HomeMy WebLinkAboutInfo Sharing Agreement Immunization DataN22402 -oon20 17 °1
WASHINGTON STATE---•
IMMUNIZATION
• -INFORMATION SYSTEM
Every age . Every vaccinaUon.
Washington State Immunization Information System
RECEIVED
Information Sharing Agreement for DEPARTMENT OF HEALTH
JUL 122018
EXCHANGE OF IMMUNIZATION DATA
Office or lrnmu~iutlor,
: Ch,,d Pt·oflle
th.e Washington State Department of Healt~ ("DOH") and H ,AiJ!~d::Plan P) for the exchange of immunization records .
• DOH is the public health agency that maintains the Washington State Immunization Information System
("11S "), 11S serves as a communications link, repository , and retrieval tool for data on the immun ization
status of individuals ("immunization data"). 11S allows health care providers and health plans to exchange
immunization data with other health care providers and health plans as authorized under Chapter 70.02
RCW.
• Provider/Plan is: (check one):
[ ] A public agency, corporation, or other entity with individual shareholders, members, officers,
employees, contractors, or other personnel who are authorized under Washington law to provide health
care or public health services to individuals .
[ ] A healthcare service contractor authorized by the Washington Insurance Commissioner to sell health
insurance to, and/or administer health insurance plans in Washington State.
[ ] A school, school district, Head Start organization , and/or ECEAP grantee authorized to provide or
coordinate healthcare services for students through personnel who are authorized under Washington law
to provide such services.
[ ] An individual authorized under Washington law to provide health care services to individuals.
• Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Chapter 70.02 RCW, the uniform
health care information act require healthcare providers to keep personal health care information
confidential. Immunization records are persona l health care data . Healthcare providers may disclose
immunization records to DOH under 45 Code of Federal Regulations (CFR) § 164.512(b)(1 )(i) and RCW
70.02.050(2) because DOH is a public health agency authorized to collect immunization data.
• Chapter 42.48 RCW governs the release for research of confidential personal records obtained or
maintained by a Washington state agency. Individually Identifiable immunization records obtained by IIS
are as such personal records. Therefore, release of 11S individually identifiable immunization data for
research is subject to the requirements of Chapter 42.48 RCW.
• Subject to the terms and conditions of this agreement, Provider/Plan and DOH may exchange
immunization records for patients cared for by Provider/Plan . The purpose of the data exchange is to
improve patient care and public health .
DOH 348•576 November 2017
THEREFORE, the Parties agree,
1. DEFINITIONS
"Agreement" means this Agreement.
"CDC" means the Centers for Disease Control and Prevention.
"De-identified immunization data" means any immunization data that does not identify nor provide a
reasonable or ready basis to identify an individual.
"IIS Immunization Data" means demographics and immunization status of individual persons collected by
I1S regardless of whether in the form of raw data or appearing in other IIS features and functions as
described in Paragraph 7. Once an immunization record is entered into IIS, the record stored in the 11S
database is 11S Immunization Data.
"11S patient record" means the 118 Immunization Data for an individual.
"Immunization record" means any record regardless of source documenting the status of individual
persons.
"Party" or "Parties" means either or both DOH and Provider/Plan.
"Provider-verified immunization record" means a valid record produced or verified by a health care
professional or facility documenting the immunization status of an individual. To be valid, the record
must be in writing, dated, and indicate the name of the health care provider responsible for
administering or reviewing each immunization, or a unique stamp of the provider or facility at which the
provider practices.
2. DATA TRANSMISSION
a. Provider/Plan shall transmit to DOH all immunization records for patients who obtain health care
services from Provider/Plan. Provider/Plan shall fill all 11S data fields for which Provider/Plan has
data.
b. DOH shall transmit or make available to Provider/Plan all 11S Immunization Data for patients
receiving health care services from Provider/Plan.
3. DATA FORMAT. The Parties shall exchange the immunization records using any of the following formats:
a. Current version of the CDC's HL7 "Implementation Guide for Immunization Messaging."
b. Web-based access, which is direct entry of data into IIS.
c. Flat file exchange through secure file transfer protocol (SFTP).
4. DAT A QUALITY
a. Both Parties shall make best efforts to provide true, accurate, and complete information including
initiating entries for new patients, updating data for existing patients, and editing records that are
incorrect or inaccurate.
b. Provider/Plan shall not enter immunization records that Provider/Plan did not provide, except that
Provider/Plan may enter (1) Provider-verified immunization records and (2) a patient's self-report of
influenza vaccine and pneumococcal polysaccharide vaccine (PPSV) as necessary to complete 11S
patient records.
c. If at any time either Party has reason to believe that the data transmitted is not true, accurate, or
complete, that Party shall promptly notify the other Party.
d. DOH does not warrant the accuracy of information DOH receives from other Providers/Plans.
e. Knowingly or intentionally providing false, materially inaccurate, or materially incomplete
immunization data is a material breach of this Agreement subject to termination for cause under
Paragraph 10.
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DOH 348-576 November 2017
5. USE OF DATA
a. Provider/Plan may use individually identifiable 11S Immunization Data solely to assist Provider/Plan
in providing direct patient health care. This includes linking immunization to patient's other health
care information and disclosing patient information to the patient or, as applicable, the patient's
parent or guardian.
b. Provider/Plan shall not access any Provider/Plan employee's 11S Immunization Data for
employment purposes without written authorization of the employee.
c. DOH may use both individually identifiable and de-identified immunization data for public health
purposes , which includes, but is not limited to, disclosing patient information to ( 1) the patient or,
as applicable, the patient's parent or guardian; (2) other health care providers who need the
information for direct patient health care and have entered into an Information Sharing Agreement
with DOH; (3) a health plan if the purpose is for treatment and the health plan has entered into an
Information Sharing Agreement with DOH; and (4) research, if the release conforms to the
requirements of Chapter 42.48 RCW.
6. DISCLOSURE OF DATA
a. Provider/Plan shall not disclose in any manner any part of the 11S Immunization Data except as the
law requires or this Agreement permits .
b. Either Party may release or disclose an individual's immunization record received from the other
Party if such release or disclosure is authorized in writing by the individual and the authorization
conforms to applicable law.
c. If Provider/Plan receives a third-party request for disclosure of I1S Immunization Data and
determines the law requires such disclosure, Provider/Plan shall notify DOH at least ten (10) days
in advance of the disclosure. DOH may seek an injunction to prevent disclosure.
7. SECURITY OF DATA
a. This Agreement shall be construed to provide maximum protection to I1S Immunization Data.
b. The obligations set forth in this Paragraph 7 shall survive completion, cancellation, expiration, or
termination of this Agreement.
c. The Parties shall strictly limit use of 11S Immunization Data to uses specified by the Agreement.
Provider/Plan shall not link 11S Immunization Data with any other information or use 11S
Immunization Data to identify or contact individuals except as authorized under this Agreement.
d. The permission to access 11S Immunization Data is limited to Provider/Plan's principals or
employees for whom Provider/plan:
i. Authorized such access;
ii. Trained in the disclosure and security requirements under this Agreement;
Iii. Maintains on file a confidentiality agreement signed by the principal or employee,
Provider/Plan may use its own confidentiality agreement but it must contain substantially
the same information as the confidentiality agreement in Attachment B; and
iv. Secured a user account with 11S login and password; Provider/Plan may secure user
accounts by submittal of copies of fonn in Attachment C.
e. Provider/plan shall:
i. Assure that no one assigned an 11S user account shares their login ID or password with
others or allows others to access 11S using their login ID.
ii. Limit access and use of IIS Immunization Data in order that the fewest number of people
see only the smallest amount of data for the least amount of time necessary to complete
required work.
iii. Assure that all people with access to IIS Immunization Data understand their
responsibilities regarding it.
iv. Retain a copy of all confidentiality agreements specified in Paragraph 7.d.iii for at least six
(6) years following termination of this Agreement.
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DOH 348-576 November 2017
f. Provider shall ensure that Provider's privacy and security practices meet or exceed the standards
set by state and federal law for the security of protected health information and as commensurate
with Provider's obligations under the law.
g. Provider/Plan shall take all steps necessary to prevent unauthorized access, use, or modifications
of 11S Immunization Data.
h. Provider/Plan shall notify DOH at DOHPrivacy Offlcer@doh .wa.gov of any suspected or actual
security breach of IIS Immunization Data within two (2) business days of discovery.
8. OTHER FUNCTIONS AVAILABLE IN IIS . Plan/Provider may utilize without charge such other 11S
functions as DOH specifically authorizes Plan/Provider to utilize. Attachment A describes 11S features and
functions.
9. HOLD HARMLESS . DOH is not liable for any general, special, consequential, or other damages that may
arise or claim to arise from any use of 11S Immunization Data by Provider/Plan, its employees, contractors,
officers, agents, or affiliated persons. Provider/Plan shall indemnify and hold DOH harmless from any
claim for damages that may arise or be claimed to arise from Provider/Plan's transmission to 11S of
immunization data that is knowingly or intentionally false, materially inaccurate, or materially incomplete .
10. PERIOD OF PERFORMANCE. The Period of Performance is 5 Y ea rs from Date o f Execution unless
earlier terminated as provided by this Agreement.
11. TERMINATION.
a. Either Party may terminate this Agreement effective as of the end of any calendar quarter,
provided the terminating Party gives written notice of termination to the other Party at least 30 days
before the end of the quarter.
b. Either Party may terminate this Agreement for cause after the other Party has failed to cure a
material breach, provided the terminating Party gives the other Party written notice of breach and
provides at least 14 days for the other Party to cure the breach.
12. SAVINGS. If funding from state, federal, or other sources is withdrawn, reduced, or limited in any way
during the Period of Performance, DOH may, in whole or in part, suspend or terminate the Agreement,
upon immediate notice, subject to renegotiation at DOH's discretion under the new funding limitations or
conditions.
13. AMENDMENT. The Parties may amend this Agreement by mutual agreement. Such amendments are
not binding unless in writing and signed by the persons authorized to bind each of the Parties.
14. APPLICABLE LAW AND VENUE. This Agreement is governed by the laws of the State of Washington.
Venue is in the Superior Court of Thurston County.
15. CONTACT INFORMATION. The following persons are the contact for all communications about this
Agreement.
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DOH 348-576 November 2017
Provider/Plan:
Contact Person and Title:
DOH:
Mail to:
Phone:
Washington State Department of Health
Office of Immunization and Child Profile
PO Box 47843
Olympia, WA 98504-7905
360-236-3595 or 1-866-397-0337
AGREED on this ~day of __ J_~_ll\.tJ ____ . 2ollli_.
By execution of this agreement, the parties so signing acknowledge they have full power and authority to enter
into and perform this agreement on behalf of the signatory as well as the business entity referenced within the
body of the agreement.
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DOH 348-576 November 2017
ATTACHMENT A
Services Available in the 11S
DOH is solely responsible for the operation and management of I IS, which benefits patients, their care providers,
health plans, public health agencies, and other entities that are concerned with assuring the effective
immunization of Washington State's population .
11S is available 24 hours a day, 7 days a week, with the exception of scheduled and unexpected outages. DOH
schedules system maintenance outside of regular business hours and with prior notice if possible.
Available Functions
11S has several role~based access levels. DOH will grant to users only those functions necessary to conduct the
user's work. The available functions in the system include , but are not limited to, the following:
• Patient record demographic data query and update
• Patient record vaccination data query and update
• A vaccination forecast displaying vaccines due for each patient. The vaccination forecast is based on the
recommended immunization schedule published by the Centers for Disease Control and Prevention
(CDC) with the advice of the Advisory Committee on Immunization Practices. The vaccination forecast is
subject to change if/when the CDC establishes new guidelines. DOH will incorporate such changes in 11S
as soon as possible.
• Vaccine ordering by providers enrolled in the State Childhood Vaccine program
• Vaccine order status tracking
• Vaccine management and accountability including: • Ability to complete the annual provider agreement to enroll or re~nroll in the State Childhood
Vaccine program • Ability to complete vaccine accountability report(s) and electronically submit them to the local
health jurisdiction
• Generation of reminder/recall to contact patients due for vaccination
• Record contraindication(s) for specific vaccines for each patient with specification of the reason for the
contraindication or precaution
• Record of adverse reactions for specific vaccine for each patient
• Generation of reports including: • Patient specific vaccination reports showing detailed vaccination history and forecast • Detailed practice-based reports such as practice immunization coverage data , vaccines
administered data, and vaccine lot data
DOH, in its sole discretion, modify or remove available functions at any time .
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DOH 348-576 November 2017
ATTACHMENT B
11S Confidentiality Agreement
I understand that my employer, ________ , (insert name of Employer) has entered into an
Information Sharing Agreement with the Washington Department of Health to view and/or exchange data in the
Washington State Immunization Information System ("11S"). My employer has made a copy of the Agreement
available to me.
I understand that I am responsible for maintaining the confidentiality of any IIS Immunization Data that I have
access to during the course of my employment. 11S Immunization Data means demographics and Immunization
status of Individual persons collected by 11S, regardless of whether In the form of raw data or appearing in other
1IS features and functions made available to my employer.
I will not share my unique IIS login code with anyone nor allow anyone to access 11S using my login code.
I will not at any time, nor in any manner, either directly or indirectly divulge, disclose, release, or communicate
any 11S Immunization Data to any third party unless specifically necessary to perform my assigned job duties,
required by law or authorized by the person, or parent or guardian of the person, to whom the 11S Immunization
Data applies. I recognize that maintaining confidentiality includes not discussing 11S Immunization Data outside
of the workplace. I will limit my own access to person-specific data In IIS to that which is necessary to perform
my job duties.
I understand that if I discuss, release, or otherwise disclose confidential data/information outside of the scope
of this policy through any means, I may be subject to disciplinary action, which may include termination of
employment.
Employee signature: Date:
Employee name (please print):
Received on (date): By: (supervisor's signature):
A signed copy of this form must be on file with the Employer before employee may access I IS .
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DOH 348-576 November 2017
ATTACHMENT C
Washington State Immunization Information System
System User Access Account for Exchange of Immunization Data
Provider/Plan Name ______________ Contract# ______ _
This worksheet Is to request user accounts to access IIS Immunization Data under the above Information
Sharing Agreement. Make add itional copies of this form if needed . Fill in the requested information for each
principal or employee who will need access lo I IS Immunization Data, then fax the form to 360-263-3590.
Each person must create a Login ID of all letters, all numbers, or a combination of letters and numbers AT
LEAST four characters long (but can be longer). Login IDs are not case sensitive . 11S will provide a temporary
password for each user. The system will prompt for a new password upon logging in the first time .
Questions? Please contact our Help Desk at 1-800-325-5599 or via email atWAIISHelpDesk@doh.wa.gov.
Login ID : ____________ (al leas/ 4 charact6rs) Office Phone (__J __ -___ Ext. __ _
Office Email:~ ___________________ Credentials, if ru,y: _____ (e.g .. MA, RN)
First Name: _____________ _ Last Name: ________________ _
Clinic Site(s): _________________________ _
Does user float between more than one clinic? _yes _no Does the user administer vaccines? __yes _no
Login ID; ____________ (at /errs/ 4 characters) Office Phone L_) __ -___ Ext. __ _
Office Email : ____________________ Credentials, if ony :. _____ (e.g .. MA, RN)
First Name: Last Name: ________________ _
Clinic Site(s): __________________________________ _
Does user float between more than one clinic? __yes _no Does the user administer vaccines? _yes _no
Login ID: ____________ (at least 4 characters) Office Phone (__J __ -___ Ext.
Office Email: ____________________ Credentials, ifany:c_ ____ (e.g., MA, RN)
First Name: _____________ _ Last Name: ________________ _
ClinicSite(s): ___________________________________ _
Does user float between more than one clinic? __ yes _no Does the user administer vaccines? __yes _no
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DOH 348-576 November 2017
Today's Date
05/29/2018
Fund/Department
116-Public Health
Kittitas County
Review Form
Grants & Contract Agreement
Agenda Date
Contract/Grant Information
'
(j I I q ( t[)J
Contract /Grant Agency: Washington State Immunization Information System Information Sharing
Agreement for Exchange of Immunization Data
Period Begin Date: June 19, 2018 I I Period End Date: June 19, 2023
Total Grant/Contract Amount: None
Grant/Contract Number:
Contract/Grant Summary: This agreement is between the Washington State Department of Health
Immunization Program and the Kittitas County Public Health Department. The agreement is in place and
allows health care providers and health plans to exchange immunization data with other health care
providers and health plans.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature: ~ 1 Administrator Date:~{ll
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
/4 / . 1. {:;-!//J
Date
Date
Signature of Board of Health member Date
Financial Information
Total Amount$ State Funds$ Federal Funds$
Percentage County Funds Matching Funds$ CFDA#
In -Kind$
Explain
Grant/Contract Review Page 1
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring-reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes D attach budget form No D Why not
New Division Created?
Revenue Code
Pass Th rough Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date :
Prosecutor Review
I Has the Prosecutor reviewed this agreement? [ Yes D No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
I Signature :
Department:
I Date :
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2