2001 NIC 011 Integrating Systems: The Challenges of Developing a Master Child Index

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Integrating Systems The Challenges of Developing
a Master Child Index to Integrate the NYC
Immunization and LeadQuest Registries
Robert Brackbill Deborah Walker Amy Metroka Paul
Schaeffer Alex Ternier Nicolas Gaglioti John
Somma Carla Rodriguez Noam Arzt (HLN Consulting,
LLC) New York City Department of Health e-mail
rbrackbi_at_health.nyc.gov
35th National Immunization Conference May 29 -
June 1, 2001 Atlanta, GA
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Objectives of Talk

• To describe the data processing issues related to
  child health registries
• To provide conceptual basis for integrating two
  child health registries
• To give an overview of challenges faced by
  project developers and how they were overcome

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Size and scope of City Immunization Registry
(CIR)

• Mandated by Amendment to NYC Health Code on
  January 1, 1997 required to have immunizations
  reported for children up to 7 years old
• Contains demographics and immunizations of
  children up to 18 years of age
• 91 of private providers are currently reporting
• Contains nearly 2 million children with over
  11.6 million immunization events

4
Size and scope of LeadQuest (Lead Poisoning
Registry)

• Originated in 1982
• Contains demographic data, blood lead test
  results, and follow-up of children up to 18 years
  of age
• 60 laboratories report blood lead tests for NYC
  residents 49 report electronically
• Contains approximately 3.9 million blood tests
  from 1.7 million children
• Contains 21,800 cases with elevated blood lead
  levels
• Approximately 49 of NYC children (6 months - lt 6
  years) were tested in 2000

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Data Base Issues of CIR

• Matching and de-duplication of records
• Having consistent and standardized address
  information
• Finding answers to analytic questions
• Reducing back-end processing

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Data Base Issues of LeadQuest

• Improving information on children without high
  test results
• Having access to better provider data
• Finding answers to analytic questions

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Commonalities of Two Registries

• Each registry covers all children in NYC
• Each registry matches new information with
  existing records
• Each registry seeks being able to provide
  complete child specific information

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Other Considerations

• Increasing accuracy of registry matching
  processing
• Creating system links for knowing as much as
  possible about individual children
• Obtaining the capacity to guide comprehensive
  prevention and intervention programs

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Concept of Master Child Index (MCI)

• Create a core demographic data base into which
  demographic data on each child would be loaded
  from participating registries
• Provide front end registry matching for new
  immunizations and lead test data
• Generate a common ID linking participating data
  systems

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Basic Development Steps in Creating MCI

• Select data elements required by MCI
• Design logical relational database
• Training and testing of matching algorithm
  (program) MEDD (Maximum Entropy De-duplication
• Formulate business rules governing the
  loading/translation of data from registries to
  MCI
• Initial data-load (order of loading is important)
  from CIR, LQ, and vital records
• Build application primary interfaces (APIs)
  between components in system

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Basic Development Steps in Creating MCI

• Build communication services for linking
  components of system including MCI, LQ, CIR, MEDD
  and geocoding service
• Design and develop MCI administration and query
  tools
• Synchronize all the databases and generate MCI ID
  for linking two registries

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Steps 1 and 2 Select Data Elements and Design
Logical Relational Database
Table structure
Entity Diagram
Child ID
Birth Date
Master Child Index (MCI)
Address
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Step 3 Training And Testing of MEDD
SEARCHING AND BLOCKING
MEDD
CIR/LQ
Manual Review
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Steps 4 and 5 - Initial Loading and Translation
of Data From Registries to MCI and MEDD
MCI
Error File
MEDD
MCI Services
Geo-coding (City Planning)
Error File
Load using Business Rules
CIR
LQ
Vital Records
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Steps 6 and 7 Build APIs and Communication
Services
MCI Database (Oracle)
MCI Database Server (Unix)
Geo-coding
MCI Services (NT)
MCI Client
MEDD
CIR Database Server (UNIX)
LQ Client
LQ Database Server (NT)
CIR Clients Power builder Provider client Batch
processing
CIR Database (Oracle)
LQ (Microsoft SQL)
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Steps 6 and 7 (Continued) Build APIs and
Communication Services
MCI Database (Oracle)
Communication Service (CORBA)
LQ Powerbuilder Application
CIR Powerbuilder Application Provider
Client Batch processing
MCI Visual Basic Application
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Organizational Challenges

• Working with multi-vendors and DOH programs
• Coordinating feedback from DOH programs with
  building of data system
• Maintaining momentum on project and avoiding
  de-synchronized development steps
• Making decisions on communication technology with
  insufficient information

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Technological Challenges

• CIR and LQ registries contain different data
  elements
• CIR and LQ registries apply different processes
  to registry matching/updating records
• Conflicting CDC standards
• Lack of over-arching DOH technical architecture
• CIR resides on a UNIX system and LQ on NT platform

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Meeting These Challenges

• Bi weekly DOH and vendor meetings and weekly DOH
  management meetings
• Formal, detailed requirements and specifications
  documents
• Separate workgroup meetings
• Providing vendors explicit criteria for each
  deliverable
• Achieving consensus from all parties on major
  decisions
• Maintaining a focus on the conceptual goals of
  the project

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Conclusions

• Developing strategies to overcome organizational
  and technological challenges is central to
  project management
• Maintaining consistent leadership encourages
  programmatic buy-in
• Fact finding and consensus building maximizes
  ownership by separate program areas