Building Regional Registries a Progress Report from California

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Building Regional Registries - a Progress Report
from California
Ayesha E. Gill, California Department of Health
Services Immunization Branch Susan M.
Salkowitz, Salkowitz Associates, LLC Noam H.
Arzt, HLN Consulting, LLC
35th National Immunization Conference, May 29 -
June 1, 2001, Atlanta, Georgia
Author Contact Information - Phone email AEG
[phone] agill1_at_dhs.ca.gov SMS (215)
438-6352 salkowit_at_hln.com NHA [phone]
arzt_at_hln.com
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Background

• California is a large and diverse state
• Total population 34 million
• Number of live births / year 530,000
• 58 counties 92 urban rural population spread
  over great distances
• A year ago the state made a transition from local
  immunization registries to regional registries.
  This is the tale of the transition.

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Background Standards Planning

• California has used a standards based model for
  registry guidelines, software evaluation, and
  technical planning.
• Regions are using four mature and tested software
  products developed by CA registries. All are now
  web based.
• The state moved to regions based on patient and
  provider activity to achieve economy of scale.

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Biggest Challenges in Forming Regions

• Organizational strategy how to unite autonomous,
  diverse counties.
• Fiscal strategy how to receive funds, make fair
  fiscal decisions, and disperse funds.
• Regional communication agreements thinking
  regionally agreements among counties, with
  providers, patients families.
• Technical strategy data migration, merging,
  testing IT support, maintain old system while
  transitioning to new.

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Constraints

• No new money to form regions.
• State spreads same 3.5 million annual support
  among 7 new regions formed by counties.
• Regions are mixed some counties with local
  registries others inexperienced.
• Current systems and users must be maintained
  during transition.
• Legislation allows new sharing partners new
  agreements needed.

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Approaches to Organizational Strategy

• Counties meet regularly to establish regional
  infrastructure agreements
• Agreements need approval of county supervisors.
• Hire consultant to work on regional charter
• Bay Area Regional Registry
• Establish region as a governmental agency
• Central Valley Immunization Information System
• Joint Powers of Agreement Commissioners

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Approaches to Fiscal Strategy

• Agree on division of labor, and the money follows
  the responsibilities.
• State funds the regions selected organizational
  lead county.
• Subcontracts allot money to jurisdictions
• State funds separate contracts for each
  jurisdiction within region.
• Select a fiscal agent for region.

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Handling Regional Agreements

• Agreements among jurisdictions in region on
  regional structure
• Charters, Joint Powers of Agreement, Contracts
• Agreements with providers other users on
  sharing data beyond county or city borders
• Agreements among jurisdictions to share data
  outside of borders
• Disclosure statements to patients families

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Communicating As A Region

• Development of MOUs, outreach material, website,
  brochures other communication
• Meshing regional and local infrastructure and
  communication
• Communicating with local jurisdiction decision
  makers to pave transition
• Helping providers through the transition

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Technical Approaches and Solutions

• Region selects host county to maintain regional
  database
• Support of host county IS Department is crucial
• HW/SW, security, testing, and training, etc.
• 3rd party user support
• Expand established software to new regional users
  (San Diego/Imperial, IEITS, NCRIDE)
• Install state-supported CCAIR software (BARR,
  CCIR, CVIIS, LACRIR, SFT)

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Technical Approaches and Solutions - 2

• Migrate records to regional database
• Merge records from jurisdictions in new regional
  database (CCIR)
• Maintain current providers during transition
• On local or stand-alone system other software
  (Acclaim, Adios, etc.)
• Move from client/server to web-enablement

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Whats Next? Californias Ongoing Plans

• The statewide semi-annual registry meeting was
  held April 2-3, 2001.
• All Stakeholders invited.
• Open discussion of regional plan and future
  directions
• Regional updates
• Coherent statewide deployment plan
• SIIS state hub architecture approved
• RFP for implementation in process
• New funding opportunities state federal