 (79%) of
Acute Care Hospitals in
Michigan are sharing
data
17 of 36 (47%) of Critical
Access Hospitals in
Michigan are sharing
data
1 of 4 (25%) of Rehab
Hospitals in Michigan
are sharing data
Total: 104 of 168 (62%)
of hospitals
Types of Facilities Sharing NHSN Data with
SHARP
120
100
Sharing NHSN Data with SHARP
Total Facilities in Michigan
80
60
40
20
0
Acute Care
Critical Access
LTAC
Rehab
SHARP Reports
www.michigan.gov/hai
 SHARP releases state-wide HAI reports quarterly,
semiannually, and annually which are posted at
www.michigan.gov/hai
 All hospital data are de-identified and aggregated
 Individual hospital data is not made public
 SHARP also compiles hospital specific HAI reports
which are only shared with those individual hospitals
SIR
www.michigan.gov/hai
 Standardized Infection Ratio (SIR) is a ratio comparing the
number of observed infections to predicted infections. It
controls for variables such as bed size, location type, medical
affiliation, and procedure type (for SSIs only).
 The number of expected or predicted infections comes from
national baseline data.
Michigan CLABSI SIR Trends
Standardized Infection Ratio
(SIR)
1.2
1
SIR=Number of Observed Infections
Number of Expected Infections
0.8
0.6
0.4
0.2
0
2009–2010
Annual*
2010–2011
Annual*
*=Significantly different from 1
**=Significantly different from previous report
2012 Annual*
2013 Annual* 2014 Annual* **
Cumulative Attributable Difference
(CAD)
 TAP reports use the cumulative attributable difference
(CAD) to rank hospitals
 CAD is generally calculated based on a target or goal SIR
 Michigan reports use the HHS Target SIR
CAD = Observed – (Predicted * SIRtarget)
 Interpretation:
 CAD>0 = “more infections than predicted” OR “number of
infections needed to be prevented to reach the HHS target
SIR”
 CAD<0 = “fewer infections than predicted” OR “number of
infections prevented beyond the HHS target SIR”
Courtesy of Allie Murad
TAP Reports
Targeted Assessment Prevention
(TAP) reports gives hospitals a
way to target problem areas and
see where they rank within a
group
 The group is the SHARPparticipating Michigan
hospitals.
Courtesy of Allie Murad
Source: http://www.cdc.gov/nhsn/pdfs/training/2015/runningtapreports_md.pdf
Courtesy of Allie Murad
SHARP HAI Data
www.michigan.gov/hai
Inpatient CDI LabID Onset Distribution
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2013 Overall
Community-Onset
Community-Onset, Healthcare Facility-Associated
2014 Overall
Healthcare Facility-Onset
2014 Device-Associated SIRs
www.michigan.gov/hai
2014 LabID SIRs
www.michigan.gov/hai
CRE Surveillance and Prevention Initiative
Staphylococcus aureus
 SHARP also has started a prevention initiative aimed to
reduce the incidence and prevalence of MDROs in
healthcare facilities in Michigan:
 Carbapenem-Resistant Enterobacteriaceae (CRE)
surveillance and prevention initiative
Citrobacter freundii
Escherichia coli
Klebsiella pneumoniae
Enterobacter cloacae
CRE Surveillance and
Prevention Initiative
2011
• Awarded ELC
funding
• Hired CRE
Coordinator
•
•
•
•
•
•
Planning Stage
2013
2012
Met with 8
• Baseline
healthcare
surveillance
systems across
ends February
the state
28, 2013
Developed
• CRE
detection and
Prevention
infection
Plans
prevention
implemented
practices survey
March 1, 2013
Formed
Collaborative
group
Recruited 21
facilities
Surveillance
began September
1, 2012
CRE Educational
Conference Kickoff!
Baseline Stage
www.michigan.gov/hai
2014
2015
• Recruited 9
new facilities
and maintained
all current
facilities for
Phase 2
• Phase 1 ends
August 31, 2014
• Phase 2 begins
September 1,
2014 - all CRE
Prevention
Plans
implemented
• Surveillance
continues
• Prevention
continues
• Confirmatory
testing,
regional
incidence,
geography, and
interest will
drive
recruitment for
Phase 3 in early
2016…
Intervention Stage
CRE Incidence in MichiganPhase 1
 327 total cases – 284 inpatients
 Baseline (Sept 2012 – Feb 2013)
 102 cases (89 inpatients)
 957,220 patient-days
 0.93 cases per 10,000 p-d
 Intervention (March 2013 – August 2014)
 225 cases (195 inpatients)
 2,791,350 patient-days
 0.70 cases per 10,000 p-d
Successes the first 2 years
 Established a baseline incidence rate for CRE
 September 2012 – February 2013
 0.93 cases per 10,000 p-d
 CRE incidence rate decreased during intervention
period
 March 2013 – August 2014
 0.70 case per 10,000 p-d
 Statistically significant (p=0.03)
 Michigan prevented 86 infections of CRE
 26 infections of CRE prevented in LTACs
Past, Present, and Future
Phase 1
Phase 2
Phase 3
Time Period
September 2012
– August 2014
March 2014 –
February 2016
September 2015–
August 2017
# Acute Care Facilities
17
24
# Long-Term Acute Care
Facilities
4
6
# CRE Prevention Plans
34
43
Baseline Incidence Rate
0.93
0.94
Post-Intervention
Incidence Rate
0.70
0.73
# Infections Prevented
86
(26 in LTACs)
* 80
(10 in LTACs)
Education and Consulting
www.michigan.gov/hai
 Another primary focus of the SHARP unit is increasing
awareness of HAIs, answering FAQs, and disseminating
best-practice and evidence-based recommendations and
guidelines
 Examples of entities/persons that ask for our guidance:
 IPs
 Gyms
 Local
 Correctional
HDs
 Healthcare workers
 Schools
Facilities
 Students
 Public
Special Collaboration
www.michigan.gov/hai
 SHARP collaborates with the MDHHS Viral Hepatitis
Unit:
 Investigating potentially healthcare-related viral
hepatitis infections (e.g. David Kwiatkowski)
 Works jointly on injection safety-related educational
campaigns (e.g. One and Only campaign)
 Contact information
 (517)335-8165
 www.michigan.gov/hepatitis
SHARP Unit Contacts
(517) 335-8165
www.michigan.gov/hai
MDHHS-SHARP@michigan.gov
www.michigan.gov/hai
o Jennie Finks, DVM, MVPH – HAI Coordinator and Unit Manager
finksj@michigan.gov
o Mike Balke, MPH- CSTE HAI fellow
balkem@michigan.gov
o Jennifer Beggs, MPH – Infectious Disease and Preparedness
Epidemiologist
beggsj@michigan.gov
o Brenda Brennan, MSPH – CRE Prevention Initiative Coordinator
brennanb@michigan.gov
o Allison Murad, MPH – National Healthcare Safety Network (NHSN)
Epidemiologist
murada@michigan.gov
o Noreen Mollon, MS CIC – Infection Prevention Consultant
mollonn@michigan.gov
Other MDHHS Entities that Interact with IPs
 Bureau of Labs (BOL)
 Office of Public Health Preparedness (OPHP)
 Licensing and Regulatory Affairs (LARA)
 Michigan Occupational Safety and Health
Administration (MIOSHA)
 Healthcare Facility Engineering
 Michigan Care Improvement Registry (MCIR)
MDHHS Bureau of Labs (BOL)
 Main Phone: (517) 335-8063
 Tours available quarterly, to
schedule call (517) 335-9654
MDHHS BOL Testing
www.michigan.gov/mdhhslab
List of Tests performed
By MDHHS BOL
Forms required to
Request testing
Regional Reference Labs
 Report Suspected Bioterrorism:
 Lansing: (517) 335-8063
 Kalamazoo: (269) 373-5360
 Grand Rapids: (616) 632-7210
 Saginaw: (989) 758-3825
 Oakland County: (248) 858-1310
Bureau of EMS, Trauma &
Preparedness
 Formerly OPHP, BTEP combines the OPHP with EMS
and Trauma. This bureau will better serve the citizens
through administration and continuous improvement
of emergency medical services, trauma system as well
as all-hazards preparedness planning and response
 Division of Emergency Preparedness and Response
(DEPR)
 Division of EMS and Trauma
Michigan Emergency Management
System
President of US
Governor
www.fema.gov/nims
Michigan State Police
State Director of Emergency Management
DHS / FEMA
All emergencies and
disasters are local
Emergency Management
Division (EMD)
MDHHS
EMD District
Coordinators
Health Preparedness
Regions
Local Emergency
Management
Local Health
Departments
Emergency Preparedness
Collaboration
Industry /
Private Sector
Public
Works
Transportation
Law
Enforcement
Hospitals
EMS
Utilities
Emergency
Management
Public
Health
Fire &
Rescue
www.fema.gov/nims
Emergency Preparedness Training
MI-TRAIN (http://mi.train.org)
Emergency Preparedness
Communication
 Statewide communication capabilities:
 Michigan Statewide Comprehensive Interoperable
Communication Plan
 Public Health Safety Communication System
(800Mhz radios)
 Health Alert Network (HAN)
MI HAN
(https://michiganhan.org)
Emergency Preparedness Regions
 8 Michigan Emergency
Preparedness Regions:
 Modeled after State Police
Regions
 Encompass 45 Local HD
Emergency Preparedness
Centers
 Each Region contains:



Medical Director
Hospital Bioterrorism
Coordinator
Epidemiologist
Strategic National Stockpile
 Able to distribute large quantities of pharmaceuticals
and medical supplies during an emergency
 Local HDs and hospitals are prepared to receive
MISNS assets
 MISNS is capable of delivering assets via ground or air
transport
BTEP Contacts
 Linda Scott – Division of Emergency Hospital
Preparedness Coordinator
 (517) 335-8150
 scottl12@michigan.gov
 Mary Macqueen – Public Health Preparedness
Coordinator
 (517) 335-8150
 macqueenm@michigan.gov
MIOSHA – Michigan Occupational
Safety and Health Administration
 MIOSHA operates under Licensing and Regulatory
Affairs (LARA)
 For healthcare inquiries contact MSIPC’s MIOSHA
liaison Eric Zaban:
 (517) 882-1022
 For general consultation and/or training contact:
 (517) 322-1809
 www.michigan.gov/miosha
LARA- Health Facilities Engineering
 Provide enforcement and interpretation of the
minimum healthcare facility design standards to reduce
the risk of transmission
 Kasra Zarbinian
 (517) 241-3422
 www.michigan.gov/hfes
Michigan Care Improvement
Registry (MCIR) www.mcir.org
 Web-based system created in 1998
to collect children’s immunization
information
 Expanded in 2006 to include adults (lifespan registry)
 Consolidates immunization information from multiple
data sources and provides immediate, real-time, patient
immunization history
 Assists with all-hazard preparedness by tracking
vaccines and medications during a public health
emergency
MCIR Activity
 9 million records
 Over 83 million shot records
 29,000 registered users
 5,500 active provider sites
The Benefits of MCIR
 High healthcare provider participation (90%)
 Reports indicate ‘pockets of need’
 Flexibility, allowing linkages with other public health
systems
 Types of information available in MCIR:
 Patient Immunization status at time of visit
 Reminders/recall letters
 Coverage level reports
 High risk influenza
 Newborn screening
 Lead results
 Early hearing detection and intervention (EHDI)
Immunization Information
 Annual Fall Conferences – www.michigan.gov/immunize
 AIM Kits – www.aimtoolkit.org
 Influenza information “FluBytes”– www.michigan.gov/flu
 Quarterly Newsletters – send an e-mail with SUBSCRIBE in
the subject line to franklinr@michigan.gov
 Beatrice Salada, State MCIR Coordinator
 saladab@michigan.gov
 www.mcir.org
Thanks!
 Questions or comments?
 Joyce Lai
 (734) 727-7204
 LaiJ@michigan.gov
 Noreen Mollon
 (517) 335-6582
 MollonN@michigan.gov