Immunization Registries Bring Tremendous Value After Natural Disaster

The Louisiana Health Care Quality Forum (LHCQF) is a private, not-for-profit organization dedicated to reshaping the quality, safety, and value of healthcare for Louisiana state residents. LHCQF was created in response to recommendations made by the Louisiana Health Care Redesign Collaborative in 2006, and was tasked with addressing health care issues in the state following Hurricanes Katrina and Rita. More recently, LHCQF received funding from the Office of the National Coordinator for Health Information Technology (ONC) to serve as both the Louisiana Regional Extension Center (REC), called the Louisiana Health Information Technology (LHIT) Resource Center , and as the State Designated Entity to build and support Health Information Exchange (HIE) in Louisiana, a program LHCQF has named the Louisiana Health Information Exchange (LaHIE) . According to LHCQF, supporting the meaningful use of electronic health records (EHRs) and facilitating statewide HIE are keys to achieving the goals of better health outcomes and creating efficiencies in the delivery of care.

The Office of Public Health (OPH) within the Louisiana Department of Health and Hospitals is committed to enhancing the quality of life in Louisiana by capitalizing on the diversity of the state’s population, promoting health through education, and providing essential preventative health care services for all residents. As an essential step to achieving these goals, in 2000, OPH received federal funds from the Centers from Disease Control and Prevention (CDC) to establish a childhood immunization registry. This registry, the Louisiana Immunization Network for Kids Statewide (LINKS), quickly became a universal registry in the State. In addition, any age restriction was removed before implementation of LINKS, and it has always served as a statewide immunization registry including immunization information for both children and adults. Additionally, the Louisiana Early Event Detection System (LEEDS) – the state’s syndromic surveillance system – and their electronic lab reporting (ELR) system, are both housed within OPH. LHCQF works extensively with OPH to ensure providers in Louisiana are able to successfully meet public health meaningful use requirements.

LINKS allows providers to use a web-based portal for easy input and transmission of immunization data into the immunization registries. From the beginning, LINKS had the foresight to allow for expansion of the registry to include all Louisiana residents regardless of age. In 2005, during the aftermath of Hurricanes Katrina and Rita, the immunization information system remained online via a backup system thereby making immunization historical data available to queries from healthcare providers caring for displaced persons both within Louisiana and throughout United States. This effort proved to be incredibly valuable and saved patients/families and immunization providers’ time, money and the inconvenience of having to unnecessarily revaccinate displaced patients.

In the years following the hurricanes, the registry continued to see successes as OPH developed additional modules for LINKS to capture vaccine inventories, electronic vaccine ordering, immunization information from school nurses, and “mass events,” such as H1N1 initiative which brought about participation of non-traditional providers such as Pharmacist, OB-GYN, Pulmonologist, Immunologist, etc.

Due to these successful initiatives, as well as extensive outreach efforts by OPH, LINKS has consistently enjoyed a high provider participation rate. With the passage of the HITECH Act, Louisiana found itself in an excellent position to ensure that providers were able to meet the public health meaningful use requirements.

“The transition from the beginning of the project to the present has been phenomenal. We have seen many successes.” –OPH

LHCQF’s goal is for LaHIE to be able to accept and transmit immunization, syndromic surveillance, and ELR data to LINKS, LEEDS, and the OPH ELR systems, respectively, by June 30, 2012. Although LaHIE will be able to accept and transmit data for all three of the public health meaningful use measures, emphasis has been placed on immunization reporting for a number of reasons.

• First, LHCQF and OPH recognize the importance of capitalizing on existing participation in the LINKS registry
• Second, because Louisiana’s LEEDS system currently only accepts syndromic surveillance data from hospitals, and because eligible providers cannot select the ELR option, providers in the state have been selecting the immunization reporting option.

As providers are adopting EHRs, OPH and the LHIT Resource Center are assisting them in engaging their EHR vendors to create direct interfaces between LINKS and their EHR products. Providers that have established these interfaces can use their EHRs to submit data to LINKS, however, the web-based portal is still available for use during this transition period. Additionally, LaHIE, has worked with OPH to create a hub that allows LINKS to interface with the statewide HIE. This gives providers two options for transmitting immunization data to LINKS and meeting the public health meaningful use requirements:

• They can transmit the immunization data point-to-point from their EHR directly to LINKS
• They can transmit immunization data from their EHR to LINKS through LaHIE.

Although still early in the process, LHCQF and OPH anticipate many providers who already participate in LINKS, such as pediatricians, will opt to utilize the point-to-point option to transmit data from their EHR directly to LINKS, while many new participants, such as adult internists and specialists, will opt to transmit information through LaHIE.

Additionally, LINKS already has functionality to transmit bi-directional messages (as long as a provider’s EHR is capable) and LHCQF is currently working to create this functionally through LaHIE. Once this functionality is readily available, LaHIE, the LHIT Resource Center, and OPH will work together to ensure providers are able to submit and query information as needed.

“Whether providers choose the point-to-point option, or to go through LaHIE, at this time our priority is to ensure that they are able to report immunization information.” –LHCQF

Education: Educating providers and vendors about the necessary specifications EHRs must have to submit to the immunization registries, as well as providers’ options for meeting the public health meaningful use requirements. The LHIT Resource Center has worked with OPH to create onboarding manuals for immunization reporting, syndromic surveillance, and ELR reporting. These manuals provide a systematic guide on the specifications and functionalities EHR must have. OPH and the LHIT Resource Center have also worked directly with the vendor community to educate them about these issues.

Awareness: Many providers in the state are still unaware that LINKS accepts adult immunization information, and consequently wrongly assume they can claim an exception for the public health meaningful use measure. LHIT has been working to correct this misunderstanding by educating the provider community about the capabilities of LINKS.

Coordination: One of Louisiana’s greatest strengths is that all stakeholders (LHIT Resource Center, LaHIE, OPH, as well as the state Medicaid agency) are coordinated in their education efforts. Louisiana’s Health IT Coordinator holds weekly meetings with LHCQF that include both the LHIT Resource Center and LaHIE, and biweekly meetings with the Assistant Secretary of Public Health within OPH. Additionally, LHCQF, OPH, and the Health IT Coordinator all communicate though informal means as needed to stay apprised of each other’s work. This coordination ensures all stakeholders are giving a unified message to providers and vendors, enabling providers to successfully meet the meaningful use public health requirements.

“There are no challenges that OPH can’t overcome, however the challenges of educating providers and vendors of the requirements of the registry are at the forefront. LHIT has been integral in these education efforts.” –OPH