Administering vaccines for children has proven to be the most effective public health strategy to control and prevent disease, according to the U.S. National Library of Medicine. Research has shown that for each U.S. birth cohort receiving vaccinations, an estimated 20 million illnesses are avoided, $70 billion dollars are saved and 40,000 deaths are prevented.
Despite this, healthcare professionals everywhere are still struggling to access their patients’ immunization records. School nurses, for instance, spent a significant amount of time hunting down this information for student enrollment. “I can’t tell you how many school nurses and school boards it would make very happy to decrease the resources needed to maintain that every year for every student,” said Susan J. Kressly, MD, FAAP. Dr. Kressly is a physician and health IT advocate focused on leveraging health information and technology to improve the health of children everywhere. After working in a healthcare practice for 15 years, she decided to open her own, Kressly Pediatrics, so she could deliver care in a smaller, more personalized environment and really get to know her patients.
“The pediatric and adolescent population is very mobile. We need to find technology and policy solutions to help ensure that wherever they go across the country, their immunization data goes with them—and is available to every provider at the point of care, and every public health agency when needed.”
Knowing that technology holds immense power to improve health, Dr. Kressly uses technology to collaborate with families, creating a shared environment where patients are active participants in their care.
But in order for patients to actively participate in their care, their health information and records need to be easily accessible to both them and their healthcare providers. Dr. Kressly quickly learned that wasn’t the case with immunization records. So back in the early 2000s, she began exploring solutions to the challenge through technology.
“I bought an EHR, and asked my innovative, tech-savvy husband, ‘Why am I paying somebody $8 an hour to type someone else’s name? Can’t we build a website for patients so they can see their data, print out their own immunization records and self-register?’ And he said, ‘I think we can do that.’” Basically, the two launched a patient portal. “At the time, it wasn’t a widely publicized concept,” said Dr. Kressly. “I wanted to use technology as my second staff member—and my most reliable one.”
Dr. Kressly’s practice has been exchanging immunization data via bidirectional interfaces for 10 years. But these efforts were futile when nearly every other practice patients were coming from didn’t do the same. In many cases it was highly unlikely that Dr. Kressly and her staff could obtain meaningful results and pull them into the EHR for a new patients. Determined to change this, in 2008, Dr. Kressly and other advocates for health information exchange started a national conversation about how to incentivize providers to participate in immunization registries.
“There are a lot of competing priorities which make improving the flow of immunization records difficult,” Dr. Kressly said. “Standards and resources are the biggest challenge in moving the needle on interoperable vaccines for children.”
To date, there is no national organization in the U.S. that maintains vaccination records. Parents are expected to store all of this information on their own, sometimes keeping a paper record for their child’s entire life. Many providers now have immunization information systems (IIS) which do track the information on the computer like patient name, sex, birth date, and vaccinations given—but the type, the information and the functionalities of these systems vary from state to state.
Many IISs have the capacity to exchange health information with other systems—they just aren’t doing it. “The biggest challenges over the last several years have been adhering to standards out there and getting everyone on the same standard at the same time,” Dr. Kressly explained. “As standards and interchange partners evolve, we’ll continue to face challenges around troubleshooting connections and data irregularities.” So if the state registry is ready to go to version X, but your vendor is still on version Y, she explained, there’s a synchronization of using the standard in the same way—so everyone stays on the same page at the same time. “It’s like refilling airplanes in flight,” she added. “It’s not easy and it takes a lot of coordination.”
So what’s the key to solving these challenges? According to Dr. Kressly, a combination of three powerful solutions: people, processes and technology.
Nearly two decades since opening her own practice, Kressly continues to advocate for increasing physician uptake for immunization registries. Her mission to improve the accessibility of information on vaccines for children led her to join the HIMSS Immunization Integration Program (IIP). Funded by the Centers for Disease Control and Prevention, the IIP began as a nationwide effort to advance the inclusion of enhanced immunization capabilities in EHRs and improve the exchange of data between EHRs and IISs.
“When you’re part of a process that’s thoughtfully exploring ways to improve the functionality of EHRs—according to specifications outlined by thought leaders—that’s a huge win for everybody.”
Dr. Kressly has been an active participant in the initiative for over three years—lending her powerful voice in the industry to amplify the program’s mission and ensure clinicians and public health entities across the country have the data needed for optimal decision-making. “It takes a village to make this happen. But if we build it right, everyone will come,” she said. “There has to be value—which means if I’m sending data and I want to get meaningful data from other sources back, it has to be real-time. I can’t make a parent with a screaming child wait in my waiting room for 30 minutes while I’m trying to track down immunization information,” she said.
“When a vaccine is administered in my practice, the magic needs to happen behind the scenes to send the data to the registry. My staff doesn’t have enough time to log on to yet another system to look up historical vaccines. There has to be functionality embedded in the EHR where I’m documenting everything else, so I can push a button and get meaningful information back in a few seconds.” Moreover, that information should be presented in an easily consumable format that follows standards and standard coding to enable the best decision-making with accurate information.
“As the technology evolves, we need to keep evolving our ability to put this information in front of people so anyone who is involved in an individual’s care has access to robust information presented in a way that’s useful to them,” she said. “How we get it to everyone else making medical decisions about vaccines for children is the next hurdle. But if we are going to choose to put patient safety, effective care and public health first, we have to all work together to find solutions that ensure interoperable immunization data is nationally available to every child—so we can improve public health through the exchange of this information.”
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Originally published October 24, 2019