Category Archives: ALERT IIS

Pharmacists Impact on Immunization

Quynh Tran, Pharm.D Candidate 2016

Pacific University School of Pharmacy

The role of pharmacists has come a long way from the classical “lick, stick, and pour” dispensary role (that is, “lick and stick the label, count and pour the pills”) and is experiencing significant growth and development. With the expansion in the scope of practice, community pharmacists are able to take on a stronger role in support of public health to improve vaccination rates and reduce the burden of vaccine preventable diseases. According to the American Pharmacist Association, three proposed roles that pharmacists can play in improving immunization rates include acting as immunization advocates, acting as facilitators and hosting other health care professionals to provide immunizations to the public, and lastly, taking on active roles as immunizers.

Pharmacists in all states are permitted to administer vaccinations, and the role of pharmacists in adult immunizations has increased significantly over the past few years. In 2011, Oregon pharmacy law allowed pharmacists to immunize adolescents down to age 11, and then in January of 2015, the law further lowered the age to 7. With less than half of adolescents receiving their yearly influenza vaccination, this change in pharmacy law can help more children get vaccinated and provide better access to immunizations.

The Oregon Immunization Program evaluated the impact of this change in the Oregon pharmacy law by using data from the Oregon ALERT Immunization Information System (IIS) limited to Clackamas, Marion, Multnomah, Polk, Washington and Yamhill Counties. The program compared influenza immunization rates before 2011 (2001 – 2010) and after the law was passed in 2011 (2011 -2014), between adolescents aged 11 -17 and those aged 7 – 10. Results revealed that between 2007 and 2014, adolescent influenza immunizations at community pharmacies increased from 36 to 6,372, with the largest increase happening after the law change, from 262 in 2010 to 2,083 in 2011. This evaluation demonstrated that expanding the scope of the pharmacist in immunizing adolescents can provide better accessibility to an adolescent population who may otherwise be unlikely to receive immunizations at clinics. This in turn can substantially help increase adolescent influenza immunization rates.

References

  1. Robison, Steve G. (2016). Impact of Immunizing Pharmacists on Adolescent Influenza Immunizations. Manuscript submitted for publication.
  2. Rothholz, Mitchel C. (2013). Role of community pharmacies/pharmacists in vaccine delivery in the United States [PowerPoint slides]. Retrieved from http://www.pharmacist.com/role-community-pharmaciespharmacists-vaccine-delivery-united-states-0

 

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Filed under ALERT IIS, DataPokes, Education, Flu, Oregon Immunization, Research, School Law, VFC

Immunizing as a Pharmacy Student

jscovell
by Jennifer Scovell
I decided on the profession of pharmacist when I was in high school. I liked the health care field but I didn’t think I could handle the “yucky stuff” involved in nursing, or the very long academic career of a physician, but pharmacy seemed like it could work. I was good at math, science, and communicating with people so I thought I would give it a shot (no pun intended). The more I learned about the pharmacy profession, the more I fell in love with it. I am very fortunate to still feel this way over 8 years later and I hope my passion only grows in the future.
I did not know that pharmacists were giving immunizations when I first started thinking about pharmacy as a career. And that’s a good thing, if I did I probably would have listed that under my “yucky stuff” category and ruled it out as a future job. When I did learn of the immunizing pharmacists, I wondered if I would be able to handle it. I, like many people, am not very fond of needles. Honestly, I don’t know of anyone who LOVES getting vaccines but I avoided the flu shot every year and the topic produced a great deal of anxiety for me.
So, when the time finally came to start my immunization training at the end of my first year of pharmacy school, I was nervous, to say the least. Our skills lab for vaccine administration came after our live lecture and self-study modules on immunization training. And the best part… as students, we had to practice giving injections on each other! This meant that not only did we have to get (and give) a couple of injections in two different sites, we KNEW that the other person had never done it before! “Exposure therapy” can be used in certain anxiety disorders or phobia disorders and I would classify this experience as such. It was my own personal “Fear Factor” episode and guess what… IT WORKED! While vaccines are still not my favorite thing to receive, I do not get anxious and I certainly do not avoid them. Just this last weekend I received my first dose of Havrix (Hepatitis A vaccine) from my local pharmacist.
Immunizing is now one of my favorite activities when interning at community pharmacies or volunteering at outreach immunization clinics. It is a great opportunity to have one-on-one time with patients to answer their questions and talk about their health. Working and volunteering at different sites with pharmacists and nurses has given me the opportunity to improve my immunization technique and learn best practices. With each vaccine I administer, I have the chance to promote immunization as the best way to protect the public from certain diseases, like the flu. As a pharmacy intern at the Oregon Health Authority Immunization Program, I have seen the passion and dedication of the people in this program and I hope that I can help strengthen the relationship between the Oregon Immunization Program and all immunizing pharmacists.

Editor’s Note: Jennifer’s last day as an intern at the Oregon Immunization Program is on Friday. She has been a fantastic addition to the team, and we will miss her!

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Alert on ALERT: All Pharmacists to use ALERT IIS

Alert

Pharmacists play an increasingly large role in immunizing Oregonians. People aged 11 years through the lifespan can be immunized by their pharmacists against diseases such as pertussis, shingles, and influenza.

Oregon’s online ALERT Immunization Information System (ALERT IIS) is an important tool for pharmacists and all vaccine providers. Most immunizations that are given in Oregon are stored in the system. As a result, the ALERT IIS provides authorized users access to millions of patient vaccination histories.

Many pharmacists, however, don’t take advantage of some very helpful ALERT IIS tools for looking up patient histories and forecasting needed vaccinations. By using the ALERT IIS, pharmacist can avoid immunizing patients unnecessarily with vaccines they’ve already received and also find out what vaccines patients need that day, and in the future. Pharmacy techs and other staff (and anyone who is an authorized ALERT user) can also access these tools.

The Oregon Board of Pharmacy and the Oregon Immunization Program (OIP) have worked together to include the use of these ALERT IIS functions in the Pharmacy Protocols. The effective date for this protocol change is no later than January 1, 2014, although pharmacies are encouraged to begin using the ALERT IIS as soon as possible.

The new language that appears in each protocol is as follows:
Effective no later than January 1, 2014, prior to administering vaccine, pharmacy personnel will look up each patient in the ALERT Immunization Information System (IIS) to determine the patient’s vaccine history and to forecast vaccines needed.

Exceptions:
• This is not required when administering only influenza vaccines, but will continue to be recommended to help increase pneumococcal vaccine rates.
• This is not required when the pharmacy/pharmacist conducts a remote vaccine clinic, but will continue to be recommended when remote connectivity is available.

The revised protocols are available here.

OIP’s ALERT IIS staff have begun working with some pharmacy chains to get pharmacists and staff enrolled and trained to access ALERT IIS. One pharmacy chain is also pilot testing a bidirectional query interface between their Electronic Health Record (EHR) and ALERT IIS; this may be an additional option other pharmacies could explore for requesting and submitting immunization information. For more information on how you and your staff can connect to ALERT, please contact Jenne McKibben at jenne.mckibben@state.or.us.

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Welcome Dawn and Jenny to OIP

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Dawn Lee and Jenny Nones

OIP welcomes two new members to the family. Dawn Lee is the new grant administrative specialist and back-up for the ALERTIIS helpdesk. Dawn has a varied background that includes clerking for the Superior Court of Clark County, 20 years in construction engineering and working for the Vancouver School District. She is a native Washingtonian and lives in Clark County with her husband and three dogs. Her family also includes three boys and two grandkids. Dawn’s favorite activity is donning her leathers, climbing on her hog and riding into the sunset. That’s correct: Dawn is a Harley-ridin’ biker chick. Her favorite recent trip was the Laughlin River Run in Nevada where she also visited the Grand Canyon. Her dream ride is to someday participate in the Sturgis Motorcycle Rally in South Dakota’s Black Hills.

Jenny Nones is a fiscal analyst who will divide her work time between OIP and the State Public Health Laboratory. Jenny just finished her Master of Public Administration in Healthcare Administration. She moved around a lot as a kid, but calls Salt Lake City her hometown. Jenny moved to Oregon about three years ago and has embraced quilting and wine touring. Her favorite winery is Anne Amie, which she says has the best parties. Jenny is also an avid traveler. Her most memorable trip recently was walking 350 miles in 30 days along the Camino de Santiago in Spain. She says she always travels alone and that adventure is perfect for solo travelers.

More staff news: Congratulations to Jody Anderson. She has been promoted from her provider services team administrative support role to full-fledged health educator! Jody’s territory includes:
• Washington County
• Crook County
• Harney County
• Deschutes County
• Jefferson County
• all Indian Health Service/Tribal clinics
• all Planned Parenthood clinics
• all Virginia Garcia clinics

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Alert on ALERT – What’s new in the IIS

 by Erin Corrigan

Alert

ALERT IIS—Oregon’s immunization information system, or registry—has been going through a lot of changes lately, and we’re excited to share some of them with you. The really big thing is that after over a year of planning, development, and testing we are now live with the CDC’s vaccine ordering and tracking system (called in that inimitable CDC way, of course, VTrckS). This means that we send orders of state-supplied vaccine directly out of ALERT into CDC’s system, and ALERT IIS is able to download shipping information that McKesson and Merck send to the CDC. Electronic data about orders of VFC and 317 vaccine will appear in a clinic site’s queue as transfers; providers simply go in and accept the shipment to move all the items into their inventory. We hope you enjoy this new feature – from our perspective, it was a long time coming!

Another change is being rolled out more slowly but is just as important: We are beginning to provide a function for clinics who send us data from their EHRs to subtract doses from ALERT’s inventory module, a process often known as “decrementing inventory via data exchange.” This means that as we receive data electronically in real time or batch loads, the shots are entered into patient records and taken out of inventory at the same time. Previously, these clinics had to manually subtract these doses from inventory, which can be a time-consuming process. Because of the requirements around using ALERT related to Oregon’s Vaccine Stewardship law, this is an important step for many of Oregon’s largest health care providers. We’re so pleased that we’re able to help our partners meet the state requirements more easily and to be better vaccine stewards.

Other goings on in ALERT include participation on some of the country’s national standards boards and workgroups related to work in Immunization Information Systems. We’ve also recently completed our annual reporting to the CDC about who participates in the registry and updated our strategic plan to map our way going forward for the next five years. We’ll update you about that in future ImmiNews Alerts on ALERT.

Community Adult Immunization Clinic

Friday, April 19, 2013 • 8:00 am to 3:00 pm
Oregon Convention Center Plaza • Portland, Oregon
777 NE MLK, Jr. Blvd. 98232

Immunize Oregon will participate in an adult vaccination clinic with Linfield’s Good Samaritan School of Nursing students. Adults can receive flu, Tdap and pneumococcal vaccinations. Other health services will be available as well.

Editors note: Oregon ImmiNews is now coming to you each and every Wednesday! Tell your colleagues and friends!

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The Oregon Immunization Program welcomes two new faces

Michelle Barber

Interoperability Grant Manager

 Michelle received her MS in applied social psychology from Portland State University in 2002. She began her tenure with the Oregon Public Health Division in 2003 as a research analyst for the Acute and Communicable Disease Program. In 2005 she took a position as an epidemiologist within the Public Health Emergency Preparedness program. In this position, Michelle became more involved with the day-to-day operations of various disease surveillance systems used in Oregon. In her new role as the interoperability grant manager for the ALERT IIS team, Michelle is excited to be a part of a team that has an excellent reputation for community partnerships as well as embracing and leading efforts to improve health information exchange in Oregon.

The purpose of the Enhanced Interoperability Grant is to improve the ability to exchange immunization data between electronic health record systems (EHRs) and ALERT IIS. The grant supports a variety of activities to accomplish these goals including providing mini grants to partner organizations to enhance their EHRs to increase the submission of immunization data submitted electronically to ALERT, and to support data exchange so clinics can receive immunization records and forecasts back into the EHR for patients at the point of service.

Michelle is a life-long Oregonian. She grew up in Troutdale and Sandy, moved to McMinnville for her undergraduate education and has lived in Portland ever since. She was a collegiate swimmer, coached swimming at the college level and belongs to a master’s swim team. Michelle loves the outdoors and any activity that involves being outside: from gardening at home to rock climbing, hiking, boating and camping.

 

Lee Schrauben

Immunization Health Educator

 Lee comes to us from the faraway land of Michigan. In April, she graduated from the University of Michigan with a MPH in epidemiology. Prior to that, Lee received a BS in interdisciplinary studies in social science, health studies from Michigan State University. She has gained public health experience in a variety of venues, including a health policy non-profit, an international tuberculosis program and a chronic disease research center. 

 As an Oregon Immunization Program health educator, Lee will serve as a resource to immunization providers in the Southern Oregon and the Columbia River Gorge regions. She will ensure that these clinics have the support they need to run top-notch immunization programs and protect Oregon residents from vaccine-preventable diseases.

 Outside of work Lee enjoys experimenting in the kitchen, traveling and dabbling in photography. Lee is a Michigan native, but is settling comfortably into the Pacific Northwest. She is enjoying her new role within the Oregon Immunization Program.

 

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Oregon shines at the 2011 National Immunization Conference

The 45th annual National Immunization Conference was held earlier this spring. Several of the Oregon Immunization staff were fortunate enough to attend and present. Our state program is regarded highly for the innovate approaches we take towards immunization practice. We’re so proud of Oregon’s team and the hard work done by our public and private clinics! We thought you might like to hear/see what Oregon staff presented at this year’s conference. 

 To view/listen to all of the presentations, click on the following link:  http://cdc.confex.com/cdc/nic2011/webprogram/meeting.html

Kick-off Award Ceremony:

Our very own Lorraine Duncan (she is the black dot in the middle) presents the 2011 Natalie Smith Award to Susan Lett, MD, MPH, Medical Director, Immunization Program, Massachusetts Department of Public Health. The award is the highest form of recognition for Immunization Program Managers and recognizes contributions and accomplishments in the area of vaccine-preventable disease prevention.

Presentations by Oregon Immunization Program Staff:

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How Vaccine-Seeking Factors Into Disparities in Adult Influenza Vaccination
Holly Groom, MPH, Research Analyst, Oregon Department of Human Services/CDC; Pascale Wortley, MD, MPH; Fan Zhang, MD, PhD, MPH

Background:  Racial/ethnic disparities in influenza vaccine uptake among adults are longstanding; research suggests they result from multiple factors. Previous studies suggest that influenza vaccine-seeking behavior may be an important aspect to consider when evaluating disparities in vaccination coverage.

Objectives:  To determine if there are differences—by race or ethnicity—in influenza vaccination-seeking behavior among adults 65+ years of age.

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25415.html

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Continuous Temperature Tracking: The Secret Lives of Vaccines
Albert Koroloff, MPH, Public Health Educator, Oregon Health Authority

Background:  Vaccines for Children (VFC) is a federally funded program that provides no-cost vaccines to providers for children who might not otherwise be vaccinated because of inability to pay. The Section 317 program is a discretionary federal grant program that provides vaccines to providers for underinsured children and adolescents not served by the VFC program. Both programs depend on the safe transport and storage of vaccines: sensitive biologicals that require very specific storage conditions. To protect this federal investment, participating VFC/317 clinics are required to check and record their vaccine storage temperatures at least twice a day.

In 2007 the Oregon Immunization Program (with approval by CDC) initiated an enhanced temperature tracking requirement. This requirement states that Oregon VFC/317 clinics will “use calibrated and NIST or ASTM certified continuous-tracking thermometers or other OIP-approved devices in both refrigerator and freezer units used to store VFC vaccines.” 

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25507.html

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IIS Data Migration: Cleaning House Before the Big Move
Mary Beth Kurilo, MPH, MSW, ALERT Director, Oregon Immunization Program; Deborah Rochat, BS; Don Dumont, PhD

Background:  In 2010, the Oregon ALERT Immunization Information System (IIS) migrated from a locally developed data warehouse platform to a customized public domain clinical records model IIS. Approximately 4.5 million demographic records and 31 million immunization records collected since 1996 were cleaned, standardized and migrated to Oregon’s new system. Oregon utilized this transition to implement stronger data standards and business rules, including those produced through MIROW (Modeling Immunization Registry Operations Workgroup).

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25505.html

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Adolescent Vaccination Uptake Among Students Participating in Tdap-Only Clinics in Deschutes County, Oregon
Holly Groom, MPH, Research Analyst, Oregon Health Authority; Heather Kaisner, BA; R. Bryan Goodin, BS, MPH; Collette Young, PhD

Background:  In 2008, Tdap (tetanus toxoid, diphtheria toxoid, acellular pertussis) vaccine was added as a school entry requirement for children entering 7th and 8th grade in Oregon.  Many local health departments provided Tdap through school-located vaccination clinics in 2008, using vaccine provided at no cost by the Oregon Immunization Program.  A condition of receiving free vaccine was that all administered doses had to be entered in Oregon’s Immunization Information System (IIS).

Objectives:  To examine uptake of all adolescent- recommended vaccines among children who received Tdap in a school setting.

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25251.html

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Adding up the Benefits of Billing for Influenza Vaccinations Administered in School-Located Clinics: Experiences From Two Oregon Counties
Holly Groom, MPH, Research Analyst, Oregon Department of Human Services/CDC; Suchita Lorick, DO, MPH; Kelly Martin, MPH; Robert Moore, MD; Julie O’Neil, MPH; Rosa Duran; Bo-Hyun Cho, PhD; Garrett Asay, PhD; Mark Messonier, PhD

Background:  Oregon’s Local Health Departments (LHD) have been coordinating with schools to provide influenza vaccination in school-located clinics at no cost to schools and parents since 2006. In 2010, after a 3-yr pilot to assist LHDs in developing partnerships, the Oregon Immunization Program ceased providing LHDs influenza vaccine at no cost for school-located clinics.  In an effort to develop more sustainable approaches for vaccine delivery to school-aged children, two counties piloted a project in the 2010-2011 influenza season to bill for influenza vaccine and/or vaccine administration in school clinics.  

Follow this link to view/listen to this presentation: http://cdc.confex.com/cdc/nic2011/webprogram/Paper25253.html

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Poster presentations:

Maureen Cassidy presents her work on increased Tdap uptake to protect the most vulnerable: infants, and to assess and improve Tdap administration by Oregon birth centers.

Carlos Quintanilla presented a poster on the pharmacy internship partnership between Pacific University and the Oregon Immunization Program.

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