View this as a webpage

• Adult Td/Tdap immunization coverage in Minnesota
• Historical immunizations? Here’s how to report them
• Complete data better supports immunization activities
• Want your practice to improve immunization coverage rates? IQIP can help!
• Learning corner: Forecaster 101
• Release updates: Production releases on security and infrastructure
• Provider spotlight: Steven Rudolph

Adult Td/Tdap immunization coverage in Minnesota

The advisory committee on immunization practices (ACIP) recommends that anyone 10 years or older receive a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at least once, and then a Tdap or Td (tetanus and diphtheria) vaccine every 10 years thereafter. As of January, 56% of adults 18 years and older in Minnesota have received a Tdap or Td vaccine within the last 10 years. This trend has remained stable over time.

Additionally, there are disparities in adult Td/Tdap immunization coverage by race/ethnicity. In Minnesota, Td/Tdap coverage is highest among white, non-Hispanic and lowest among Hispanic and Asian/Pacific Islander, non-Hispanic adults.

What can you do to help improve adult tetanus immunization coverage in Minnesota?

• Adults who haven’t previously received Tdap should get a dose, especially if they’re in close contact with babies, to protect against whooping cough. Tdap is needed even if the adult was vaccinated with DTaP as a child or has been sick with pertussis in the past. The first Tdap can be administered at any time—even if the adult has recently had a tetanus (Td) shot.
• Make sure that adults have received a Tdap or Td vaccination in the past 10 years.
  • Assess every adult patient at every visit to prevent missed opportunities to vaccinate.
  • Recall to clinic adults who have not received a Tdap or Td vaccination in the past 10 years.
    • The client follow up (CFU) tool in MIIC can assist in identifying those that have not received a Tdap or Td. Learn more about utilizing CFU with our user guidance at Client Follow-Up MIIC User Guidance and Training Resources
      • Tip: Select the ‘tetanus-containing vaccine’ option.
• Tdap can be used whenever Td/Tdap is routinely recommended and for wound management. Using Tdap rather than Td provides additional protection against pertussis.
• Update MIIC with missing immunization information.
  • Adults born before 2002 and adults who have lived outside of Minnesota, may not have a full childhood immunization history in MIIC.
  • If you have record of immunizations that are not in MIIC, report the historical immunizations following the guidance below on how to report historical immunizations.
• Make a strong recommendation for Tdap vaccination during pregnancy. Tdap vaccination is recommended during every pregnancy.

Historical immunizations? Here’s how to report them

Adults born before 2002 and those who have lived outside of Minnesota are less likely to have a complete immunization record in MIIC. If you receive immunization records that are not in MIIC, you should report them to MIIC as historical doses. A historical immunization is an immunization that your organization reports to MIIC on behalf of a different organization that administered it.

Before reporting the historical immunization to MIIC, clients should provide proof of their immunizations. The documentation provided should include the vaccine administered date, vaccine name, and the client's demographic information.

Learn more about historical immunizations, including acceptable proof of immunizations and data entry methods at Capturing Immunizations Not Currently in MIIC (PDF).

For questions about reporting historical immunizations, contact the MIIC help desk at health.miichelp@state.mn.us.

Complete data better supports immunization activities

Complete demographic information improves the accuracy and usability of MIIC data. It is important to update or confirm demographic information for your patients not only when vaccinating your patients, but also when entering their historical immunization records or when your patients specifically request updates outside of vaccination appointments. Improved data quality helps us provide better important services to both you and your patients.

Complete and up-to-date address information is particularly necessary to ensure immunization reminder/recall notifications reach the right person and that immunization coverage rates accurately reflect in the population of a certain geographic area. Every client encounter is an opportunity to confirm:

• Complete addresses are entered in MIIC (i.e., full street line, city, state, and zip code).
• All reported address information is accurate, current, and saved in the right fields.
• Only one address is saved in MIIC (i.e., do not move/send previous addresses information to the other address line).
• Unnecessary address information, such as the name of a building or an administrative note (e.g., “Need Address”), is not entered.
  • Additional lines needed for mailing (e.g., "C/O") should only be included in the 'Other Address Line' in MIIC.

Because many electronic health records (EHR) send data automatically to MIIC it’s important to remember this both when entering information directly into MIIC and when entering information into your EHR.

Want your practice to improve immunization coverage rates? IQIP can help!

Providers enrolled in the Minnesota Vaccine for Children (MnVFC) program are encouraged to participate in the immunization quality improvement for providers (IQIP) program. IQIP promotes and supports the implementation of provider-level quality improvement strategies designed to increase vaccine uptake among children, adolescents, and older teens in adherence to the ACIP-recommended routine schedule.

Providers who participate in IQIP are connected with a trained public health professional who will guide the provider through 12 months of quality improvement (QI) support that starts with a site visit. Site visits can be in-person or virtual and consist of:

• A clinic workflow assessment.
• Review of current immunization coverage rates.
• Selecting strategies to implement or improve upon immunization clinic best practices.

Check-ins throughout the 12-month cycle help prioritize QI activities. If your organization already has QI goals or programming, IQIP can support those efforts with technical assistance and resources.

Email Health.IQIP@state.mn.us to request an IQIP site visit today or to learn more about IQIP.

Learning corner: Forecaster 101

At the bottom of each immunization record in MIIC is a list of vaccine groups showing whether a vaccine series is complete or when future doses can be administered based on ACIP guidelines. This clinical decision support for immunization (CDSi) or forecaster is a great tool to support immunization practice. Forecaster information should be used in conjunction with other information you have about your patient.  

Complete vaccine series have a pink “Complete” banner. The forecaster includes up to four dates when a vaccine group requires additional doses. 

The date columns are:

• Earliest date: The earliest possible date the next dose of a vaccine in the vaccine group can be given, according to ACIP recommendations.
• Recommended date: the recommended date for the next dose in the vaccine group.
• Overdue date: The date at which a client is considered to be overdue for their next dose. The overdue date is set a few months or a year after the recommended date, depending on the vaccine group.
• Latest date: The latest possible date the client is eligible to receive a vaccine. Not all vaccine groups have a latest date, but some, such as DTaP, do. In the image above, the latest date for DTaP is the day before the client’s seventh birthday.

Due to the seasonal nature of influenza and Routine COVID vaccines, the forecaster will recommend another dose, regardless of when a dose is received in a given season. Rest assured that this does not mean that additional doses are required for clients who have completed the initial series or received their single annual shot.

Release updates: Production releases on security and infrastructure

Monthly production releases continue to focus on security and infrastructure. However, we made some user-facing changes as well.

MIIC will now accept diacritic characters (a purposeful mark added to a letter) in name data. Organizations may now send name data to us through electronic exchange and users can input data into the user interface with several of the most common accents. MIIC will then save that information as is rather than reject the data or convert it to a non-diacritic version.

We have added an additional measure to the childhood assessment report to assess receipt of 2 doses of influenza vaccine, spaced at least 28 days apart, by 24 months of age. 

Provider spotlight: Steven Rudolph

Organization, position, and length of position

Steven Rudolph is the MIIC Administrator for the Minneapolis VA Health Care System and has been in this position since January 2020.

How long have you been a MIIC user?

4 years.

Your organization recently onboarded for electronic data exchange with MIIC. Describe that process and how it has impacted immunization practice for your organization.

The exchange begins through the IZ gateway, a national data center. The night before a patient’s scheduled appointment the electronic health system triggers a query that reaches out to MIIC to pull the patient’s records from the database and compares with the records they have in the health system. If an immunization from MIIC is not in the VA system, the electronic health system adds that immunization from MIIC. The records or any additional vaccinations send automatically to IZ gateway which goes to MIIC for all immunization records from primary and specialty care. Automatically sharing has made sure that providers are looking at records as up to date as possible and avoiding duplicate records or doubling vaccinations for patients that may have already taken place. Electronic data exchange streamlines the process and helps make sure that those who haven’t been immunized are encouraged to be immunized and helps the VA with patients who see providers outside their organization.

What benefits does electronic data exchange with MIIC bring to your organization and your clients?

Electronic data exchange brings a better whole health care approach to patients. This ensures they can get care outside of as well as within our organization by having a single MIIC record. It also gives all providers the opportunity to get the best possible care and gives them the maximum information for immunizations that will protect them. This leaves out the mystery of when a patient got an immunization, especially when receiving outside care.

How do you support staff who still need to access the MIIC user interface (e.g., to run reports, verify data submissions)?

I set up accounts when providers haven’t been using MIIC recently or need an account set up. I also help with resetting passwords and talk with providers who use IZ gateway and MIIC. Providers generally use the MIIC user interface 1-2 times a week to verify immunization dates especially with patients with similar names. We currently have about 60 active users of MIIC (users in the last 90 days) and I help make sure they can access the most up to date and accurate data.

What advice do you have for other organizations considering onboarding for electronic data exchange with MIIC?

It’s an amazing resource that can help organizations give patients best possible care by giving the most up to date and accurate data and strongly encourage other organizations do it to participate.

What other immunization projects are you/your organization looking forward to?

Since covid I’ve been very active in the flu/covid committee, getting information out to patients as new vaccines come out or as vaccine recommendations change to ensure patients are as informed as possible and to encourage disease prevention.

health.state.mn.us