Electronic Health Records and Immunization Information Systems Interoperability: Measuring Impact on Immunization Outcomes

INTRODUCTION: Immunization is an intervention proven to reduce morbidity and mortality for several infectious diseases, yet coverage remains less than optimal, especially among minorities and the poor. Challenges to adequate coverage are associated with access and consolidated immunization documentation to support clinical immunization decision making. Efforts to improve access and service delivery include Community Guide recommended interventions, the Vaccines for Children (VFC) Program, and electronic data exchange between provider electronic health records (EHR) and state and city immunization information systems (IIS). AIM: The purpose of this study is to 1) determine if EHR-IIS interoperability improves immunization outcomes and 2) identify how EHR-IIS interoperability may improve the capacity to support activities to increase appropriate immunization. METHODS: Data reported by state IIS for immunization provider sites both prior to and after the establishment of or the improvement of an existing EHR-IIS interface were analyzed to examine changes in 1) the mean difference in the proportion of 19 to 35 month old children at these sites who were up-to-date for age-appropriate immunizations, and 2) the mean difference in completion of key demographic and vaccine-related fields for 4m to 6 year-old children associated with enhanced sites in the IIS. RESULTS: Statistical analysis yielded evidence of a positive change in the mean difference in the proportion of children aged 4m to 6 years with key demographic and vaccine data in IIS. A statistically significant change in the mean difference of up-to-date status in 19 to 35 month olds was not detected. DISCUSSION: Evidence suggests that EHR-IIS interoperability can improve the capacity of IIS in targeting of immunization services to underserved populations and support accountability for the VFC program. Implementation of EHR-IIS interfaces must be performed thoughtfully and support accountability and with an understanding of the impact of the interface on IIS data used to support immunization program activities. Immunization outcomes for children at provider sites engaging in electronic data exchange with IIS should continue to be monitored. Additional analysis must be done to identify the interoperability factors that are positively and negatively associated with improved immunization outcomes

Assessment of the Current Reporting Requirements of the Kentucky Immunization Registry

Immunizations are essential to societal health and wellbeing. Throughout one’s lifespan, immunizations are to be administered incrementally to decrease the prevalence of preventable diseases. Despite this, there are disparities in the rates of vaccinations across the country. Numerous guidelines and regulations have been published regarding the administration and scheduling of vaccines. Certain vaccinations are mandatory in order to be able to attend school or hold certain occupational positions and normally proof of administration is required. Immunization registries were created to monitor and record patient-specific data about administered vaccines. These confidential reporting systems were developed to improve population health by allowing for the surveillance of vaccine compliance, disease prevention, and missed opportunities. While some regulations surround individual state registries, most states do not require vaccine reporting by the majority of healthcare providers. The Kentucky Immunization Registry (KIR) requires the reporting of only specific administered vaccines. This reporting gap leaves a large amount of data out of the system. The intent of the immunization registry is to improve vaccination rates, but unless data is submitted to the registry, its full potential cannot be achieved. The purpose of the research is to assess pharmacists\u27 views of the KIR and to determine if there is a need to further increase vaccination reporting requirements. Out of the 1,000 pharmacists randomly selected to complete a survey, there was a response rate of 142. Pharmacists, on average, agreed that they were in favor of increasing KIR reporting requirements. On average, pharmacists reported being unfamiliar with the KIR, but this did not have a significant impact on how pharmacists responded to questions concerning increasing KIR reporting. It was also discovered that pharmacists who were neutral in opinion or disagreed with the current reporting requirements of the KIR appeared to be more unfamiliar with the KIR compared to other groups. The respondents regarded missed opportunities and preventable diseases as important issues in Kentucky. Those who believed these were important issues also slightly agreed that mandating the KIR would improve missed opportunities and preventable disease rates. Immunization registries are becoming more prevalent in today’s healthcare community. Despite this, unfamiliarity with the KIR is still present. Satisfaction with the current reporting requirements is neutral among those surveyed, but a need for reporting all vaccines to the registry is observed. Surveyed pharmacists, on average, viewed missed opportunities and preventable diseases as issues in Kentucky, but mandating immunization reporting to the KIR as a possible solution for improving rates only received slight support. Implications of these findings suggest that there is a need for increased education and training on the KIR to increase reporting

Implications of a national immunization registry an alliance to win the race for the future care and accuracy of pediatric immunization

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries

Divergent approaches in the vaccination of recently arrived migrants to Europe: a survey of national experts from 32 countries, 2017

Background: Migrants within the European Union and European Economic Area (EU/EEA) may be underimmunised and lack documentation on previous vaccinations. We investigated approaches to vaccination in recently arrived adult and child migrants, and guideline availability and implementation. Methods: Between March and May 2017, a national vaccination expert from every EU/EEA country and Switzerland completed an electronic questionnaire. We used descriptive analyses to calculate percentages, and framework analysis to synthesise free-text responses. Results: We approached 32 countries (response rate 100%). Although 28 experts reported vaccination guidance at national level, specific guidelines for recently arrived migrants were only available in six countries and not consistently implemented. Twenty-three countries administered vaccinations during on-arrival health checks. Most experts recommended multiple vaccination opportunities be made available: at point of entry (n = 13) or at holding level (reception centres, migrant camps, detention centres) (n = 21). In 30 countries, child migrants without evidence of previous vaccination were re-vaccinated according to the national schedule. Diphtheria-pertussis-tetanus and polio vaccinations were given to migrant children in all countries, measles-mumps-rubella (MMR) in 31 countries, hepatitis B vaccination in 25. Low levels of catch-up vaccination were reported in adult migrants, with only 13 countries offering MMR and 10 countries charging fees. Conclusion: Existing guidance is often not migrant-specific and may not be applied in practice; clarification is needed on which vaccines should be given. Strategies are needed specifically for catch-up vaccination in adult migrants. Vaccinations should be offered in multiple settings, free of charge, with sufficient guidance and training provided to front-line healthcare professionals

Evaluation of the System Attributes of Timeliness and Completeness of the West Virginia Electronic Disease Surveillance System\u27 NationalEDSS Based System

Despite technological advances in public health informatics, the evaluation of infectious disease surveillance systems data remains incomplete. In this study, a thorough evaluation was performed of the West Virginia Electronic Disease Surveillance System (WVEDSS, 2007-2010) and the West Virginia Electronic Disease Surveillance System NationalEDSS -Based System (WVEDSS-NBS; March 2012 - March 2014) for Category II infectious diseases in West Virginia. The purpose was to identify key areas in the surveillance system process from disease diagnosis to disease prevention that need improvement. Grounded in the diffusion of innovation theory, a quasi-experimental, interrupted, time-series design was used to evaluate the 2 data sets. Research questions examined differences in mean reporting time, the 24-hour standard, and comparison of complete fields (DOB, gender etc.) of the data sets using independent samples t tests. The study found (a) that the mean reporting times were shorter for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all vaccine-preventable infectious diseases (VPID) in Category II except for mumps; (b) that the 24-hour standard was not met for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all VPID in Category II except for mumps, and (c) that most fields were complete for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all VPID in Category II except for meningococcal disease. Healthcare professionals in the state can use the results of this research to improve the system attributes of timeliness and completeness. Implications for positive social change included improved access to public health data to better understand health disparities, which, in turn could reduce morbidity and mortality within the population

Implementation of a Pharmacy-Based Adult Vaccine Benefit: Recommendations for a Commercial Health Plan Benefit

BACKGROUND: Although vaccination rates in children exceed 90% in the United States, adults are vaccinated at far lower rates. In order to address this issue, additional community immunizers are needed, and pharmacists are in an ideal position to fill this void. OBJECTIVES: To explore issues and barriers related to implementation of a pharmacy-based adult vaccine benefit and develop recommendations supporting a pathway for benefit expansion. METHODS: A literature review on the current environment surrounding pharmacy-based adult vaccinations and structured interviews were conducted to inform an expert panel meeting using a modified Delphi process (pre/post survey). The goal was to develop recommendations on how to improve access to adult vaccines. RESULTS: Findings suggest employers play a key role in requesting changes in benefit design to include pharmacy-based vaccinations. However, the lack of consistent communication between pharmacists and primary care providers remains a significant barrier. CONCLUSIONS: Pharmacy-based access to vaccinations improves patient access and benefits individuals and employers. In order to take advantage of this opportunity, pharmacists must be viewed within the broader context of preventative care, including pharmacy-based vaccinations

Global routine immunization strategies and practices (GRISP) : a companion document to the Global Vaccine Action Plan (GVAP)

ISBN 978 92 4 151010