The Michigan Care Improvement Registry (MCIR)

1. The Michigan Care Improvement Registry (MCIR) Kyle Enger, MPH engerk@michigan.gov March 2009

2. MCIR’s reason for being 1. Improve immunization practice • Clinicians can access complete child immunization records • Automatic assessment of children • Remind families that they need immunizations • Account for immunizations given • Clinicians & LHDs save time and $$$ • More people get immunized 2. Provide information for public health & research • Basic assessments • Advanced analysis

3. Data source: MCIR(Michigan Care Improvement Registry) • Operational since 1998 (but has older data) • Web-based application • Birth-to-death immunization registry • < 20 y age restriction removed June 2006 • ~95% of providers participate • Mostly pediatricians & family practice • Good coverage nearly everywhere • Detroit, Oakland, and Wayne are improving • Some border counties have lower coverage

4. Many MCIR functions are handled at the regional level: Provider recruitment Provider training LHD data requests Bug reporting Help desk Advisory boards MCIR Regions

5. MCIR activity • 4.7 million person records (MI pop: 10 million) • Over 57 million immunizations recorded • 13,000 user logins to MCIR every day • 2,334 provider sites submitted data in 2007 • 50% of all MDCH web traffic • Over 35,000 registered users

6. MCIR is currently linked with: • Vital Records • Childhood Lead Poisoning Prevention Program • WIC • Medicaid • Department of Education

7. Collection of Immunization Data • Direct data entry into MCIR, via web interface • Health care providers • Local health depts. • Schools, daycares • Transfer from electronic medical records • Transfer from billing systems • Paper scan forms

8. Mcir.org

9. MCIR demo

10. Sample paper iz. recordfrom MCIR

11. Current Immunization Profile for 19 - 35 Month Old Children Based on MCIR Data Keweenaw Keweenaw Houghton Houghton Otonagon Otonagon Baraga Baraga Luce Luce Gogebic Marquette Gogebic Marquette Alger Chippewa Alger Chippewa Schoolcraft Schoolcraft Iron Iron Mackinac Mackinac Dickinson Dickinson Delta Delta Cheboygan Cheboygan Emmet Emmet Menominee Menominee Presque Isle Presque Isle Charlevoix Charlevoix Alpena Montmorency Montmorency Otsego Antrim Otsego 0 - 29% Antrim Alpena Leelanau Leelanau Grand Crawford Grand Crawford Oscoda Alcona Benzie Kalkaska Kalkaska Oscoda Alcona Traverse Benzie Traverse Manistee Wexford Missaukee Iosco Roscommon Manistee Wexford Missaukee Roscommon Ogemaw Iosco 30 - 49% Ogemaw Arenac Arenac Gladwin Gladwin Mason Lake Osceola Clare Mason Lake Osceola Clare Huron Huron Midland Oceana Newaygo Mecosta Isabella Midland Bay 50 - 59% Oceana Newaygo Mecosta Isabella Bay Tuscola Sanilac Tuscola Sanilac Montcalm Gratiot Saginaw Muskegon Montcalm Gratiot Saginaw Muskegon Lapeer Kent Lapeer Kent Genesee 60 - 69% St. Clair Genesee Ottawa Ionia Clinton Shiawassee St. Clair Ottawa Ionia Clinton Shiawassee Macomb Macomb Allegan Barry Eaton Ingham Livingston Oakland Allegan Barry Eaton Ingham Livingston Oakland 70 - 79% Van Buren Calhoun Jackson Washtenaw Wayne Detroit Kalamazoo Detroit Kalamazoo Calhoun Jackson Washtenaw Wayne Van Buren Monroe Berrien Lenawee Cass St. Joseph Branch Hillsdale Monroe Berrien Lenawee Cass St. Joseph Branch Hillsdale 80 - 89% August 2008 January 2001 4:3:1:3:3:1 90 - 100% 4:3:1:3:3:0

12. MCIR vs. NIS, 19-35m

13. MCIR vs. NIS, teens

14. Td & Tdap iz.

15. PCV7 shortage

16. Exemptions by antigen

17. Time-to-immunization

18. Birth date County of residence Patient address Gender Name (parent & patient) Characteristics of health care provider School district Vaccine type Date vaccine given Vaccine funding source Which health care provider gave the vaccine Vaccines waived Overall immunization status Examples of data in MCIR

19. Ways to access MCIR data • Immediately: • Publicly available data (mcir.org/mcirdata.html) • Fairly quick: • Request deidentified or HIPAA-limited dataset • potterr1@michigan.gov, engerk@michigan.gov • Might require IRB approval or data use agreement • MDCH IRB & data use agreement required: • Request identifiable data from MDCH • Direct access to data • MDCH data warehouse (contains most important fields) • Oracle database (contains everything)

20. Mcir.org/mcirdata.html You can access MCIR data resources online via this webpage (mcir.org/mcirdata.html). Some resources require Michigan Health Alert Network (HAN) access. They can also be provided upon request.

21. MCIR research policy • Please inform MCIR about any research you do, even if it only uses deidentified data • Immunization providers have broad access to MCIR data via its web interface • This is for patient care purposes ONLY • It DOES NOT allow research using MCIR data • Seek MDCH IRB approval & data use agreement • MCIR may decline requests for data • Limited resources: 1 FTE assigned to MCIR research • No formal research policy document exists (yet)

22. MCIR data are good, NOT perfect • MCIR only contains what people report • Not all clinicians participate (completely) • MCIR only contains MI info (exceptions exist) • Border counties tend to have lower coverage • Adolescent and adult data are incomplete • Data on 20+ year olds allowed in June 2006 • Clinicians still getting used to using MCIR for adults • MCIR isn’t notified when people leave MI • These people look incomplete to us, and inflate denominators • 25% more 11-18 year olds in MCIR than US census estimates • Data are sometimes wrong • Duplicate records, typos, omissions, mistakes, etc.

23. MCIR research collaborations • Research on reminder/recall methods • Kevin Dombkowski, UM Pediatrics • UM epi student intern projects • Andrea Weston, hepatitis A uptake in 1 year olds • Erin Rees, characteristics of LHDs assoc. with iz. coverage • Numerous projects with CDC • Uptake of influenza, Tdap, & MCV4 • PCV7 & Hib shortages, etc. • Association of waiver clusters with pertussis clusters • Saad Omer, Johns Hopkins • NIS-Registry study (National Immunization Survey) • Use MCIR data to check reliability of NIS results • HPV4 uptake (brand-new collaboration) • Divya Patel, UM Ob. & Gyn.

24. Questions? Kyle Enger engerk@michigan.gov http://mcir.org