C19 OCHIN IIS Task Summary Page

Many investments have been made on the health center/network/PCA side, the EHR side and on the state IIS side during the pandemic as part of the COVID-19 response. NACHC would like your organization to provide an update on your connectivity with state/territory IIS systems. You can answer the questions below for each state individually or summarize on one sheet if it is easier.

1. What state IIS systems do your health centers report to? Are there any that do not automatically report electronically via the EHR? If not via the EHR, how is reporting done?

OCHIN is currently reporting in these states, all automatically via the EHR, but we have more scheduled for go-live later this year:

Alabama

Alaska

California

Colorado

Connecticut

Georgia

Idaho

Illinois

Indiana

Louisiana

Maryland

Massachusetts

Minnesota

Missouri

Montana

New Jersey

New York

North Carolina

Ohio

Oregon

South Carolina

Texas

Washington

Wisconsin

2. Which IIS systems do your health centers have access to IIS data? Are the queries done one at a time by staff? Can you automate queries for a patient? Can you make a bulk query to the state IIS?

a) OCHIN currently has a query interface live in these states, with more scheduled for later this year:

Alabama

Alaska

California

Colorado

Connecticut

Georgia

Idaho

Illinois

Indiana

Maryland

Massachusetts

Minnesota

Missouri

Montana

New Jersey

North Carolina

Ohio

Oregon

South Carolina

Texas

Washington

Wisconsin

b) Queries can be performed manually by staff, but will also be performed automatically when a patient checks in for an appointment. OCHIN has the capability to schedule a bulk query using the existing interfaces to each state but the barrier to implementing this across all states is that many registry systems cannot support bulk queries. Currently, OCHIN has bulk query setup to occur automatically nightly in the following states to help our health centers with COVID vaccine outreach:

Alaska

California

Connecticut

Georgia

Idaho

Minnesota

Montana

Oregon

South Carolina

3. Does the IIS system display data in the EHR interface to users? Are there health centers who could access these functions but do not?

Yes, this data is displayed in a standard format in the EHR and is made available for a user to manually reconcile. Some states return vaccine forecast data and this is also displayed. It is unlikely that health centers aren’t accessing this functionality since it’s displayed as part of the rooming process. However, some clinics are better about ensuring that staff complete the reconciliation step.

4. What are the challenges or impacts of the IIS reporting requirements and interoperability (or lack thereof) for IIS data?

There can be a number of challenges for integrating with an IIS:

i. Technical capabilities:

Some IIS still do not fully support a query interface so our clinics do not have an easy way to retrieve immunization history for their patients. Technical connection requirements can also vary somewhat. While most IIS do conform to the CDC HL7 specs for reporting, the submission can be via web service, SFTP, or VPN. SFTP is the least reliable, most maintenance heavy, and is still used by some registries.

ii. Consent requirements:

Some states require that patients opt-in to sending data to the registry before the clinic can submit their data electronically. This is a significant workflow barrier because, if the consent is not on file before the data is transmitted, the clinic has to manually review the errors and resubmit. This is also a significant barrier to ensuring that the patient’s future treating providers have access to their health history and could lead to multiple doses of the same immunization being administered.

iii. Onboarding process:

Some registries have extremely difficult hurdles and barriers in their onboarding processes:
1. Two-week onsite review with each physical clinic location so that one health center was not live with the registry integration until all of their physical locations had participated in this process, scheduled to take over a year but was somewhat shortened to a few months.
2. Lengthy QA review where the integration is live and sending Production data to the registry but needs to be validated before it is fully live. This process can take just 30 days, or close to 2 years. Either way, there is a period of time where the clinic must manually submit data even though their system is automatically transmitting because the registry would not complete validation using a test environment.
3. Communication with an actual person at the registry can be spotty. At least one registry will only communicate via their anonymous ticketing system, regular email will not work and they won’t hold a meeting at any point to review QA. A general contact email is always useful as a starting point, but once an integration project begins it can be a significant barrier to communication.
4. Third-party passthrough requirement can complicate the integration. Sometimes an HIE is responsible for sitting between the health center and the registry for the integration. This is usually because the registry lacks the technical resources to handle direct integration but it can introduce complications by requiring an additional contractual relationship with the HIE and also make troubleshooting issues difficult because there is an extra step in the integration connection.