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Improving immunization delivery using an electronic health record: the ImmProve project
David G Bundy1, Nichole M Persing, Barry S Solomon
1Divisions of General Pediatrics and Epidemiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Insights
Electronic health record (EHR) prompting showed limited impact on overall pediatric immunization rates. However, it significantly improved Hepatitis A vaccine delivery and showed promise for Human Papillomavirus (HPV) vaccination in adolescents.
Area of Science:
- Pediatric Preventive Services
- Public Health Interventions
- Health Informatics
Background:
- Immunizations are crucial pediatric preventive services but face delivery challenges.
- Reliable immunization delivery is essential for child health and disease prevention.
- Existing systems may not adequately support timely vaccination for all children.
Purpose of the Study:
- To assess the effectiveness of EHR-derived immunization prompting on pediatric immunization rates.
- To measure the impact of clinical decision support (CDS) and provider bulletins on vaccination delivery.
- To identify specific vaccines or age groups that benefit from EHR-based interventions.
Main Methods:
- A study was conducted in a large, urban, pediatric primary care clinic.
- Two interventions were evaluated: point-of-care CDS and provider-specific bulletins for overdue immunizations.
- Immunization rates were compared between periods with and without CDS active.
Main Results:
- Overall immunization rates for a composite of recommended vaccines did not differ significantly between intervention and control periods.
- Hepatitis A immunization rates before age 2 were significantly improved during the intervention.
- Human Papillomavirus (HPV) immunization rates remained low but showed improvement in 14-year-olds by the end of the intervention.
Conclusions:
- EHR-derived immunization prompting had a limited effect on overall immunization delivery in a population with high baseline uptake.
- The interventions demonstrated clearer benefits for newer vaccines with lower initial uptake, such as Hepatitis A and HPV.
- Targeted interventions may be more effective for specific vaccines or populations with lower vaccination coverage.
Objective:
Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record-derived immunization prompting.
Methods:
Operating in a large, urban, hospital-based pediatric primary care clinic, we evaluated 2 interventions to improve immunization delivery to children ages 2, 6, and 13 years: point-of-care, patient-specific electronic clinical decision support (CDS) when children overdue for immunizations presented for care, and provider-specific bulletins listing children overdue for immunizations.
Results:
Overall, the proportion of children up to date for a composite of recommended immunizations at ages 2, 6, and 13 years was not different in the intervention (CDS active) and historical control (CDS not active) periods; historical immunization rates were high. The proportion of children receiving 2 doses of hepatitis A immunization before their second birthday was significantly improved during the intervention period. Human papillomavirus (HPV) immunization delivery was low during both control and intervention periods and was unchanged for 13-year-olds. For 14-year-olds, however, 4 of the 5 highest quarterly rates of complete HPV immunization occurred in the final year of the intervention. Provider-specific bulletins listing children overdue for immunizations increased the likelihood of identified children receiving catch-up hepatitis A immunizations (hazard ratio 1.32; 95% confidence interval 1.12-1.56); results for HPV and the composite of recommended immunizations were of a similar magnitude but not statistically significant.
Conclusions:
In our patient population, with high baseline uptake of recommended immunizations, electronic health record-derived immunization prompting had a limited effect on immunization delivery. Benefit was more clearly demonstrated for newer immunizations with lower baseline uptake.
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