Overcoming Interoperability Challenges to Make the Michigan Care Improvement Registry an Important Tool to Assure Timely, Accurate Immunization of Patients

Tina R. Scott, section manager, Assessment and Local Support, Michigan Care Improvement Registry, Michigan Department of Health and Human Services

The Michigan Care Improvement Registry (MCIR) is the state-run immunization information system (IIS), which stores the immunization history of patients in the state. It’s also a long-running, high-effort successful collaboration between the state’s healthcare providers and the Michigan Department of Health and Human Services.

Getting Started

The roots of the system go back to 2006, when Michigan brought together healthcare organizations, local health department representatives, Medicaid, and public health representatives to formulate a consensus document that provided guidance on the key drivers of early health information exchange (HIE) implementation. In the early years, the factor that ushered interoperability forward was the acknowledged need and value of HIE data in public health reporting. The first public health reporting message needed to involve the largest number of providers, and in Michigan that meant reporting vaccinations to MCIR.

In Michigan, providers are required to report child vaccinations within 72 hours, but there was no requirement for reporting adult immunizations. MCIR began receiving data through its HIE network in 2012 and from commercial pharmacies in 2013.

Overcoming Challenges and Seeing Success

The concept may sound simple: a patient goes to a doctor’s office and the doctor calls up the patient’s vaccination history as well as what vaccines the patient needs – a process known as query forecast/query history or clinical decision support. Behind the scenes it is an incredibly complex technical feat over a decade in the making.

One complication: healthcare providers use a variety of different electronic health record (EHR) systems and have different procedures for how they collect and report vaccination records to the IIS. The IIS must also return patient records in a way that the variety of EHRs can present the information to healthcare providers in a way that enables them to treat their patients effectively. This exchange of data is called interoperability, and it is most efficient when the systems involved use a standard of data exchange.

Additional complications include the fact that patients receive vaccinations from a variety of sources and the reporting of adult vaccinations traditionally lagged far behind the reporting of child vaccinations. The MCIR has been able to address these challenges and has become an important tool for doctors and public health officials. In recent years, the quantity and quality of immunization being reported – for both children and adults – has improved significantly, and the number of healthcare providers accessing the data to help treat their patients has skyrocketed.