Health Issues - Vaccine- Preventable Diseases
IHS Initiative: Influenza Vaccination of Health Care Personnel (HCP)
The Department of Health and Human Services (HHS) launched an initiative to improve influenza vaccination rates among Health Care Personnel (HCP) with the goal of reaching the Healthy People 2010 objective of a 60 percent influenza vaccination rate among HCP. In 2006, influenza vaccination rates were 42% for HCP. As part of this initiative, HHS asked all HHS agencies, including IHS, develop a plan to promote vaccination of HCP with influenza vaccine, and collect and report data on HCP vaccination coverage to HHS.
In response to the HHS initiative to promote influenza vaccination of HCP, IHS developed a plan to report on influenza vaccine coverage for their HCP. Guidance documents and tracking and reporting forms were developed and can be accessed from the IHS website. In addition, IHS has developed three PowerPoint presentations about influenza vaccination to help educate staff. These presentations can be modified and used by facilities to assist with this initiative. Each IHS Area has designated an Area Influenza Coordinator who worked with facilities to collect reports on HCP influenza vaccination coverage. Facility reports were aggregated into an Area report and submitted to the IHS Division of Epidemiology and Disease Prevention's Immunization Program. The Area reports will be used to develop a national IHS report to send to HHS as part of this initiative. The final report will also be posted on the IHS website.
Medical record scattering is a common problem and can affect patient care. For immunizations, incomplete information can lead to over or under immunization and wasted resources. CDC has supported the development of state immunization registries, referred to as immunization information systems (IIS), to address these issues. Immunization data stored in the IHS RPMS, however, are usually not included in state immunization information systems (SIIS) as it may not be feasible for sites to enter the immunizations they provide into two systems (the RPMS and the state IIS).
The IHS Immunization Data Exchange initiative has resulted in the development of software that extracts immunization data from the RPMS system and sends it to SIIS using standard Health Level Seven (HL7) messages in accordance with CDC's HL7 standards for immunization, published in the Implementation Guide for Immunization Messaging. In response to the data sent from the RPMS, SIIS can create a file of immunizations missing in the RPMS data and sends that back to the facility. This information can then be downloaded into the RPMS, alleviating the need for staff to enter the information into the RPMS, and ensuring that a patient's complete immunization history is available to the provider.
The software was released nationally in August 2005, and is currently used in many states, in 11 Indian Health Service Areas, with plans to expand to additional sites and states.
How it works
RPMS sites can send immunization messages to state immunization information systems (SIIS) using the RPMS Immunization Package (BI) and the RPMS Immunization Interface Management software (BYIM).
The RPMS database has all the basic data - patient info, immunization info, etc. Within RPMS there is also a package called GIS - Generic Interface System. GIS has all the tools that take the required data from RPMS, puts the data into HL7 (Health Level 7) messages. Once the HL7 messages are correct, GIS takes batches of the HL7 messages and places them into basic 'Notepad' type, flat files in the specified directory/folder.
After these files are placed in the directory, the Simple Message Mover (SMM) transport software takes over. SMM is a secure transport mechanism which takes the file and moves it from one secure environment - the environment which hosts the RPMS database - and sends the file via secured transfer to another secure environment - the IIS).
The SMM does have limited capability to customize some of the information within the HL7 message as part of the transfer process. Many states have very specific requirements and because RPMS can interface in up to 34 states, it is not possible for the IHS Interface software to meet the needs of each state.
Therefore, the IHS has partnered with the American Immunization Registry Association's Interoperability Testing Project to create adaptors for RPMS sites in each state. AIRA sends RPMS test messages to each state participating in the testing project and uses the state feedback to create a profile, or adaptor, that RPMS sites can apply when they configure SMM. By using SMM, RPMS sites can not only connect to various IIS, but they can also successfully message in HL7, even when variations to the CDC HL7 specification exist.
States that IHS, Tribal and Urban RPMS sites can connect with using the Simple Message Mover:
This initiative will improve patient care by allowing any IHS, Tribal or Urban provider who uses RPMS to have access to a child's complete immunization history, thereby ensuring appropriate immunization. For more information about this initiative and how it is working in your state, contact your Area Interface Team [PDF - 225 KB].
For any issues with your current interface, please submit a ticket to the help desk.
National Immunization Reporting System (NIRS)
NIRS is a web-based reporting tool used to collect quarterly immunization data from IHS/Tribal/Urban facilities nationwide. NIRS was developed in partnership with the IHS Public Health Nursing Program to improve the quality and timeliness of immunization data. Please see our policies/resources page for a PowerPoint presentation and a WebEx recording of a NIRS training. We plan to enhance the NIRS reports in 2009 to include options for users to develop trend graphs for their facility and Area. Until then, we have included two templates to help graph immunization data. The graphs were developed with help from the Portland Area Immunization Program.
For more information on NIRS please contact Cheyenne Jim or Amy Groom