Texas Department of State Health Services

1. Texas Department of State Health Services Immunization Resources and UpdatesImmTrac Program & HPV Updates 2016 HPV Seminar February 26, 2016 James Loiselle, MPA Legislative Liaison, IDCU www.ImmunizeTexas.com

2. Outline • ImmTrac Snapshot • Registering for ImmTrac • ImmTrac Replacement Project • Project Update • Benefits for Providers • Reminder/Recall Functionality • HPV Update • Summary

3. ImmTrac Snapshot:Q4 2015 138.7 million immunizations recorded 7.3 million Texas children 2.3 million children under age 6 years 92.8% parents “grant” consent for their newborn babies 499,134 ImmTrac Adult Clients 202,343 immunization history reports generated per month (average)

4. ImmTrac Snapshot:Q4 2015 cont. 9,581 active online user sites 39,488 first responders or first responder family members 18 years of age and older 1,257,416 disaster-only clients

5. Immunization RecordsTotal Vaccine Doses (Total as of this Quarter) 2012 2014 2013 2015

6. Immunization RecordsTotal Vaccine Doses (Annual)

7. Active Online User Sites(Total as of this Quarter)

8. Active Online User Sites

9. Registering for ImmTracwww.immtrac.org • It’s Free • Register online at http://www.immtrac.org • It Helps Increase Vaccine Coverage Rates • It allows providers to search for immunization histories on new patients • It assists with lost records or records that are difficult to interpret • It provides a method for doctors to send recall and reminder notices of pending or overdue immunizations • It’s the Law • House Bill 1921 requires all health-care providers to report to ImmTrac all vaccines administered to children younger than 18 years of age

10. Registering for ImmTracwww.immtrac.org

11. Registering for ImmTracwww.immtrac.org

12. Registering for ImmTracwww.immtrac.org

13. ImmTrac2 Update • Largely federally funded project with some GR funding • Estimated project expenditures for the complete system 2013-2017 are $7.3M • Wisconsin Immunization Registry (WIR)-based system • Phase one rollout – Registry functionality scheduled for May 2016

14. Remaining Timeline • Present – March 2016: • System Testing (internal and external users) • March - May 2016 • Training Users • May 23, 2016 • Registry Go-Live Date

15. ImmTrac2 Benefits for Providers • This new system will: • Provide more detailed immunization history and forecasting, making it easier to determine vaccine duplication and maintain an immunization schedule • Enhance user functionality by allowing providers to reset their own password • Allow ad-hoc report capability and simplify report development • Provide enhanced Reminder/Recall functionality

16. Current Reminder/Recall Functionality • Checks patients against the ACIP schedule • Reports can be run at set intervals (e.g., Daily, Weekly, Monthly, Quarterly, Yearly) or at custom intervals • Selectable Age or Date Range • Providers can choose by organization, with or without subordinates • Providers can choose County or ZIP code

17. Current Reminder/Recall Functionality cont. • Reports can be output to different formats • Hard Copy • CSV file • Letters • Labels • Letters are generated by the ImmTracsystemand cannot be modified by providers

18. ImmTrac2 Reminder/Recall Functionality • Create specific reports and save them • Select vaccines (i.e., one, some, or all) • Ability to include subpotent doses • Choose Due Dates (Due Now, Past Due, or both) • Dates • Target Date Range • Date of Birth Range • Age Range

19. ImmTrac2 Reminder/Recall Functionality cont. • Occupation (First Responders and Families) • High Risk or Exemptions • Sorting Options (e.g.,last name, first name, provider, county, etc.) • Output Options • Customizable letters that can be saved • CSV file • Hard Copy

20. ImmTrac2 Reminder/Recall Report

21. ImmTrac2Reminder/Recall Report cont.

22. ImmTrac2 Reminder/Recall Report cont.

23. ImmTrac2 Reminder/Recall Letter

24. ImmTrac2 Summary • ImmTrac2 is designed to: • Allow for existing functionality of ImmTrac to be enhanced to honor stakeholder feedback and provide improved functionality for system users • Meet CDC requirements • Uphold Modeling of Immunization Registry Operations Workgroup (MIROW) best practices

25. HPV Vaccine Availability • Texas Vaccines for Children Program • Uninsured or underinsured children • CHIP • Native American or Native Alaskan heritage • Medicaid • Adult Safety Net • Providers include FQHC’s, RHC’s, FPC’s, Community Health Centers, and STD/HIV clinics • HPV vaccine available for uninsured adults

26. HPV Vaccine Uptake in Texas • 2014 vaccine ordering data was analyzed to compare Tdap and HPV vaccine among TVFC providers • 1.4 doses of HPV vaccine ordered for every dose of Tdap • Ideal ratio 3.0 (meaning for every 1 Tdap, 3 HPV are administered) • Customized adolescent vaccine ordering profiles were sent to over 2,300 providers

27. Customized VFC Provider HPV Ordering Mailout • Vaccine ordering data from iTEAMS assessed for all adolescent vaccines (HPV, Tdap, MCV4) • Examined ordering data from 2013-2015 • Created customized profiles with HPV:Tdap ratio and overall ordering data • Sent customized email reports to providers

28. HPV Customized Tables Tables included in customized report sent to TVFC providers

29. HPV-Tdap Vaccine Ordering Ratios • Jun-Sept 2014 • 1 Tdap:1.15 HPV • Total HPV orders: 215,769 • Jun-Sept 2015 • 1 Tdap:1.35 HPV • Total HPV ordering: 231,158 Ideal Ratio: 1 Tdap:3 HPV

30. www.thecommunityguide.org/vaccines/universally/index.html Evidence-Based Strategies to Improve Vaccination Coverage at the Clinic Level • Reminder/recall system • Provider level • Parent/patient level (e.g., postcards, telephone calls, text messaging) • Standing orders • Provider assessment and feedback • Assessment of vaccination coverage levels within the practice and discussion of strategies to improve vaccine delivery • Utilizing an Immunization Information System, ImmTrac

31. A Call to Action for Texas Healthcare Professionals • Recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines • Educate yourself about HPV and HPV vaccines • Inform your colleagues and staff to ensure consistent, positive message delivery to patients, parents • Communicate vaccination benefits to patients, parents at every opportunity • Make vaccination procedures routine and focus on ways to reduce missed opportunities

32. Questions? James Loiselle, MPA James.Loiselle@dshs.texas.gov