Robust online immunization registries improve patient and public health

Abstract

Data show that using immunization information systems (IISs)—central repositories for vaccine records that may encompass large populations or entire states—improves vaccination rates. Robust IISs not only compile patient records but also make it possible to assess and identify patients who need certain vaccines or who are due for their next dose. But how effective can this be? According to the results of APhA and APhA Foundation projects, extremely. CDC and APhA partnered on a project with the goal of advancing pharmacists and pharmacies as active contributors to IISs. Working in demonstration sites, participants improved workflow and raised IIS awareness, which resulted in a 13.25% increase in information inputted into the IIS. Some chain pharmacies automatically capture and share data on the immunizations they provide, but that isn’t always enough. “They can collect how many vaccines they actually did just by nature of doing business, but if names are entered incorrectly, fields are left blank, or there is a duplicate entry, that doesn’t all go to the state IIS,” said Albert Bach, PharmD, a professor of pharmacy at Chapman University. Bach was a member of the team that conducted the project and produced the final report, Immunization Collaboration Among Pharmacists and Other Healthcare Providers. Project IMPACT results•1,080 patient histories of vaccinations reviewed•1,566 vaccines forecasted as due based on IIS•1,334 unmet needs eligible for vaccination (36 contraindications, 196 potential duplications discovered)•41.4% administration increase in number of vaccines•447 unmet needs addressed and documented in IIS •1,080 patient histories of vaccinations reviewed•1,566 vaccines forecasted as due based on IIS•1,334 unmet needs eligible for vaccination (36 contraindications, 196 potential duplications discovered)•41.4% administration increase in number of vaccines•447 unmet needs addressed and documented in IIS “What makes the IIS really useful is two-way, bidirectional communication, when your computer system is able to reach into IIS and spit back information to the pharmacist about patients needing vaccines or due for a second dose of a certain vaccine,” Bach said. In October 2015, APhA Foundation launched the Project IMPACT Immunizations Pilot to evaluate the impact of an innovative practice model on the identification of unmet vaccination needs and vaccination rates. It all started at a Grand Rounds presentation that Ben Bluml, RPh, senior vice president, research and innovation at the APhA Foundation, delivered at Merck. “[Merck’s] vaccine team was lamenting that only 1% to 2% of patients who get a flu vaccine get any additional type of vaccine, and about how there are so many unmet needs out there,” he said. Bluml believed it was possible to build a better model. Washington was the perfect place to launch the Project IMPACT Immunization Pilot because its state IIS was one of the most accurate and up to date. “Washington’s registry has a history of both pharmacist and physician participation as well as other health care providers. That was one important criterion as we evaluated geographies for our pilot,” Bluml said. The project had enough funding to set up eight pilot sites for a 6-month evaluation period. Here’s how it worked. Pharmacists would access the vaccination history of patients seeking a flu shot. The technology interface of the point-of-care application that connected to the IIS included clinical decision support and would generate a patient-specific vaccination forecast. Pharmacists would assess the patient and use their clinical judgment to recommend appropriate vaccinations. To say the project was successful is an understatement. “Best practice at that point was 2% additional non-influenza vaccines. With our pilot, the results were 41.4% additional vaccines addressing unmet needs,” Bluml said. “While most would’ve been happy if we’d doubled or quadrupled existing market trends, it turns out that we [decupled twice-over] the results of best practices at that point.” The Project IMPACT Immunizations Pilot identified patients who should receive vaccines, but pharmacists played a vital role in interpreting what the IIS forecasted to ensure it was best for the patient. There were many times when using the IIS’s recommendations alone would not have been good. “The reality is that you’ve got to have the pharmacist assessment in the equation. Even in Washington, where we have a relatively complete, very accurate registry, we still had a significant percentage of patients [in whom] pharmacists identified duplications, contraindications, and reasons why they should not receive the vaccines that the technology projected or forecasted were due,” Bluml said. “Without that assessment in the mix, additional challenges could have been created. The technology combined with the pharmacists’ assessment is the solution.”