Gus Birkhead, M.D., M.P.H. Deputy Commissioner, Office of Public Health

1. Incorporation of Registries in Electronic Health Records(and vice versa)ASTHO Immunization Registry Summit Wednesday, August 4, 2010Crystal City, VA Gus Birkhead, M.D., M.P.H. Deputy Commissioner, Office of Public Health New York State Department of Health

2. NYS IIS History New York State (outside of New York City) Voluntary participation since 1994. Regional registry model Legacy system required installation of software and updates on each office computer. Individual consent required. New York City has mandatory registry (NYCIR) since 1997.

3. NYS Public Health Law 2168 Effective January 1, 2008, Mandatory reporting by health care providers of immunizations given to persons age <19 years. Consent not required Past immunization history must be reported if not previously reported. With written consent, immunizations given to persons 19 years and older can be reported. Vital records birth certificate information, including immunizations administered at birth, “seed” the NYSIIS. Allows NYSIIS – NYCIR data exchange

4. NYIIS Implementation As of May 1, 2010: 3.1 million patients 36.4 million immunizations 9,200+ individual users 3,100+ health care provider practices 1,500+ schools Coverage: 78.7% of NYS children (outside of NYC) age <6 years have >2 shots in NYSIIS

5. NYSIIS Implementation and EHRs NYSIIS accepts standard HL-7 messages via batch load from EHRs Certified 56 vendors serving 664 practices, plus 141 practices using in house systems. 10 million of the 17 million annual transactions. An additional 18 vendors are in process of certification Exchanging with 8 managed care plans for HEDIS Barriers: Not bi-directional or real time. Not automated. Vendor by vendor/practice by practice set up. Not all practices served by certified vendors have current EMR software or are willing to pay for NYSIIS service. New version of HL7 2.5.1 requires upgrading NYSIIS and vendor software.

6. Link NYSIIS to the New State HIE Infrastructure $1 billion public and private investment in the Statewide Health Information Network for New York, or SHIN-NY; Testing the Universal Public Health Node (UPHN), a system designed facilitate bi-directional data between State DOH and local health information exchanges across the state for public health functions; Replace batch uploads to NYSIIS from EMRs.

7. STATEWIDE HEALTH INFORMATION NETWORK FOR NEW YORK – (SHIN-NY)

8. STATEWIDE HEALTH INFORMATION NETWORK FOR NEW YORK – (SHIN-NY)

9. Child Health Information Integration Project – CHI2 Integrate child health data held by state health department, to benefit providers, PH programs and children. Initially use NYSIIS as a base Lead laboratory results Newborn hearing screening results Develop an integrated system built on the statewide information infrastructure: Newborn Metabolic Screening Program Early Intervention (0-3 yrs) – 75,000/year WIC (pregnant women and kids age 0-5) – SPARCS Hospital discharge incl. ED visits eMedNY Medicaid billing system

10. CHI2 Vision Physician with patient Immunizations Lead Newborn screening WIC services Pharmacy history Early intervention program services Pharmacy utilization Etc. PH Program Manager Follow up kids with conditions of public health interest (lead) Quality monitoring Monitor population health PH Administrator Program monitoring and administration Reimbursement • PH Researcher • Conduct studiesto create generalizable knowledge • Parents/families • Assurance of complete medical history • Maximize care • Minimize unnecessary or dangerous care

11. Child Health Information Initiative (CHI2)Overview of Integration Components Available Data Sources Original Source Applications (NYSIIS, SPDS, etc.) NYSDOH Systems Environment DOH Vital Records (SPDS) Other External Partners (OTDA, OCFS, etc.) CHI2 Environment (Hardware & software: TBD) DOH Immunization Registry (NYSIIS) DOH Researchers Providers Source Data Access layer CHI2 Data Access Layer DOH Childhood Lead Registry Linkages to Map Child Source Records CHI2-Enhanced Source Applications Statewide Health Information Network for New York (SHIN-NY) …Other DOH Child Health Information Systems New CHI2-Specific Applications

12. Principles for CHI2 Development Maximize the use of the existing information infrastructure Develop a standard infrastructure that promotes everyday use, access and data sharing Improve bidirectional communication Employ standards to assure a seamless flow of information

13. Approaches to Support IIS Development and Integration ARRA: Funds used to accelerate work on a universal public health node to connect internal and external systems together Health Care Reform - Meaningful use criteria, guidance and funding to support enhanced ability for clinical data to be reported, aggregated and analyzed for public health purposes. Statewide IT policy planning

14. Public Health, HIE and EHRs – Factors to Consider Broader thinking by Public Health about the potential for new uses of data; Overcome barriers of silo funding/thinking; Funding to support system upgrades is critical; for example funding is needed to upgrade to HL 7 2.5.1 New system must be developed with interoperability in mind. Public Health will need to operate dual systems (current and new HIE-based systems) until HIE-based systems are validated and all providers have access.

15. Recommendations for Federal Agencies to Support Public Health HIE • Actively engage public health to assure that HIT goals and standards can be achieved and are useful for public health program purposes. • Develop national standards for HIE that have been widely vetted in the PH community. • Assure data from HIE are valid, accurate and timely. Resources will be needed to assure this validation. • Assure that federal funding for categorical public health programs is flexible enough allow cross-program collaboration such as New York is undertaking in its CHI2 initiative.