Immunization Data Exchange with the EHR


In light of the highly publicized widespread outbreak of the Swine flu, it is certainly pertinent to touch on how organizations may utilize an Electronic Healthcare Record (EHR) data exchange from the EHR to an immunization registry to contribute in the effort to control this pandemic. Resolutions by the American Medical Association (AMA) and the American Osteopathic Association (AOA) note that the “lack of accurate immunization records represents a major reason for missed opportunities to vaccinate” and “immunization registries offer a cost-saving solution that ensures access to accurate immunization records at every visit.”

It is well-documented that registries can save health care provider money by drastically reducing the time it takes to pull a child’s medical record, review his immunizations, enter the new shots, and re-file the record. However, a stand-alone registry application requires duplicate data entry in the case where an EHR acts as the practice’s clinical data repository. In situations where a stand-alone immunization registry solution is already instituted in a practice, productivity increases of 30 to 50% can be realized by integrating the clinical repository system, namely the EHR, with the state registry via a data exchange.

Introduction

An immunization data exchange facilitates the share of data between the immunization registry and the EHR by bringing registry information into the EHR and also sending data to the immunization registry with every administered immunization. Integrating the EHR with the immunization registry offers the capability of sustaining high immunization rates and low disease levels via sharing of clinical data. As a result of these immediate benefits, providers will also realize many long-term benefits such as a reduction in paperwork, staff time and costs associated with immunization related activities. Most importantly though, are the direct patient outcomes in that the immunization data exchange prevents unnecessary (duplicate) immunizations.

Benefits

  • Compliance – On average, less than 80% of shots given are entered
  • Data Accuracy – Over 15% error rate when completed by clinical staff
  • Data Availability – 50% of 2 year olds have 2 or more providers
  • Provide record consolidation of immunization information
  • Facilitate management of immunizations so that children receive only the vaccines they need within the appropriate time-frames
  • Decrease time spent by office staff seeking immunization histories
  • Generation of timely immunization reports to assist with reporting requirements and other quality improvement initiatives.
  • Elimination of redundant entry of patient data in both EHR and registry application
  • Immediate availability of immunizations to the enterprise.
  • Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc)
  • Custom reports can also be created and deployed to supplement current paper processes for documentation of immunizations (for instance a summer camp requires all medications, immunizations, allergies be documented)

immunization ehr interface

And perhaps the biggest benefit is that many groups are able to negotiate with the immunization registry to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view – the practice actively contributes to the patient immunization record via a data exchange from the EHR to the registry – the registries are often happy to provide financial incentive for practices to participate in an electronic data exchange.

Cost Savings

A study published in the American Journal of Preventative Medicine found that the annual cost for a practice to participate in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $.65 to $7.74. It was noted in this study that annual per-patient costs were lowest in the sites that used an automated data-entry interface. The main conclusion reached from this study was that ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Implementation of an interface to accept and send electronic transfers of records avoid duplicate data-entry tasks and decrease provider costs.

For additional information regarding Galen Healthcare Solutions’ data exchange / interface services visit our website or contact us:

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5 Comments

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  1. 1
    John Lynn

    Do you know which places have an automated Immunization Registry? Our state has a registry, but we have no way to automate the receiving or sending of information through an interface. At least not one that I know of. That might be the other problem. They don’t let people know about the various exchanges either.

  2. 2
    Justin Campbell

    John,

    Great question – thanks for your response. In my research I was unable to find any documentation of interfacing capabilities to the Nevada Immunization Coalition (NIC), however I did make an inquiry (http://immunizenevada.com/contact-nic/) as to when NIC anticipates delivery of HL7 integration capabilities.

    I do note that there does not seem to be any standardization amongst state immunization registries, however there are some instances in which states modeled their implementations after another’s (for instance, NM modeled their HL7 integration after CO).

    In terms of our experience with designing and implementing data exchanges with state registries, a quick list of states we have experience with follows:
    •Maine (http://www.maine.gov/dhhs/boh/ddc/immunization/providers/data-exchange.shtml) – we designed and deployed the first integration with the state immunization registry
    •Colorado
    •New Mexico (https://nmsiis.health.state.nm.us/PR/portalHeader.do;jsessionid=0a28157957e5a60cdd2282e84764819fb42c02826607.e3mOaNaSah4Ne34Lc3eOaN8Nchv0n6jAmljGr5XDqQLvpAe)
    •Tennessee
    •North Carolina
    •Texas

    I am not sure how up to date the site is, but for more information, I would reference the following: http://www.immregistries.org/members/index.phtml
    -Justin

  3. 3
    Tyler Suacci

    Justin – great timing with this article. We’ve started discussions with our local immunization registry and look to implement a bi-directional interface. I have a couple questions that have come up in our initial discussions.

    1. Being that Allscripts EHR doesn’t have an outbound immunization interface (that I know of), how have you been advising clients to collect this information and share it with the registry? Our state’s registry doesn’t communicate in HL7, so I’m leaning towards creating a daily SQL job to extract and output the immunization data for the past day in a flat file.
    2. How have the registries known for which patients to send immunization data to the Allscripts EHR? The registry isn’t going to send every immunization record on file and continue to send everything; plus we only want data for our EHR patient population. Again, I’m thinking about creating a daily job to extract the patients that are scheduled for upcoming appointments and sending that file to the registry, asking for immunization records for those patients only.

    Any advice would be helpful.

    Thanks.

  4. 4
    Justin Campbell

    Tyler,

    Great questions. Thank you for continuing the dialogue.

    In terms of #1, the hooks are already in place in the application to populate the event table with immunization records if the module has been deployed and is in use so you should be set in that regard. There is a procedure within the AE-EHR API (application programming interface) to extract immunization data, and this data can then be mapped to a VXU (unsolicited vaccination record update) HL7 message to be sent to the registry if they support said transaction.

    In terms of #2, I do not believe there is a clear-cut, built-in solution in the AE-EHR, and I think your proposed approach sounds fantastic so long as the registry supports VXQ (query for vaccination record) HL7 messages.

    Hope this helps!

    Cheers,
    Justin

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