Immunization coverage assessment: Methodological considerations and opportunities with Panorama data Part 2

Transcription

1 Immunization coverage assessment: Methodological considerations and opportunities with Panorama data Part 2 Karen Hay, Business Lead Soma Sarkar, Epidemiologist Ontario Public Health Integrated Solutions Branch Ministry of Health & Long-Term Care APHEO Workshop, Sept. 16, 2014

2 Summary Panorama status update Panorama business intelligence and reporting strategy Immunization coverage concepts terminology and comparisons between IRIS and Panorama Panorama data, reports, forecaster Data quality improvement Data standards and interoperability goals Ontario Public Health Integrated Solutions Branch 2

3 Panorama in Ontario Panorama s Immunization module has been successfully implemented in 35/36 Ontario public health units! Significant achievements include: The establishment of a single provincial record repository of standardized immunization information in Ontario. The provincial immunization repository now contains 5.7 million client records and 80.5 million immunization records. Over 1,300 end-users registered Over 2,500 immunization clinics have been held using Panorama Definition of provincial immunization standards. Accurate, comprehensive, and up-to-date information available to assist provincial immunization program in its efforts to increase protection of children from vaccine-preventable disease further ensuring the right student received the right immunization at the right time. Establishes use of the Ontario Education Number (OEN) by PHUs to support school immunization programs for better matching of immunization records exchanged between schools/boards and PHUs. Standardizing the way provinces and territories input and process immunization data, as well as laying the foundation for the exchange of this information with other jurisdictions in Canada. Ontario is the first province to be live with the Panorama release 2.5 series. Ontario Public Health Integrated Solutions Branch 3

4 Panorama Reporting Strategy Access to Panorama data is planned through a long-term business intelligence strategy: In-Application Reports Data Extract Ad Hoc Reports Function: operational reports masked datasets for analysis and surveillance analysis and surveillance Accessed from: Panorama Panorama and/or public website BI portal (e.g. Cognos) Record level or aggregate? both both (de-identified at both levels) both PHI? yes no sometimes Users: PHUs PHO, PHD, PHUs PHUs, PHO, PHD Others?: researchers, public When: now, ongoing Fall 2014, ongoing? Self Service: limited to defined parameters no drag and drop, slice and dice, drill down/up/through, statistics, etc Reporting Format: XLS, PDF CSV XLS, PDF, CSV, etc 4 Ontario Public Health Integrated Solutions Branch

5 Immunization Coverage Terminology Immunization coverage terms are sometimes used interchangeably, when in fact they represent distinct concepts: Assessing coverage for surveillance Assessing for Accountability Indicators Assessing for ISPA Assessing against the Publicly Funded Immunization Schedules for Ontario (i.e. Forecaster) Complete-for-age vs up-to-date vs on time vs completedthe-series vs fully immunized vs compliant There is no field in either IRIS or Panorama that stores these measures; they must be derived or calculated based on how they are defined, using the available data elements. Ontario Public Health Integrated Solutions Branch 5

6 Coverage Measures used in IRIS and Panorama: Based on Forecast Status Panorama Compliance report is similar to complete-for-age reports in IRIS Addresses some limitations but others still remain Accommodates for the various agent-antigen combinations administered Forecast status is point-in-time; impacts comparability across PHUs Ontario Public Health Integrated Solutions Branch 6

7 Coverage Measures used in IRIS and Panorama: Based on Forecast Status Complete-for-Age (IRIS) Predefined complete-for-age IRIS reports (12) Compliance (Panorama) Predefined compliance report, designed to support ISPA process Predefined criteria of forecast status Overdue User-defined criteria of forecast status Overdue Due, Overdue Eligible, Due, Overdue Coming soon: Up to date, Eligible, Due, Overdue Specific antigen or agent combinations Disease-based, multiple diseases can be selected for a combined assessment Provides as-of date feature Point in time (no as-of-date feature) Ontario Public Health Integrated Solutions Branch 7

8 Panorama Forecaster: What You Need to Know for Forecaster-based Assessment Panorama s forecaster has two functions: Validation based on ON Immunization schedule dose rules, interaction rules, manual overrides. E.g., M-M-R dose given too close to VARIVAX ; dose might not provide sufficient immune protection Forecasting based on gender, DOB, imms history, exemptions, contraindications. E.g., client had dose 1 of Twinrix 12 months ago; overdue for dose two Eligible Date Due Date Overdue Date Antigen, Antigen-to-Agent Roll-up Automatically reforecasts in specified situations Ontario Public Health Integrated Solutions Branch 8

9 Coverage Measures used in Panorama: Not based on Forecast Status Now available: by dose count Compliance report Improvements to be implemented: as-of-date administered, specify antigen(s) Up-to-date and On-time coverage for Surveillance Opportunities for comprehensive coverage assessment Methodological considerations TBD by PHO through Panorama datasets for Client Details, Immunizations, Mapping files Ontario Public Health Integrated Solutions Branch 9

10 Coverage Measures used in Panorama: Not based on Forecast Status Compliance by dose count (b) by School/School Board/ Daycare Includes option to use Panorama forecast validation Predefined report available Disease-based, multiple diseases can be selected and assessed separately Disease-based dose count but could be enhanced to be antigen specific e.g. Men-C vs MVC4 Point in time (no as-of-date feature) but could be enhanced based on administered date Some caveats for multi-dose series or diseases that have many possible agent combinations Up-to-date (as defined in PHO slide 5) Distinct from forecast status of Up-to-date (which did not exist in IRIS) No predefined report; methodology TBD with available data elements On time No predefined report; methodology TBD with available data elements Ontario Public Health Integrated Solutions Branch 10

11 Panorama data: Building Blocks for Coverage Assessment Meningococcal Disease scenario (adapted from PHO Slide 7) The table uses a minimum set of Panorama data to illustrate the ability to do the following: group cohort by Birth Year, Grade, Age in Years, etc count doses by Disease, Antigen, Agent, Trade Name, etc only include doses administered before a certain date (as-ofdate feature) only include doses administered up to a certain age milestone (as per up-to-date definition) Microsoft Excel Worksheet To see a full list of demographic and immunization data elements that are in scope for Panorama data entry, see [Best Practices and Data Standards] Ontario Public Health Integrated Solutions Branch 11

12 Progress on Panorama Data Quality In recognition of the substantial impacts that the implementation of Panorama has had on public health activities, the ministry has undertaken a number of change management initiatives to support the transformation of public health practice in Ontario. Key among these are Panorama working groups. Led by subject matter experts from public health units, these groups define common business processes related to immunization, inventory, and investigations/outbreak management activities as related to Panorama functionality. Recommendations take into account flexibility at the local level to accommodate necessary variation in practices, but encourage standardization across the province. Current working groups that are improving data quality in Panorama include: Best practices for the documentation of historical immunizations Data quality and duplicate resolution estimated duplicates after migration from IRIS to Panorama = ~15% Reports building capacity for analysis and interpretation of Panorama data Audit privacy and data quality audit reporting and processes Ontario Public Health Integrated Solutions Branch 12

13 Data Standards in Public Health Data standards are the cornerstone of high-quality, meaningful health information: The consistent use of standard terminology, vocabulary, and definitions supports the ability to exchange data across systems with meaning. Standards are also critical to the sound interpretation of evidence drawn from multiple sources to be used to make informed decisions for policies and programs. At the most basic level, data standards are about the standardization of data elements: (1) defining what to collect, (2) deciding how to represent what is collected (by designating data types or terminologies), and (3) determining how to encode the data for transmission. -- Institute of Medicine report Patient Safety: Achieving a New Standard for Care Lack of data standards compromises the quality and utility of data: Problems arise when one term has multiple meanings or when two or more terms refer to the same concept but are not recognized as synonyms. For example, Ontario public health units (PHUs) used the Immunization Records Information System (IRIS) to record immunization data, but did so in the absence of data standards e.g., each health unit used a separate instance of IRIS, defined fields in IRIS differently, and put different data in the same fields which has limited comparability of immunization data across (and even within) PHUs, and hampered provincial immunization coverage analysis. Standards are mandatory for integration & interoperability: Data standards are crucial for the integration of public health information systems with other systems across the health sector, regardless of vendors or locations. Ontario Public Health Integrated Solutions Branch 13

14 Immunization Data Standards in Panorama Ontario s Panorama team, with Canada Health Infoway, has established immunization record data standards (using the most comprehensive clinical healthcare terminology in the world SNOMED-CT) to support the electronic capture of vaccine information. These standards are a foundational step for healthcare system interoperability. System agnostic, and are being communicated to other domains beyond public health (e.g., primary care, hospitals, pharmacies, corrections) and other systems that record immunizations (e.g., EMRs, pharmacy systems). Are being considered for adoption by other jurisdictions (e.g., MB, SK, QC, PHAC, federal corrections, CIHI) Configured into Panorama s inventory and immunization modules. E.g., Tdap Boostrix GSK is a Trade Name for Agent Tdap containing Antigens Tetanus (T) that protects for Disease Tetanus Adult Diphtheria (D) that protects for Disease Diphtheria Adult acellular pertussis (ap) that protects for Disease Pertussis Ontario Public Health Integrated Solutions Branch 14

15 Anticipated Benefits of Immunization Data Standards Accurate electronic immunization records Enabled Ontario to code provincial immunization schedule rules with unprecedented precision in Panorama = clinical decision support. Vaccine bar-coding (for administration and inventory) Consumer mobile health applications (e.g., e-yellow card) Integration of EMR data in public health information systems Transfer of immunization records from one jurisdiction to another Vaccine safety surveillance (AEFIs) Support comparative analyses of immunization data (e.g., how many people in Canada received Twinrix? How many people in Canada received a vaccine that protects against Hepatitis A?). Data are more easily compared when a common code is used to identify a concept over time and across jurisdictions. Simplified immunization coverage reporting, since they enable the calculation of immunization coverage for a specific disease (e.g., polio) by allowing for the consolidation of components from single and combined vaccines (e.g., injectable polio vaccine, IPV; oral polio vaccine, OPV; and diphtheria, pertussis, tetanus, polio, DPTP; diphtheria, pertussis, tetanus, polio, haemophilus influenzae B, DPTP-Hib). Ontario Public Health Integrated Solutions Branch 15