By Brian Bamberger, Life Sciences Practice Lead
Broad adoption of electronic health records (EHRs) holds promise to promote the use of vaccines. The recent measles epidemic is an instructive example.
Federal investigators got to the heart of the epidemic by identifying measles-infected people, most of whom were unvaccinated visitors to Disneyland in California or had been exposed to infected visitors at the theme park. Because of these exposures, the disease quickly spread to more than 100 cases in January alone. This is more than the entire country typically sees in a year, according to the Centers for Disease Control and Prevention (CDC).
As measles cases spread outside California to nearly 20 states plus the District of Columbia, officials scrambled to contain the disease by identifying those who had yet to be inoculated. According to the CDC, approximately 1 in every 12 children are either unvaccinated for measles and other diseases or have not kept their shots up to date.
Here is where the use of EHRs could come into play in such an epidemic and help promote vaccine use. First, EHRs can help physicians identify those needing shots by reviewing patient vaccination histories, even those who’ve been vaccinated in one state and have since moved to another. Vaccination histories include pertinent information regardless of a patient’s insurance coverage. Patients who refuse vaccinations because of religious or other objections can be flagged. EHR data can then help public health officials and physicians identify unvaccinated individuals who might have been exposed to measles, so they can be asked to observe a voluntary quarantine in order to contain the disease’s spread.
According to media reports, officials in Utah located more than 380 people who could have come in contact with two Disneyland vacationers who got the measles and asked many of them to quarantine themselves at home for 21 days. EHRs undoubtedly were central to the process because of efforts by the IC3 Beacon Community, which is part of a federally funded initiative to build and strengthen local health information technology (healthIT) infrastructure, promote use of EHRs and test innovative approaches to improving outcomes and lowering costs. IC3 serves three counties in the center of Utah, including urban Salt Lake County and rural and frontier areas of Summit and Tooele. Among its goals, IC3 focuses on using technology to improve communicable disease reporting by replacing paper reports with electronic reporting capabilities. Utah is one of the nation’s most wired states thanks to adoption of healthIT by the Intermountain Healthcare System. Based in Salt Lake, this nonprofit health care organization includes 22 hospitals and a medical group having more than 185 physician clinics — all of which utilize EHRs.
Factoring into this connected landscape are electronic immunization registries, which have become important tools toward improving the accuracy of vaccine documentation and facilitating outreach to patients (e.g., appointment reminders). EHRs provide most of the data for these registries, largely because the federal meaningful use EHR incentive program requires them to report such information to immunization registries. (Click here to learn more about a federally funded program in San Diego that uses a disease registry to improve pediatric immunization rates.)
Additionally, nearly all school systems require that students be up to date with shots before beginning a new school year. EHRs can provide students necessary vaccination records and help identify those with vaccination gaps that must be addressed.
Although vaccines are given early in childhood, college students and young adults need certain immunizations, too. The vast majority of states mandate that college students obtain certain vaccinations or boosters on a regular basis, while many institutions have additional voluntary and mandatory vaccine requirements. For example, approximately 80% of states require meningococcal conjugate vaccine for college students or other students living in a dorm. The Tdap vaccine — which protects against tetanus, diphtheria, and pertussis — often is required for college students, especially athletes. Vaccines for hepatitis B and human papillomavirus (HPV) are highly recommended for high school and college students.
In short, EHRs can help identify unvaccinated students and have become an important tool in containing the spread of disease. They are key to helping physicians and public health officials promote the use of vaccines for millions of students at the start of every school year and in response to any disease outbreaks. Federal statistics indicate that nearly 50 million students attended public elementary and secondary schools in 2014, and roughly 21 million students were enrolled in American colleges and universities.
Naturally, EHRs also are useful in ensuring that adults are vaccinated. Opportunities include initial vaccinations for such highly communicable diseases as measles and HPV; boosters for a number of conditions, including tetanus; and recommended annual and periodic vaccinations for such maladies as flu, shingles and pneumonia. Certain jobs may also require employees be vaccinated; for example, those working in close quarters with others or who travel frequently to foreign countries. However, circumstances entailed with adult immunizations are more complicated than for children. Physicians must activate the immunization reminder feature of their EHR. They may have disabled this feature in response to alert fatigue or because of the perception that most people are immunized, so there would be little risks in turning off this reminder. That perception may change in the face of the current measles outbreak. In addition, physicians need an updated vaccine list (there are more additions) and an updated schedule. The practice also needs easy access to vaccine coverage rules from insurers.
Issues for pharmaceutical companies appear in practices with EHRs when a new vaccine or schedule change is approved. Updating practices takes time and may cause confusion. In some cases, new vaccines must be added manually by the practice. Getting a vaccine added to its EHR system not only ensures that the practice will bill for the activity, but will be able to transmit the vaccine information to its state immunization registry. Addition of a new vaccine also enables the EHR to automatically recognize that it satisfies the vaccination reminder function, helping to streamline that process.
Vaccine schedule changes may also cause problems. Most must be completed by the EHR vendor, with practices then downloading the content when available. Many pharmaceutical companies assume the EHR vendors update schedules quickly, but nothing could be further from reality. In fact, some EHRs wait for practices to inquire about missing or outdated schedule information before making an update.
Sales representatives will benefit from education that will enable them to address issues with practices and Point-of-Care Partners (POCP) is ready to help. POCP has researched the ways practices work with vaccines and vaccine schedule updates for the top 20 EHRs, as well as the features available for identifying and recalling patients who are candidates for vaccines. Let us know how we can help you put our expertise to use.