1. Implementation of a bi-directional exchange between immunization information systems (IIS) and electronic health records (EHRs) demonstrated a higher rate of up to date immunization status, 75% compared to 81.6%, and a lower rate of overimmunization, 8.8% compared to 4.7% in the post-implementation group.
2. The human papilloma virus (HPV) vaccine was found to be the most common overimmunized vaccine.
Evidence Rating Level: 2 (Good)
Study Rundown: The lack of centralization of immunization records in the United States amongst the pediatric population contributes to either children receiving the same immunizations more than once or children not receiving certain immunizations at all. Currently, immunization information is only uploaded in a unidirectional manner: from EHR to IIS. In order to access information in the IIS, physicians must log in from a separate internet browser, an inefficient system that does not promote full-integration. In an effort to obtain more accurate rates of up to date immunization status, overimmunization, and underimmunization, authors of this study examined data from a bi-directional immunization data exchange between IIS and EHRs. Data from pre-implementation and post-implementation periods was analyzed. Results indicated that the rate of children and adolescents who were up to date on their immunizations increased significantly in the post-implementation period. In addition, the percentage of children and adolescents who were overvaccinated decreased. This study demonstrates that data exchanges between IIS and EHRs can not only improve child and adolescent immunization status, but also allow for these resources to be allocated to underimmunized communities.
In-Depth [retrospective cohort]: Data was examined from 5 primary care pediatric practices in New York City for a total of 6452 children seen in the pre-implementation period and 6124 seen in the post-implementation period. Implementation included exchange of immunization data via EzVac, a local immunization registry that extracts information directly out of the EHR utilized at the study sites into an IIS. Comparing pre-implementation and post-implementation data, the proportion of children and adolescents who were up to date on their immunizations increased for all age groups from 75% to 81.6% (absolute difference, 6.6%;95% [CI], 5.2% to 8.1%). In addition, the percentage of overimmunization children between pre-implementation and post-implementation decreased from 8.8% to 4.7% (absolute difference, −4.1%; 95% CI, −7.8% to −0.3%). The HPV vaccine was the most common overimmunized vaccine.
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