Implementation of Adult and Adolescent Schedule

Contra Costa County Health Services, California 1

Implementation of Adult and Implementation of Adult and Adolescent ScheduleAdolescent Schedule

Contra Costa County Health Services

Siu Wing Tong, Ph.D.

Information Systems Division


What is CCAIR?What is CCAIR?

Contra Costa Automated Immunization Registry is a centralized data repository designed to accept and consolidate all immunization history records from multiple providers

Prototype developed in 1995


What is CCAIR?, Cont’dWhat is CCAIR?, Cont’d

CA DHS (partial) funding started in January 1996

Remaining funding picked up by County

In-kind supportsPiloted in Contra Costa Public Health in

1996


What is CCAIR?, Cont’dWhat is CCAIR?, Cont’d

Selected by CA DHS in 1999 after HumanSoft collapse for replication elsewhere in the state

Selected by Nevada State Health Division in 1999


What Happened To CCAIR?What Happened To CCAIR?

Turned over a copy of web-enabled source code to CA DHS in 2001– After the 2nd IRC held in Little Rock, AK– CA DHS now maintains their CAIR version

3.x


What Happened To CCAIR?, Cont’dWhat Happened To CCAIR?, Cont’d

Contra Costa Health Services retained client/server copy of source code

Continue to operate as standalone registry


dot-NET Conversiondot-NET Conversion

Porting of client-server version to Microsoft dot-NET– Started in November 2001

Finished the first prototype before the 3rd IRC in PA in October 2002

Prototype presented at 3rd IRC


Scheduling in CCAIRScheduling in CCAIR

Modeled after ACIP recommendationsTable-driven logic for next due date

recommendationsValidate/invalidate shots given based

on minimum age & intervals


Scheduling in CCAIR, Cont’dScheduling in CCAIR, Cont’d

Help text to show ACIP recommendations

“WHY button” text to explain CCAIR internal logic


Why A&A?Why A&A?

CCAIR for children has been in Contra Costa County for years, covering primarily children 0 to 5 years of age

Mature and in use since 1996Desire to expand


Why Now?Why Now?

CCAIR is linked into Patient Care Information System, our County’s Electronic Health Record project, which is intended for all ages

New vaccines expected for older patients


A&A In CCAIRA&A In CCAIR

Finished implementation of some adolescent schedule by 1998– HBV 2-dose formulation– VZV adolescent schedule after age

13Started selected implementation of a

subset of A&A in 2003 after dot-NET rewrite


Current ScopeCurrent Scope

Which subset of ACIP A&A schedule for this current first phase– Influenza– 3-dose adolescent DTP (or Td)– Td (Tetanus Diphtheria) boosters– Pneumococcal polysaccharide


Goals & ChallengesGoals & Challenges

Follow ACIP A&A scheduleSelect a subset to implement in the initial

attemptMaintain current table-driven architecture

– Ease of maintenanceLeverage existing mechanisms

– VZV, HBV-2dose, Rotavirus


Goals & Challenges, Cont’dGoals & Challenges, Cont’d

Discover new mechanisms needed– Repeating doses, age dependency,

disease dependency, seasonal natureLink up with other tracking systems

– Asthma, Prenatal/OB


How Does It Work Now?How Does It Work Now?

One single table for all schedules of vaccine groups of interest

One record for each recommended dose

Lots of parameters in each dose record storing min/max age, intervals, conditional skips and many others


How Does It Work Now?, Cont’dHow Does It Work Now?, Cont’d

Match one shot with one schedule record

The last unused or unassigned schedule record will be used for calculation of next-due-date recommendation.


What’s Needed?What’s Needed?

Apply new table parameter valuesChange conditional skip to relativeAdd new “repeating” parameterCreate multiple age ranges of

recommendationAdd new “seasonal” parameter


Our FindingsOur Findings

Td 3-dose series– May use existing DTP 5-shot series– Need new skip condition that is relative to

a previous dose, not to a particular, fixed dose number

– Cannot easily specify the recommended vaccine codes from DTP to Td etc.


Our Findings, Cont’dOur Findings, Cont’d

Td Boosters– Need new “repeating” parameter– User may specify a shot as booster shot– Put “repeating” scheduling record (for

booster) at the end of the series



Influenza– Need new “repeating” parameter– Need new “seasonal” parameter

To specify the starting of the season

– Need two records in schedule tableThe second one being “repeating”



Pneumococcal Polysaccharide– Separate group from PNU conjugate– Avoid recommending both PNUps

and PNUcon– Disease history or medical conditions

To store or not to store


Our ExperiencesOur Experiences

More difficult to maintain totally table-driven algorithm

Complexity of scheduleDependency on sensitive disease

history & medical conditions– How best to obtain information– To store or not to store in registry


ContributorsContributors

Erika H. JenssenCarol FitzgeraldAtes TemeltasSiu Wing Tong


Contact UsContact Us

Siu Wing Tong, Ph.D.

Information Technology Supervisor

Contra Costa County Health Services

595 Center Ave, Suite 200

Martinez, CA 94553

[email protected]

Documents

Implementation of Adult and Adolescent Schedule