An Immunization Q&A with Shiree Southerland

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Dr. Shiree Southerland, CMS
Dr. Shiree Southerland, CMS

Shiree Southerland, PhD, RN, BSN, currently works as a Health Insurance Specialist within the Center for Clinical Standards and Quality (CCSQ), Quality Improvement and Innovation Group (QIIG) at the Centers for Medicare & Medicaid Services (CMS). Her primary responsibility includes serving as a Subject Matter Expert for the adult immunization work being conducted by Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs). In this capacity, Dr. Southerland provides programmatic technical assistance and works collaboratively with the National Coordinating Center (NCC). Prior to joining CMS, Dr. Southerland worked at the Health Resources and Services Administration’s Bureau of Primary Health Care, providing technical direction in all aspects of grant management to Federally Qualified Health Centers (FQHC) located in rural North and South Dakota, Kansas, Nevada, Arizona and Wisconsin. Dr. Southerland maintains her clinical practice as a bedside nurse working at a large, well-known research and teaching hospital in the Baltimore area, where she primarily practices in the areas of medicine, research, hospice/​palliative care and surgical oncology. Throughout her career, Dr. Southerland has continued to teach both classroom-based and online courses in public health, liberal arts, gerontology/​behavioral health and nursing at several universities. She is currently serving as a content developer in an online undergraduate course in health disparities for undergraduate public health students.

Q. What is new or different about Quality Innovation Network-Quality Improvement Organizations’ (QIN-QIOs’) current immunization-related activities than in past years?

Our current immunization work evolved from a recent CMS Special Innovation Project in Oregon and Wisconsin that was designed to improve physician reporting to state immunization registries. We took the lessons learned from that project and expanded the QIN-QIOs’ scope of work to focus not only on reporting but on improving immunization rates among minority and underserved populations in 37 states and territories nationwide. Specifically, we want them to help these states increase their rates of influenza, pneumonia and herpes zoster vaccinations. The herpes zoster vaccination helps prevent shingles – a terrible disease that is not necessarily life threatening but that has long-term side effects like debilitating nerve pain that can severely impact quality of life.

Q. What are some examples of national or community partners and stakeholders with whom QIN-QIOs will be collaborating on their immunization work, and how specifically will they be working together? 

One organization I have worked with extensively is the National Adult and Influenza Immunization Summit (NAIIS) – a group of more than 700 public and private partners dedicated to addressing and resolving adult and influenza immunization issues. I recently gave a presentation at their annual meeting. I encourage all QIN-QIOs to get acquainted with this organization due to the valuable resources on their website and the workgroups in which they can get involved. QIN-QIOs also can access the resources of the U.S. Department of Health and Human Services' (HHS) National Vaccine Program Office and the Immunization Action Coalition.

As far as community partners are concerned, QIN-QIOs generally have good contacts with local senior centers and local or regional chapters of organizations whose members are Medicare beneficiaries. They also may want to work with pharmacies, health departments and home health agencies on their immunization activities. Because of the integrated nature of our prevention work, we encourage QIN-QIOs to work closely with the providers, partners and beneficiaries involved in existing cardiac care initiatives. That will enable us to provide better coordinated care and to approach beneficiaries from a holistic health perspective.

Q. While QIN-QIOs are tasked with increasing the rate of Medicare beneficiaries who receive influenza and herpes zoster vaccinations, their most aggressive goal is to deliver pneumonia vaccinations to one million previously unimmunized Medicare beneficiaries nationwide by 2019. Why is achieving this goal so important?

In short, because pneumonia – together with influenza – is the eighth leading cause of death according to data from the Centers for Disease Control and Prevention (CDC). We want to improve the quality of life and overall health of Medicare beneficiaries at the community level as well.

Q. The QIO Program is known for being data driven, and health care providers appreciate QIN-QIOs’ ability to help them extrapolate, understand and submit data. How does this numbers-related work contribute to meeting national immunization goals and protecting the health of Medicare beneficiaries?

The QIN-QIOs’ numbers-related work contributes to improving health data portability through increased reporting to the state immunization registries. As a beneficiary, your personal health record (PHR) becomes portable as you move from provider to provider. All of your medical information is housed in a national system. We want to make sure that all current Medicare beneficiaries’ immunizations are recorded in their state registry, so that they can easily access the information and transfer it to new providers. Keeping track of this data is also important for providing chronic disease management for conditions like heart disease and chronic obstructive pulmonary disorder. QIN-QIOs are identifying providers that are not currently reporting data to their state registry and are helping them get their electronic health record systems to talk” to the registry. 

"We want to help providers provide total care for their patients, particularly since getting the flu can be deadly for beneficiaries with multiple chronic conditions."

My own family has benefited from the portability of immunization data. This summer, we needed to pull my daughter’s immunization records before she attended summer camp. Our provider was able to seamlessly download them from the state registry and sent them to me. Even if we move to another state, this information will continue to be easily accessible. The good thing about the registry is that the records of children who are my daughter’s age are already in there; when their generation ages into adulthood and eventually to Medicare beneficiary status, their records will still be in there. Now we just need to ensure that current Medicare beneficiaries’ immunization records are added to the state registries as well.

Q. How will QIN-QIOs engage beneficiaries in helping improve immunization rates?

There is an opportunity to do so by including them in learning and action networks (LANs) and in community-based work. QIN-QIOs can work with their local senior centers, Medicare beneficiary-oriented organizations and home health agencies to identify beneficiaries who want to collaborate with them. Flu season is almost upon us, so we need to start doing this by late August or early September.

Q. Anything else you would like QIO News readers to know?

Our immunization work aligns with current Advisory Committee on Immunization Practices (ACIP) guidelines outlining the Standards for Adult Immunization Practice; HHS’ Adult Immunization Plan; Healthy People 2020 goals; and the work of HHS’ National Vaccine Program Office. We are very excited to be launching this initiative nearly nationwide and are hopeful that we will learn a lot and be able to roll it out to all states and territories in the near future.