Transcript Implementing a Scanning Solution for Data Capture Into An

Implementing a Scanning Solution
for Data Capture Into An
Immunization Information System
Jenne McKibben, Oregon ALERT IIS
National Immunization Conference
Wednesday, April 21, 2010
Background: Scanning in Oregon

Oregon received a 2008 grant from CDC to
explore innovative data capture methods for
aggregate reporting of flu vaccine doses in the
2008-2009 season
Used the grant to purchase and test implementation of
2 sided patient level scannable form and Datacap
software to process and verify forms
 Initial pilot tests looked promising for data capture
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See Kathy Scott’s 2009 NIC presentation at:
http://cdc.confex.com/cdc/nic2009/webprogram/Session9402.html
High-Level H1N1 Timeline
Late 2008 – Oregon
awarded CDC Scanning
Grant to explore
“Innovative Data Capture”
March 2009 –
Presented early
scanning findings at
NIC
April 2009 – First
cases of H1N1
announced
September 2009 –
launched scannable
vaccine record
April 2009 – Proof of
Concept completed for
Oregon’s New IIS
October 2009 – first
H1N1 vaccine
arrives and is
reported to IIS
April 2010 – H1N1 data
still being reported, new
H1N1 providers still
being enrolled
October 2009 –
Completed design
documents for new IIS
July 2010 – Go live
for Oregon’s New
IIS
H1N1 – Early Decisions

Oregon began planning its response to H1N1 in Spring
2009 when first cases were reported

Distribution was planned to counties, tribes and state
agencies (state hospital, etc.), with allocation by these
entities to other providers

H1N1 reporting to the IIS was required as a condition
of receiving vaccine

Slow expansion to lifespan (based on 2008 legislation)
was fast-tracked
H1N1 Data Submission
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Providers were encouraged to use existing methods
of registry data submission for H1N1 data
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Scannable Vaccine Administration Form
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Electronic transfer, barcode submission
Intended to be used in mass vaccination clinics
Web Entry

Quick entry method via the web
H1N1 Data Submission
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Complicating factors:
Number of enrolled primary IIS sources jumped
from ~650 to ~1900
 Only ~30% of H1N1 providers were existing
providers
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Occupational health, EMTs, pharmacies were new
Many providers were immunizing outside their
patient population, so EMR/claims data transfers
were insufficient

Parents of pediatric patients, clinic staff and their
partners/family members, etc.
New Submission Methods

Simplified options for gathering data from new
partners, and/or for inputting data when
capacity overwhelmed current submission
methods (mass vaccination settings, etc.)
Streamlined online web entry
 Scannable Vaccine Administration Records
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Streamlined Online Web Entry
Scannable Vaccine Admin Record
Oregon’s Hardware and Software
Scanning Set-Up
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1 scan PC and 1 background PC (dual 2.3 GHz
processors, 3 GB RAM, 74.4 GB Hard Drives)
Kodak i610 scanner utilizing “perfect page”
technology and “FireWire” connection to PC
Datacap/Taskmaster Software 7.5
Virtual Rescan (VRS) Software
H1N1 Data Capture

To date:
~870,000 doses submitted from ~1450 sources
 ~250,000 H1N1 doses have been submitted on
scannable forms
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Some data still coming in
~5,000-10,000 doses per week (some historical)
 Some non-traditional partners still working on
getting all data submitted

Simplified Scanning Workflow
Majority of data was
submitted electronically
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47% submitted through electronic transfer
13% submitted through IRIS
4% submitted through barcode/hard copy
36% submitted through scanning/web entry
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Note combined category
Breakdown of Data Submission
IRIS - LHD Medical
Record
HL7
13%
31%
15%
Flat-File
Barcodes
5%
4%
Scanning
32%
Web Entry
H1N1 Metrics:
Early Assumptions and Realities

Assumption: ~80% of providers would use existing
method for submission

Reality: Only ~30% of providers were existing, and thus even
had an existing method to use
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These providers were high-volume, however
Many existing providers used multiple methods
Assumption: Scannable forms could be verified in ~30
seconds or less
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Reality: On average, verification times were ~1 minute 15
seconds per form
Reality: Data quality issues abound
Reality: Oregonians have poor handwriting
Strategy Shift

By December, ALERT IIS was becoming
backlogged in verifying the 30-40% of data
coming in on scannable forms
Captured aggregate scanned data prior to verification
to continue accurate CRA reporting, but data to web
for clinical decision support was behind
 Reached out to partners to encourage submission
through method other than scannable forms
 Began diverting internal processing of scannable
forms to streamlined web entry

Breakdown of Data Submission:
What Would Have Been
7%
29%
Scanning
Web Entry
Breakdown of Data Submission:
What Was
31%
Scanning
Web Entry
5%
Lessons: Scannable VAR Forms
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Pros
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User acceptance of form
was extremely high
New users could use form
with little training/set-up
Tested the boundaries of a
new capture method
Great aggregate capture
method found
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Cons
 Challenges aligning H1N1
pins and AL reporting
numbers
 Quality issues were
substantial with new
submitters
 Verification of handwritten
demographic information
was very time-consuming
 Processing became
backlogged
 Integrated new scanning
system into already taxed
existing Registry
Oregon’s Response
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We responded by partnering with preparedness to hire
18 additional staff to verify and hand-enter backlog of
H1N1 data via streamlined web entry screens
Entire backlog was eliminated within ~8 weeks
Data cleaning and deduplication challenges continue
Early Lessons Learned
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Centralized processing is not feasible for a statewide response
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We need to leverage data already in the IIS
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As a state, we need broad agreement re: minimum data set
capture
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This access will come with new IIS system
Due to gathering of adult demographics this season, this will be even more
beneficial
Example: Pilot test told us no priority group capture, but Public Health
wanted/needed it
Users need full access to data they submit to IIS
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Clinical decision support
Surveillance, monitoring, planning, etc.
Acknowledgements
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Co-author
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Mary Beth Kurilo, ALERT Director
Rick Hammontree, IIS Project Manager
ALERT IIS Team
H1N1 Partners and Stakeholders
Contact Information
Jenne McKibben, ALERT Training Lead
[email protected]
971-673-0280