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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.

Academic Pediatrics
|June 4, 2013
PubMed
Summary

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.

Keywords:
clinical decision support systemsimmunizationsquality improvement

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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.