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SE MN Beacon Immunization Initiative

Lacey HartDr. Rajeev Chaudhry

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SE MN Beacon SE MN Beacon Immunization GoalsImmunization Goals

•Assess current processes of vaccine administration and documentation•Collect baseline vaccination rates and assess improvements•Conduct gap analysis•Provide recommendations for improvement for population health

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Phase I: Gap AnalysisPhase I: Gap AnalysisDecember 22 , 2010 – March 14, 2011December 22 , 2010 – March 14, 2011

– Identified baseline metrics using Health Information Technology (HIT) across SE MN practices

– Mayo Clinic Rochester (MCR): • Used Point of care decision support system to identify patients

with chronic conditions • Provided decision support for providers for adult patients who

need vaccinations during any visit in practice• Used population management system to identify population of

patients who are due for vaccinations for a primary care practice• Integrated the process with state registry comparison

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Current Data FlowCurrent Data Flow

Data RepositoryMIICSEMIC

Provider

Public Health

Pharmacies

Provider

Provider

Schools

Daycare

Long-term Care facilities

BeaconDiabetic/Asthma Population

Unvaccinated Intervention

Employers

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OMC Diabetic Population

OMC Asthma Population

MC Diabetic Population

MC Asthma Population

MHS Diabetic Population

MHS Asthma Population

WHSDiabetic Population

WHS Asthma Population

Immunization Filter Immunization Filter Immunization Filter Immunization Filter

MIIC MIIC (SEMIIC)(SEMIIC)RegistryRegistry

ProvidersPublic Health

Pharmacies

Unvaccinated MC/MHS

Unvaccinated WHS

Schools

Daycare

Long-term Care facilities

Employers

Gaps IdentifiedGaps Identified

Providers

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Gap Analysis Method

• Winona Health and Mayo Clinic Rochester identified all asthma and diabetic patients (age 18+) who have not received influenza vaccine in 2010 (MCR = 18,700 and WHS = 1,881)

• Local records compared to MIIC database and found:– 910 Winona Health System eligible for influenza vaccine (Letters

sent on 2/4/2011)– 5996 Mayo Clinic (Baldwin Family Medicine, Baldwin Primary

Care Internal Medicine, Kasson Clinic, Mayo Family Clinic NE, Mayo Family Clinic NW)

• Letters sent from MCR starting 2/10/2011 in a staggered manner• Letters sent by Winona in Feb 2011• Monitoring and tracking vaccine improvement will continue through

March 16, 2011

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Script for Response to Mailings

Response to questions related to SE MN Beacon Immunization Initiative

Thank you for your call. How can I help answer your question?Our records show as of December 31, 2010, you may not received a flu shot.Have you had your flu shot elsewhere? E.g. At a pharmacy? At a flu clinic at work? It isn’t too late to get your flu shot. Getting immunized is one of the best ways we can help keep ourselves healthy and safe from communicable diseases.Would you like to schedule an appointment to get your flu shot?Who is your primary care provider?

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Results of Letter Intervention

Provider 1 Provider 2

Response Rate 24%

Telephone calls <50

Employer Flu Clinic 11%

Retail Pharmacy 26%

Primary Care Provider 52%

Other 11%

Chose not to get flu shot 40%

# Vaccinated after letter intervention

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Response Rate 20 %

Telephone calls 3

Employer Flu Clinic 21%

Retail Pharmacy 5%

Primary Care Provider 3%

Other 23%

Chose not to get flu shot 25%

# Vaccinated after letter intervention

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Gap Analysis Gap Analysis

• Identified 120 pharmacies in SE MN, only 14 participate in MIIC

• Pharmacists who administer vaccination are required to notify primary care MD but may not report to MIIC; fax information to MD

• Some pharmacies do not participate in Mark of Excellence training programs and may not report to MIIC

• Corporate pharmacy policies direct vaccinations to corporate office (difficult to separate the 11 county area)

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Gap Analysis Gap Analysis

• Unclear who reports to MIIC at open flu clinics; Need exploration of employer flu clinic processes

• Unclear of processes in schools, day care, long term care etc

• Reporting delays impact point of care

• Explore duplicates in population aggregate

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• Need to reinforce MIIC/SEMIC database enhancement & utilization as central repository for vaccination data to manage SE MN Beacon population health

• Develop plan to address duplicates in population aggregate

• Need further study needed in direct entry into MIIC and impact at the point of care

• Review tracking and real time management of immunizations using SEMIC

Issues IdentifiedIssues Identified

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Issues Identified

• Conduct process mapping of process work flows in retail pharmacies, day care, employer flu clinics etc and determine needs for data exchange from other sites of vaccine delivery and reporting

• Define proactive practice intervention workflows for high risk population in need of vaccine

• Explore SEMIC repository data access via other modes of electronic access (i.e. iPhone, iPad, etc)

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A gentleman called WHS re the letter his wife had received. He informed that his wife had been in a long term care facility in Winona for over a year now. He was confused as to why she had not been given a flu vaccine when they both got them every year. I checked her records, and informed him that she had not in fact gotten her vaccine. The gentlemen couldn’t believe that she was under the watchful eye of a doctor, and yet she hadn’t received her yearly flu vaccine at long term care facility. Husband took the letter to LTC and requested that she be vaccinated ..

SE MN Beacon Immunization InitiativeSE MN Beacon Immunization InitiativeA patient story ….A patient story ….