Immunization improves with bidirectional data exchange between EHRs and registries

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EHR vendors need to do more

While meaningful use regulation requires that EHRs only feed information to immunization registries, more should be done by them to help retrieve information from them.

“I would love for the EHR vendors to address this issue and establish bidirectional communication with local/regional immunization registries to help with decision-making at the point of care,” Dr. J. Howard Smart said in an interview.

He also noted other challenges. Registries do not share data across state lines and even within states, such as California, regional registries are not sharing information.

“So even if someone comes from Los Angeles, we are not going to have immunization registry data for them.”

That being said, even if it were just bidirectional information on a local level, it would be a great asset to the practicing pediatrician.

“We are worried about both kinds of errors [missing scheduled vaccinations or overvaccinating], and having bidirectional information would really help that confidence.”

Dr. Smart is chief of pediatrics at Sharp Mary Birch Hospital for Women and Newborns in San Diego, Calif.




The implementation of bidirectional information sharing between electronic health records (EHRs) and immunization registries resulted in improved pediatric immunization coverage, according to new research in Pediatrics.

Researchers analyzed data from five practices providing pediatric primary care in the New York–Presbyterian Hospital Ambulatory Care Network 6 months before and after a 2009 implementation of a function that allowed for data from the N.Y. Citywide Immunization Registry to be downloaded directly to local practice site EHRs. Prior to that, data could only be uploaded from EHRs, and pediatricians would need to consult the registry separately to check immunization records.


Researchers found that after the implementation of bidirectional information sharing, “significant improvements in pediatric immunization coverage, a reduction in overimmunization for adolescents, and increased completeness of immunization records were observed,” Dr. Melissa S. Stockwell, professor at Columbia University, New York, and her colleagues, wrote in an article appearing online May 5 and scheduled for publication in the June 6 issue of Pediatrics (doi: 10.1542/peds.2015-4335).

According to the research, up-to-date status increased from 75% before to 81.6% after implementation for more than 6,000 children during each period. The percentage of overimmunized decreased from 8.8% to 4.7%.

Researchers suggested that the reason for the improvement was that doctors could make more informed decisions immediately about immunization rather than having to wait for family members to return for a later visit with paper immunization records.

“With full immunization data available electronically at point of care, clinicians may have felt more certain that they had accurate, complete immunization data and that the child was indeed missing the immunization,” Dr. Stockwell and her colleagues wrote. “It has been shown that children of parents who lack paper records are more likely to be underimmunized.”

The researchers reported no conflicts of interest. The study was supported by the Agency for Healthcare Research and Quality.

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