Effects of automated immunization registry reporting via an electronic health record deployed in community practice settings
10 February 2013
accepted: 25 May 2013
19 December 2017 (online)
Background: Among the expected benefits of electronic health records (EHRs) is increased reporting of public health information, such as immunization status. State and local immunization registries aid control of vaccine-preventable diseases and help offset fragmentation in healthcare, but reporting is often slow and incomplete. The Primary Care Information Project (PCIP), an initiative of the NYC Department of Health and Mental Hygiene, has implemented EHRs with immunization reporting capability in community settings.
Objective and Methods: To evaluate the effect of automated reporting via an EHR on use and efficiency of reporting to the NY Citywide Immunization Registry, we conducted a secondary analysis of 1.7 million de-identified records submitted between January 2007 and June 2011 by 217 primary care practices enrolled in PCIP, pre and post launch of automated reporting via an EHR. We examined differences in records submitted per day, lag time, and documentation of eligibility for subsidized vaccines.
Results: Mean submissions per day did not change. Automated submissions of new and historical records increased by 18% and 98% respectively. Submissions within 14 days increased from 84% to 87%, and within 2 days increased from 60% to 77%. Median lag time decreased from 13 to 10 days. Documentation of eligibility decreased. Results are significant at p<0.001.
Conclusions: Significant improvements in registry use and efficiency of reporting were found after launch of automated reporting via an EHR. A decrease in eligibility documentation was attributed to EHR workflow. The limitations to comprehensive evaluation found in these data, which were extracted from a registry initiated prior to widespread EHR implementation suggests that reliable evaluation of immunization reporting via the EHR may require modifications to legacy registry databases.
Citation: Merrill J, Phillips A, Keeling J, Kaushal R, Senathirajah Y. Effects of automated immunization registry reporting via an electronic health record deployed in community practice settings. Appl Clin Inf 2013; 4: 267–275
- 1 Papadouka V, Schaeffer P, Metroka A, Borthwick A, Tehranifar P, Leighton J. Integrating the New York Citywide Immunization Registry and the Childhood Blood Lead Registry. Journal of Public Health Management and Practice 2004; 10: S72-S80.
- 2 Boom J, Dragsbaek A, Nelson C. The Success of an Immunization Information System in the Wake of Hurricane Katrina. Pediatrics 2007; 119 (06) 1213-1217.
- 3 Freeman VA, DeFriese GH. The challenge and potential of immunization registries. Annual Review of Public Health 2003; 24: 227-246.
- 4 Committee on Practice of Ambulatory Medicine.. Immunization Information Systems. Pediatrics 2006; 118 (03) 1293-1295. doi: 10.1542/peds.2006-1723.
- 5 Centers for Disease Control and Prevention.. Progress in Immunization Information Systems - United States, 2009. Morbidity and Mortality Weekly Report 2011; 60 (01) 10-12.
- 6 Miller PL, Frawley SJ, Brandt C, Sayward FG. Tools for Immunization Guideline Knowledge Maintenance: II. Automated Web-Based Generation of User-Customized Test Cases. Computers and Biomedical Research 1998; 31 (Suppl. 03) 190-208. doi: 10.1006/cbmr.1998.1471.
- 7 Kolasa MS, Chilkatowsky AP, Stevenson JM. al e. Do Laws Bring Children in Child Care Centers Up to Date for Immunizations?. Ambulatory Pediatrics 2003; 3 (03) 154-157.
- 8 LeBaron CW, Chaney M, Baughman AL, Dini EF, Maes E, Dietz V. et al. Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994. Journal of the American Medical Association 1997; 277 (08) 631-635.
- 9 Khare M, Piccinino L, Barker LE, Linkins RW. Assessment of Immunization Registry Databases as supplemental sources of data to improve ascertainment of vaccination coverage estimates in the national immunization survey. Archives of Pediatric Adolescent Medicine 2006; 160 (08) 838-842.
- 10 Salmon D, Smith P, Navar A, Pan W, Omer S, Singleton J. et al. Measuring immunization coverage among preschool children: past, present, and future opportunities. Epidemiology Review 2006; 28: 27-40. Epub 2006 Jun 1.
- 11 Stecher DS, Adelman R, Brinkman T, Bulloch B. Accuracy of a state immunization registry in the pediatric emergency department. Pediatric Emergency Care 2008; 24 (02) 71-74.
- 12 Kwong J, Manuel D. Using OHIP physician billing claims to ascertain individual influenza vaccination status. Vaccine 2007; 25 (07) 1270-1274.
- 13 Wilton R, Pennisi AJ. Evaluating the Accuracy of Transcribed Computer-Stored Immunization Data. Pediatrics 1994; 94 (06) 902-906.
- 14 Ronveaux O, Arrieta F, Curto S, Laurani H, Danovaro-Holliday MC. Assessment of the quality of immunization data produced by the national individual registration system in Uruguay, 2006. Rev Panam Salud Publica 2009; 2: 153-160.
- 15 Pringle M, Ward P, Chilvers C. Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer. British Journal of General Practice 1995; 45 (05) 537-541.
- 16 Stecher DS, Adelman R, Brinkman T, Bulloch B. Accuracy of a state immunization registry in the pediatric emergency department. Pediatric Emergency Care 2008; 24 (02) 71-74.
- 17 Davidson AJ, Melinkovich P, Beatty BL. Immunization Registry Accuracy – Improvement with progressive clinical application. American Journal of Preventive Medicine 2003; 24 (03) 276-280.
- 18 Greene S, Ping Shi M, Dutta-Linn M. al e. Accuracy of Data on Influenza Vaccination Status at Four Vaccine Safety Datalink Sites. Am J of Preventive Medicine 2009; 37 (06) 552-555.
- 19 Sy LS, Liu IL, Solano Z, Cheetham TC, Lugg MM, Greene SK. et al. Accuracy of influenza vaccination status in a computer-based immunization tracking system of a managed care organization. Vaccine 2010; 28 (32) 5254-5259. Epub 2010 June 8
- 20 Irving S, Donahue J, Shay D, Ellis-Coyle T, Belongia E. Evaluation of self-reported and registry-based influenza vaccination status in a Wisconsin cohort. Vaccine 2009; 27 (47) 6546-6549.
- 21 Irigoyen M, Findley SE, Chen S, Vaughan R, Sternfels P, Caesar A. et al. Early Continuity of Care and Immunization Coverage. Ambulatory Pediatrics 2004; 4 (Suppl. 03) 199-203.
- 22 Kempe A, Steiner J, Refrew B, Lowery E, Haas K, Berman S. How Much Does a Regional Immunization Registry Increase Documented Immunization Rates at Primary Care Sites in Rural Colorado?. Ambulatory Pediatrics 2001; 1 (04) 213-216.
- 23 Kukafka R, Ancker J, Chan C, Chelico J, Khan S, Mortoti S. et al. Redesigning electronic health systems to support public health. Journal of Biomedical Informatics 2007; 40 (04) 398-409.
- 24 New York City Health code section 11.04 and 11.07(d). [cited 2012 August 11] Available from: http://www.nyc.gov/html/doh/downloads/pdf/cir/healthcode2005.pdf.
- 25 Citywide Immunization Registry.. Web File Repository Guide 2010. Available from: http://www.nyc.gov/ html/doh/downloads/pdf/cir/cir-dei-wfr-guide.pdf.
- 26 New York City Department of Health and Mental Hygiene. Primary Care Information Project [cited 2012 August20]. Available from: www.nyc.gov/pcip.
- 27 The City of New York. (2013, 1/30/2013). CIR: How to Report Retrieved 3/19/2013, from http://www.nyc. gov/html/doh/html/living/cir-how-to-report.shtml
- 28 Contract # C023699. 2007-2010.
- 29 Centers for Disease Control and Prevention. Vaccine and Immunizations: Immunization Schedules 2012. [cited 2012 August 11] Available from: http://www.cdc.gov/vaccines/recs/schedules.
- 30 Centers for Disease Control and Prevention. Vaccine and Immunizations: IIS Frequently Asked Questions 2012 [cited 2012 May 11]. Available from: http://www.cdc.gov/vaccines/programs/iis/faq.htm.
- 31 Centers for Medicare and Medicaid Services. EHR Incentive Program: Department of Health and Human Services; 2011 [updated September 30, 2011; cited 2011 October 20]. Available from: http://www.cms.gov/EHRIncentivePrograms/
- 32 Silow-Carroll S, Alteras T, Stepnick L. Patient-Centered Care for Underserved Populations: Definition and Best Practices: W. K. Kellogg Foundation; 2006 [cited 2012 May 22]. Available from: http://www.esresearch.org/documents_06/Overview.pdf