How analytics sharpens state disease surveillance, lower costs

In the early 1990s, state public health agencies and several major cities began planning and developing large databases of immunization records to help health care providers track vaccines administered to children. With these databases, providers were able to access consolidated records of patients to make sure they were current with vaccinations they needed.

Today, these agencies are increasingly turning to more advanced analytics to better leverage the millions of records they’ve collected in these immunization registries − or immunization information systems (IIS).

With these advanced features, public health officials are gaining greater insight into public health care trends that could improve patient outcomes and lower costs. Analytics, for example can help health care agencies spot areas with lower up-to-date vaccination rates or enable providers to better manage vaccine inventories in real time.

National attention on analytics has emerged only in the last three years or so even though many immunization registries have been around for a decade plus, said Gary Wheeler, Hewlett-Packard’s immunization services portfolio executive. That’s because the initial focus was on building systems with good, quality data sets − and that was critical. “Because if you do analytics on inaccurate data, you’re not going to get the outcomes that you want,” he said.

Improving population health

In the late 1990s, HP helped Wisconsin develop the underlying technology for its immunization registry. This system has since been shared with 19 other states, including Oregon, which migrated over in 2010 from its then 14-year-old homegrown system.

Oregon’s system contains about 48 million records covering about 5.3 million patients (including those of former state residents), according to Mary Beth Kurilo, director of the Oregon ALERT IIS, which is part of the state’s Public Health Division.

Authorized providers in Oregon have Web-based access to immunization records of nearly 100 percent of babies, adolescents and teenagers up to 18 years old and currently about 70 percent of the adult population. These records include patients with private insurance, Medicaid and Medicare.

The ALERT IIS runs on an Oracle platform with transactional and data mart databases supported by HP, Kurilo said. Analytics is performed on the data mart, which is a replicated data set.

From the start, Oregon had analysts to research and spot trends through the registry. These days, analysts have more tools at their fingertips. Kurilo said they use Oracle PL/SQL to extract data from backend tables and analyze it through various analytic tools − including SAS, IBM SPSS and others − to run ad hoc and canned reports.

For example, health officials can assess the impact of new vaccines coming to market or the effect of drug shortages. Analytics can also help drug suppliers keep track of vaccine stocks and better estimate their future needs, particularly for influenza. And local clinics can use the system to find out how many of their patients are up to date on their shots − and send reminders to those who aren’t.

With this capability, the state can even support school districts in handling vaccine exemptions, children whose families have opted not to have them immunized.

For example, Kurilo said, in a pertussis (whooping cough) outbreak,  officials can generate a list of students who are not up to date with the pertussis-containing vaccine. Schools can also issue reminders to students alerting them that their immunizations are due or past due. Plus, schools can get a list of exempt students and decide to send them home for their protection, she added.

High value on data

So far, 90 percent of Oregon’s immunization data comes directly from about 1,200 providers − hospitals, private physician practices, specialty clinics and pharmacists − through an electronic data exchange with their electronic health records or other systems. Ten percent of records are manually entered, Kurilo said.

Before Oregon can “onboard” or accept an electronic data feed from a new provider into ALERT IIS, the provider must adhere to certain data specifications. Two state staffers test the data content and format to ensure it meets a certain level of quality before it can be shared. The data is transmitted in either real time or in daily or weekly batches.

In addition to primary source data, the state also gets secondary source data from Medicaid, large health plans or other organizations that may not have provided a vaccine shot, but can supply claims data about a particular shot to backfill any missing information.

With thousands of reports transmitted almost hourly, Kurilo said the system uses very sophisticated algorithms to provide “probabilistic” matching that can merge reports from various sources for the same patient or even multiple reports of the same immunizations for one patient.

The state has extensive standardized data quality protocols on existing data,  and it maintains close relationships with providers to make sure they adhere to high-quality data standards, she said. State staffers also review records that may need a little more scrutiny. Once these records are approved, they go live in the database for providers to access.

A future analytics view

Oregon is continuing to add adult immunization records to the registry, and this expansion will help the state better analyze flu vaccine uptake, enabling analysts to compare statistics with reported influenza cases or flu-like cases across the state in real time, Kurilo said.

And with pharmacists playing a greater role in immunizations, Oregon plans to use analytics to not only see how well the system is capturing such records, but also how pharmacies are using the registry to provide shots.

“We’ve had a few high-profile cases of pharmacists immunizing for pneumococcal right after the patient received his pneumococcal at his provider’s office because the patient didn’t remember and the pharmacy didn’t check,” Kurilo said. “We want to make sure that everyone is leveraging this consolidated record particularly as patients are more and more mobile and getting their vaccinations in different locations.”

Nationally, states are eyeing the integration of two-dimensional (2-D) barcoding to label and track vaccines. According to the Centers for Disease Control and Prevention, which funded a recent two-year pilot, a 2-D bar code could contain vaccine product identification information, the lot number and expiration date.

By scanning this information directly into a registry, states can quickly, accurately and automatically analyze specific vaccines that have been distributed to providers. Not only could this reduce administrative errors, such as incorrect, expired or recalled vaccines, but officials could identify patients who may have been vaccinated with a product that had a problem.

“It’s important for patient safety if there was ever an issue with an additive or something in the vaccine and we need to know who had this particular lot of the vaccine,” HP’s Wheeler said.

Kurilo, who is the immediate past president of the American Immunization Registry Association, said as these systems continue to evolve they can serve as a model for how other health care agencies can better collaborate, use advanced technology, improve service and save money.

She said an early study estimated that for every dollar spent on registries, the health care system saved about $7 in terms of a provider’s time, resources and efforts. However, Kurilo added there hasn’t been a good cost-effectiveness study since then.

“What we hear anecdotally from providers is that [these registries are] incredibly efficient for them, so, to some extent, these systems have really sold themselves.”