Strategies for Tracking Patient Immunization Status

Dr Lewis discusses his organization’s leveraging of EMR to track immunization status of patients.

James Lewis, PharmD, FIDSA:The EMR [electronic medical record] can be a blessing and a curse. If you say electronic medical record, many physicians will start throwing things at you. But it can be an extremely useful tool if you have the organizational support to build the rules in it to fire reminders. On the inpatient side, we as an organization have very clear rules built in our EMR that trigger if a patient is due [for vaccination]. But those vaccination flags are there in the outpatient setting as well. I didn’t get reminded [at my doctor appointments], and I know for a fact that my personal chart has that Shingrix [vaccine for the prevention of shingles] message. Having a reminder built in to the EMR is not enough. Perhaps it needs a visual flag that says a patient is due for this. We could do a better job there.

The state of Oregon, where I live and practice, has a very cool database where individuals are supposed to report what vaccines patients received. That’s a huge help. Historically, 1 of the major problems has been that if I walk into pharmacy X, but I got my flu vaccine at pharmacy Z, then maybe there’s no way for pharmacy Z or X to know what has gone on at the other pharmacy. This is 1 of the struggles of not having better integration in our electronic medical records. This is another reason that we’d like to see that going forward, so other providers can see exactly what’s gone on. Until we reach a point in the adult space where vaccinations by other providers are more visible, we’re going to struggle. One public health wish list thing that I’d like to see is better cross-talk among EHRs [electronic health records]. We’re getting there, but it’s been a slow slog.

The ACIP [Advisory Committee on Immunization Practices] recommendations are possibly 1 of the most important things in vaccination practice that occur. Nothing, in our organization and in most organizations, moves until ACIP has blessed it. You’ve seen the CDC [Centers for Disease Control and Prevention] put it out in the official MMWR [Morbidity and Mortality Weekly Report]recommendations for adult and pediatric vaccinations. That triggers everything. If something isn’t in there, it’s not going to happen. This is 1 of the cornerstones of vaccination practice in the United States. That’s a really good thing. ACIP does a phenomenal job of being extremely evidence based, of meeting regularly, and being pretty darn transparent in why and how they’re doing what they’re doing. There have been times that I’ve wanted to throw objects at them—namely, the extremely confusing pneumococcal vaccination recommendations that made everybody want to gouge their eyes out for 5 to 10 years. Thankfully, they’ve improved those in the last couple of years with the arrival of new conjugate vaccines. But for me, for our organization, and for pretty much every organization that I’m aware of, if ACIP doesn’t move on it, it’s not going to happen. They’re extremely critical. Anybody interested in this space can follow them very easily. If you’re interested in this space, I highly encourage you to look at their meetings. They do a nice job.

Transcript edited for clarity.

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