Utilizing an Electronic Health Record System to Improve Vaccination Coverage in Children
24 December 2009
accepted: 26 June 2010
16 December 2017 (online)
Background: Electronic Health Records (EHR) are widely believed to improve quality of care and effectiveness of service delivery. Use of EHR to improve childhood immunization rates has not been fully explored in an ambulatory setting.
Objective: To describe a pediatric practice’s use of Electronic Health Records (EHR) in improving childhood immunization.
Methods: A multi-faceted EHR-based quality improvement initiative used electronic templates with pre-loaded immunization records, automatic diagnosis coding, and EHR alerts of missing or delayed vaccinations. An electronic patient tracking system was created to identify patients with missing vaccines. Barcode scanning technology was introduced to aid speed and accuracy of documentation of administered vaccines. Electronic reporting to a local health department immunization registry facilitated ordering of vaccines.
Results: Immunization completion rates captured in monthly patient reports showed a rise in the percentage of children receiving the recommended series of vaccination (65% to 76%) (p<0.000). Bar-code technology reduced the time of immunization documentation (86 seconds to 26 seconds) (p<0.000). Use of barcode scanning showed increased accuracy of documentation of vaccine lot numbers (from 95% to 100%) (p<0.000).
Conclusion: EHR-based quality improvement interventions were successfully implemented at a community health center. EHR systems have versatility in their ability to track patients in need of vaccines, identify patients who are delayed, facilitate ordering and coding of multiple vaccines and promote interdisciplinary communication among personnel involved in the vaccination process. EHR systems can be used to improve childhood vaccination rates.
- 1 U. S. Department of Health and Human Services.. Healthy People 2010: Volume I Conference ed. Washington, DC: US Department of Health and Human Services; 2000
- 2 Centers for Disease Control and Prevention.. Recommended immunization schedules for persons aged 0-18 years: United States, 2010. MMWR Morb Mortal Wkly Rep 2010; 58 51&52 1-4.
- 3 Centers for Disease Control and Prevention.. Recommended immunization schedules for persons aged 0-18 years: United States, 2009. MMWR Morb Mortal Wkly Rep. 2009; 58 (33) 921-926.
- 4 Mell LK, Ogren DS, Davis RL, Mullooly JP, Black SB, Shinefield HR. et al. Compliance with national immunization guidelines for children younger than 2 years, 1996-99. Pediatrics 2005; 115: 461-467.
- 5 Stokley S, Rodewald LE, Maes EF. The impact of record scattering on the measurement of immunization coverage. Pediatrics 2001; 107: 91-96.
- 6 American Academy of Pediatrics, Committee on Infectious Disease 1998-1999.. Recommendations on combination vaccines for childhood immunization. Pediatrics 1999; 103: 1064-1077.
- 7 Luman ET, McCauley MM, Stokley S, Chu SY, Pickering LK. Timeliness of childhood immunization. Pediatrics 2002; 110: 935-939.
- 8 Klein JO, Myers MG. Vaccine shortages: Why they occur and what needs to be done to strengthen vaccine supply. Pediatrics 2006; 117: 2269-2275.
- 9 Kempe A, Babbel C, Wallace GS, Stokley S, Daley MF, Crane LA. et al. Knowledge of interim recommendations and use of Hib vaccine during vaccine shortages. Pediatrics 2010; 125: 914-920.
- 10 Fiks AG, Hunter KF, Localio AR, Grundmeier RW, Bryant-Stephens T, Luberti AA, Bell LM, Alessandrini EA. Impact of electronic health-based alerts on influenza vaccination for children with asthma. Pediatrics 2009; 124 (01) 159-169.
- 11 Fiks AG, Grundmeier RW, Biggs LM, Localio AR, Alessandrini EA. Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric population. Pediatrics 2007; 120 (04) 707-714.
- 12 Kemper AR, Uren RL, Clark SJ. Adoption of electronic health records in primary care pediatric practices. Pediatrics 2006; 118 (01) e20-e24.
- 13 Spooner SA, Classen DC. Data standards and improvements in quality and safety in child healthcare. Pediatrics 2009; 123 (02) S74-S79.
- 14 Samaan ZM, Klein MD, Mansour ME, DeWitt TG. The impact of the electronic health record on an academic pediatric primary care center. J Ambulatory Care Management 2009; 52 (03) 180-187.
- 15 Adams WG, Mann AM, Bauchner H. Use of an electronic medical record improves the quality of urban pediatric primary care. Pediatrics 2003; 111 (03) 626-632.