H1N1 Vaccine Providers Boost State Immunization Registry

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The novel H1N1 pandemic has provided Virginia with an opportunity to greatly enhance its statewide Virginia Immunization Information System (VIIS).

The electronic registry system, established in the 2005 state legislative session, was experiencing a slow rollout before the pandemic. About 200 private providers were registered before a pandemic was declared.

It was kind of a hard sell initially, said Diane Helentjaris, MD, MPH, Deputy Director of Epidemiology for the Virginia Department of Health. The benefit is that, "if you participate, then you can get into the VIIS when a kid comes in. If the kid got a shot at the health department, (the registry) would have all the information in there."

When the pandemic was declared, the state health commissioner said providers who wanted to vaccinate would have to use the registry.

"We decided to do H1N1 vaccination in a public-private partnership using private doctors, pharmacies, clinics, retail stores, and FQHCs" (Federally Qualified Health Centers), Helentjaris said. "They could register on the state's web site. First they registered their interest. As materials became available from the CDC, they could fully register. They agreed to record their immunizations using VIIS."

Public Health Emergency Response (PHER) funds were made available to physicians and healthcare facilities to ease the transition to the VIIS. Some costs were associated with modifying Electronic Medical Record (EMR) to conform to the data elements in the VIIS. For healthcare practices lacking an EMR, $1,000 grants are being offered to offset some costs of educating and implementing the VIIS program in their practice.

About 100 providers sought those grants, said Helentjaris, who described the funding as a final incentive.

PHER funds also enabled the Virginia Department of Health, Division of Immunization (DOI) to add 14 temporary staff to train providers in the use of VIIS. During September 2009, DOI staff conducted 125 webinar training sessions that trained more than 600 medical and office staff statewide. On-line training modules also were developed that allowed healthcare staff to complete VIIS training on their own time.

In just a few months, the VIIS registry expanded to 3,278 registered H1N1 vaccination sites. This number was continuing to grow in December 2009. As a result, the state reached its three-year business plan provider registry enrollment goal ahead of schedule. It is hoped that providers will become familiar with the VIIS and continue to use it to record all immunization doses they administer throughout the year.

All but a few hundred providers have entered data on immunization, Helentjaris said in a December interview. Health department staffers are working with providers who have not yet entered data.

"We think these providers will continue to be VIIS participants because they will have learned the beauty of being able to tap into these records for the kids," she said. "They can avoid excess immunizations, where you vaccinate the child because the records are missing. It is especially helpful in tracking increasingly mobile populations."

The data has also helped Virginia track vaccine uptake. More than 1 million H1N1 vaccinations were given in 2009, she said.

"We've got graphs by age of who has had a shot reported, whether (it was) obtained in private or public sector," Helentjaris said. "The curves are different, which makes sense. The vast majority of H1N1 immunizations were given to children. The private sector did pre-school kids and public sector did schools. The private sector did more of the chronically ill, which makes sense. Over-65 tails off because they were only in target groups if they were healthcare workers."

Despite the initially slow uptake of the VIIS program, Virginia saw great benefits to having the system in place before the pandemic. For example, some of the early registrants were insurance companies with many records, so doctors who enrolled to receive the H1N1 vaccine often found their patient information was already in there, Helentjaris noted.

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