CAIR - California Immunization Coalition

California Immunization Registry
(CAIR) Update
Steve Nickell, PhD
Chief, Registry and Assessment Section
CA Immunization Branch
California Immunization Coalition Meeting, April
2015
California Departm ent of P ublic Health
The California Immunization Registry
(CAIR) System
• Imperial County has agreed to
join CAIR !!
• CAIR now a consortium of all
10 regional registries in CA –
no current data linkage
• 7 of 10 use same ‘CAIR’
software (87% of population)
• The ‘CAIR 7’ registries are
hosted at UCB and managed
by IZB staff
CAIR
Imperial
California Departm ent of P ublic Health
CAIR – Current Numbers*
Measure
0-5 yrs
6-18 yrs
19+ yrs
All Ages
CA Population
2,992,123
6,589,563
29,671,633
39,253,319
Patients In
3,005,249
6,782,336
11,119,366
20,906,951
% of Pop. In
100.4%
102.9%
37.5%
53.3%
Patients w/ >2
doses
1,897,984
4,856,627
4,503,889
11,258,500
% w/ >2 doses
66.9%
75.9%
16.9%
30.6%
1 year Change
+9.3%
+7.1%
+4.6%
+5.2%
Vaccine Doses
31,711,807 105,832,645 49,926,831
187,471,283
* As of March 31, 2014. All regions.
California Departm ent of P ublic Health
CAIR – New Online Tools
• CAIR Online Enrollment - http://enroll.cairweb.org
• CAIR Account Update – http://accountupdate.cairweb.org
• Allows existing accounts to update Site info, add or remove
Users, or change User status
• CAIR User Training Management
• Management of webinar and ‘live’ training activities
including automated distribution of passwords post-training
• CAIR IZ Portal (DE only) – https://igs.cdph.ca.gov/cair
• All will be retained in CAIR 2.0
California Departm ent of P ublic Health
‘CAIR 7’ – Technical/Provider Support
(Richmond)
Technical
Michael Powell
CAIR Manager
IZB Technical Lead
Staff
Newton Sambajon
Database Admin
Ayumi Taniguchi
Data Operations
Jag Talluri
Programmer
Cheryl Scott
Quality Assurance
Megan Mojica
Web Dev
Jason Narine
Web Dev/DE
Eric Dansby
Data Exchange
Arlisha Adams
Data Exchange
Staff
Role
Provider Support
Cecilia Sandoval
Provider Support/Help Desk
Supervisor
Role
Danielle Sullivan
Amy Adams
Pong Vilaisouk
TBN
Phone and email
provider support
California Departm ent of P ublic Health
‘CAIR 7’ – Local CAIR Reps (LCRs)
VFC /CAIR Old Names
Senior Field Reps
NorCal (INNC, SFT)
Cindy Klaisle
Bay Area (BARR)
Steve Vantine
Cent. Valley (CVIIS, CCIR)
Souk Mouanoutoua
Local CAIR Reps
Jennifer Toten
Marcia Santillan
Jeanette Chapman
Giselle Garcia
Monica Hernandez
Iris Cheever
LA (LINK minus Orange)
Laurel Fowler
Monique Harris
Janet Ajao
SoCal
(IE, Orange)
Colleen Mallen
Heather Murphy
Twila Crook
California Departm ent of P ublic Health
‘CAIR 7’ – LCR Trainings During Past
Year
Type
# Trainings
# Trained
Power
(Inventory)
174
666
Regular
444
3,558
TOTAL
618
3,865
California Departm ent of P ublic Health
‘CAIR 7’ – Data Exchange Specialists
DES
CAIR Regions
NorCal (INNC)
Arlisha Adams
Gr. Sacramento (SFT)
Bay Area (BARR)
Central Coast (CCIR)
Eric Dansby
Central Valley (CVIIS)
LA-Orange (LINK)
Inland Empire (VAX)
California Departm ent of P ublic Health
‘CAIR 7’ - Definitions
• ‘Data exchange’ (DE) - the submission to or receipt from
CAIR of immunization data electronically.
• ‘Flat file’ - a simple, delimited text file with data elements
arranged in a particular order. The current CAIR 1.0
software is only capable of receiving electronic data in
‘flat file’ format.
• ‘HL7’ - stands for ‘Health Level 7’, a structured electronic
data format that has become the national standard. CAIR
1.0 is able to accept HL7 formatted data via an installed
HL7 translator that converts the incoming HL7 message
into CAIR’s required ‘flat file’ format.
California Departm ent of P ublic Health
‘CAIR 7’ - Definitions
• ‘Meaningful use’ (MU) – multi-year $46B federal EHR
Incentive Program that incentivizes the adoption and
'meaningful use' of electronic health records (EHR)
systems. One of the key MU measures is electronic
submission of immunization data in HL7 format to an
immunization registry.
The MU Program has 3 Stages, each with increasing requirements:
MU Stage
Immunization reporting measure
Stage 1
Submission of a single HL7 message
Stage 2
‘Ongoing data submission’
Stage 3
Ability to request and receive IZ info from IIS in realtime
(2017, proposed)
California Departm ent of P ublic Health
‘CAIR 7’ - Definitions
• ‘Testing’ - period during which provider site submits ‘test’
HL7 messages to CAIR and these are monitored for proper
formatting and adherence to CA HL7 specifications. Both
dummy data followed by real patient data are monitored.
Once 50 -100 ‘no error’ messages are received, the Site is
upgraded to ‘production’.
• ‘Production’ – HL7 data submitted by provider site is now
being queued for import into one of the CAIR 7 registries.
Note: Doses will not be immediately accessible in CAIR translation/batching/off-hours import is required.
California Departm ent of P ublic Health
‘CAIR 7’ IZ Portal
• Why Needed?
– Limited staff to manage ‘onboarding’
– Huge potential volume of electronic data submitters (MU)
– MU Stage 2 req. to register and communicate with data submitters
• Developed for IZB by STC (contractor) through Cal-eConnect/
CHeQ through cooperative agreement with CHHS using
ONC/MU funds
• Portal features:
– Registration, including automated credentialing via email
– Message testing and validation, including automated diagnostic
emails for each test message received by CAIR
– ‘Onboarding’, via Portal Admin
• Launched August 2013
California Departm ent of P ublic Health
‘CAIR 7’ IZ Portal - Status*
Site Type
Total
Sites
Data Submission Status^
# Testing
#
‘Production’
1. Direct submission
1,208
1,116
92
2. Submits via DA&
3,748
791
2,957
1,920
3,049
97
99
Total Submitter Sites 4,956
3. Data Aggregator (DA)&
197
TOTAL Registrants 5,153
& Entity
that submits data on behalf of other Sites
* As of 4/21/2015
California Departm ent of P ublic Health
8/19-25
9/2-8
9/9-15
9/23-29
* As of 4/7/2015
3/30-4/5
3/23-29
3/16- 22
3/9-15
3/2- 8
2/23-3/1
2/16-22
2/9-15
2/2-8
1/26-2/1
1/19-25
1/12-18
1/5-11
12/29-1/4
12/22-28
12/15-21
12/8-14
12/1-7
11/24-30
11/17-23
11/10-16
11/3-9
10/27-11/2
10/20-26
10/13-19
10/6-12
9/29-10/5
9/22-28
9/15-21
9/8-14
9/1-7
8/25-8/31
8/18-24
8/11-17
8/4-10
7/28-8/3
7/21-27
7/14-20
7/7-13
6/30-7/6
6/23-29
6/16-22
6/9-15
6/2-8
5/26-6/1
300,000
5/19-25
5/12-18
5/5-11
4/28-5/4
4/21-27
4/14-20
4/7-13
3/31-4/6
3/24-30
3/17-23
3/10-16
3/3-9
2/24-3/2
2/17-23
2/10-16
2/3-9
1/27-2/2
1/20-26
1/13-19
1/6-12
12/30-1/5
12/23-29
12/16-22
12/9-15
12/2-8
11/25-12/1
11/18-24
11/11-17
11/4-10
10/28-11/3
10/21-27
10/14-20
10/7-13
9/30-10/6
500,000
9/16-22
600,000
• >13.3M
thus far
Weekly Messages
• >1M/month
Sites in
'production'
• ~50%
Kaiser
3000
400,000
2500
Kaiser
2000
Sutter
1500
100,000
Sites in 'production'
0
8/12-18
200,000
8/26-9/1
Messages/Wk
‘CAIR 7’ IZ Portal – Messages by Week
4000
3500
1000
500
0
Wk
California Departm ent of P ublic Health
‘CAIR 7’ IZ Portal – MU Attestation
MU Stage
MU Req.
Attestation
Stage 1
‘Single test
message’
Any automated email from Portal
confirming message status
Stage 2
‘Ongoing data
submission’
Email confirming ‘ongoing
submission’ sent to:
Any Site submitting a ‘production’
message (HL7 RXA-11 field = CAIR ID)
or
Any Site using an integrated or cloudbased EHR system when their
Sending Facility/HIE sends a
‘production’ message
California Departm ent of P ublic Health
CAIR – Majority of New Doses Now DE
100%
% of New Doses
80%
60%
40%
% HL7 DE Doses *
% 'Flat file' DE Doses
54.7%
% 'User Interface' Doses
20%
0%
* All except CAIR SJ
Quarter
California Departm ent of P ublic Health
CA IIS History
Counties
1990s
10 ‘Regions’
State IIS
2000s
1 ‘CAIR’
2010s
County G
County A
County C
County H
County F
County B
County D
CAIR
CAIR
County E
County I
California Departm ent of P ublic Health
CAIR 2.0 Project
• Goals
– Merge ‘CAIR 7’ regional data into a single state IIS ‘hub’
– Replace current legacy software with new SW
(Wisconsin Immunization Registry (WIR), used in 17
other states, including NY and TX)) that is state-IT
compliant and supports the ‘meaningful use’ EHR
Incentive Program (HL7)
– Connect to 3 ‘independent’ registries to allow patient
search and record retrieval (HL7)
California Departm ent of P ublic Health
CAIR 2.0 – Funding Formula
Funding
Source
Assumption
Formula
% of
Project
Costs
State GF
70% Medicaid eligible kids in
CAIR
10% x 70%
7%
CMS
70% Medicaid eligible kids in
CAIR
90% x 70%
63%
30%
30%
(10% match)
(90% match)
IZ Grant
(remaining costs)
30% of kids not Medicaid
eligible
100%
California Departm ent of P ublic Health
CAIR 2.0 - Progress
• New CDPH ITSD Project Lead, very efficient/
organized
• Meeting with HP to map out necessary changes
to WIR/Alert (e.g. add BC and YC, adding VFC
Compliance reports, Tb module, etc.)
• Data migration discussions w/ HP have begun
• Training/Communication planning in progress
California Departm ent of P ublic Health
CAIR 2.0 – Challenges
• General
– Approval Delays
• Project: FSR
• Procurement: RFP, RFO, IFB???
– Project Leadership Changes
• Previous ITSD Project Lead Deb Wong retired
abruptly and Liz Gaffney stepped in to replace
California Departm ent of P ublic Health
CAIR 2.0 – Challenges
• Hardware/licensing/infrastructure
– CDPH ITSD failed to provide the proper hardware/
hosting environment when HP needed to begin CAIR
2.0 SW customization per contract schedule
(Mar-Apr 2015)
– HP is hosting development phase offsite (out of scope)
– HP has had rearrange schedule/tasks to accommodate
longer project schedule and delayed hardware
deployment
– Timeline has slipped 6-7 months
California Departm ent of P ublic Health
CAIR 2.0 - Progress
• Supplementary funding docs submitted or
nearly submitted:
Document Function
Submitted Approval
IAPDU
Additional 90/10 match funding for
hardware and Oracle licenses, HP
scope; additional IZB $$$ and state
GF match already in place
Yes
CMS
(60 days)
SPR
Required State IT Project update
Being
finalized
CA Tech
(??)
In process
Leg (??)
Section 11 Legislative review if State Project
increases cost by >20%
California Departm ent of P ublic Health
CAIR 2.0 – 3 Training Phases
CAIR 2.0 Implementation/Training
Phases (Clinical)
# of
Orgs/Sites
# of Users
1. NorCal, Gr. Sac, Central Coast, IE
576
5,324
2. Bay, Central Valley
753
7,339
3. LA-Orange
865
7,586
2,195
20,249
TOTALS
California Departm ent of P ublic Health
CAIR 2.0 - Timeline
2015
Task
2016
2017
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Hardware/Software
Delivered
Built
Application
Requirements
Development
QA Testing
UAT
Data Migration
Planning/Script Development
Testing Validation
Production Data Migration
Training
Material Development
Implementation
Train the Trainer
Support
Phase 1 (NC,GS, CC, IE)
Phase 2 (BA, CV)
Phase 3 (LAO)
California Departm ent of P ublic Health
CAIR 2.0 – Data Sharing w/ 3 Ind
• CAIR staff and CDC IIS Project Director visited
three ‘independent’ registries (CAIR SJ, CAIR SD,
and CAIR Imperial) to discuss CAIR 2.0 Project and
future options for ‘independent’ registries
• All 3 are interested in sharing data with CAIR
‘hub’
• Plan is for CAIR ‘hub’ to receive updates in semi
real-time
California Departm ent of P ublic Health
CAIR 2.0 – Data Sharing
Stage 3
query/response
CAIR
San Joaquin
CAIR
San Diego
CAIR
‘hub’
CAIR
Imperial
California Departm ent of P ublic Health
CAIR 2.0 – Improved Performance
w/ Datamart
California Departm ent of P ublic Health
Questions?
• Steve.Nickell@cdph.ca.gov
California Departm ent of P ublic Health