Journal:The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality
| Full article title | The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality |
|---|---|
| Journal | Online Journal of Public Health Informatics |
| Author(s) | Woinarowicz, Mary A.; Howell, Molly |
| Author affiliation(s) | North Dakota Department of Health, Division of Disease Control |
| Primary contact | Email: mary dot woinarowicz at nd dot gov |
| Year published | 2016 |
| Volume and issue | 8(2) |
| Page(s) | e184 |
| DOI | 10.5210/ojphi.v8i2.6380 |
| ISSN | 1947-2579 |
| Distribution license | Custom open-access |
| Website | http://ojphi.org/ojs/index.php/ojphi/article/view/6380 |
| Download | http://journals.uic.edu/ojs/index.php/ojphi/article/download/6380/5638 (PDF) |
 |
This article should not be considered complete until this message box has been removed. This is a work in progress. |
Abstract
Objectives: To evaluate the impact of electronic health record (EHR) interoperability on the quality of immunization data in the North Dakota Immunization Information System (NDIIS).
Methods: NDIIS "doses administered" data was evaluated for completeness of the patient and dose-level core data elements for records that belong to interoperable and non-interoperable providers. Data was compared at three months prior to EHR interoperability enhancement to data at three, six, nine and twelve months post-enhancement following the interoperability go live date. Doses administered per month and by age group, timeliness of vaccine entry and the number of duplicate clients added to the NDIIS was also compared, in addition to immunization rates for children 19–35 months of age and adolescents 11–18 years of age.
Results: Doses administered by both interoperable and non-interoperable providers remained fairly consistent from pre-enhancement through twelve months post-enhancement. Comparing immunization rates for infants and adolescents, interoperable providers had higher rates both pre- and post-enhancement than non-interoperable providers for all vaccines and vaccine series assessed. The overall percentage of doses entered into the NDIIS within one month of administration varied slightly between interoperable and non-interoperable providers; however, there were significant changes between the percentage of doses entered within one day and within one week with the percentage entered within one day increasing and within one week decreasing with interoperability. The number of duplicate client records created by interoperable providers increased from 94 duplicates pre-enhancement to 10,552 at twelve months post-enhancement, while the duplicates from non-interoperable providers only increased from 300 to 637 over the same period. Of the 40 core data elements in the NDIIS, there was some difference in completeness between the interoperable versus non-interoperable providers. Only middle name, sex, county, phone number, mother’s maiden name, vaccine manufacturer, lot number and expiration date were significantly (>=5%) different between the two provider groups.
Conclusions: Interoperability with provider EHRs has had an impact on NDIIS data quality. Timeliness of data entry has improved and overall doses administered have remained fairly consistent, as have the immunization rates for the providers assessed. There are more technical and non-technical interventions that will need to be accomplished by NDIIS staff and vendor to help reduce the negative impact of duplicate record creation, as well as data completeness.
Keywords: Immunization information systems, electronic health records, meaningful use, HL7, data quality
Introduction
Immunization information systems (IISs) are confidential, population-based systems that record immunization administration data from participating providers, provide consolidated immunization histories at the point of care and provide aggregate data on vaccinations for use in surveillance to increase immunization rates and reduce vaccine-preventable disease.[1] In 1995, the Centers for Disease Control and Prevention (CDC) compiled a list of required and optional core data elements for IIS. The National Vaccine Advisory Committee (NVAC) reviewed and updated the IIS core data elements as part of their Initiative on Immunization Registries.[2] The CDC incorporated the NVAC recommendations and again updated the IIS core data elements in 2012 to correspond with the IIS functional standards and IIS Strategic Plan for 2013-2017.[3][4] The purpose of the core data elements is to help standardize the capture of data in the IIS and to facilitate the consistent exchange of data between the IIS, electronic health record (EHR) systems and other IIS.[2][3]
When the American Recovery and Reinvestment Act (ARRA) was enacted in 2009, one of its goals was to promote the adoption and increase the “meaningful use” of EHRs.[5] The Centers for Medicare and Medicaid Services (CMS), in coordination with the Office of the National Coordinator for Health Information Technology (ONC), have set different criteria that must be met by participating providers in order to receive an incentive payment. One of the public health reporting criteria included in all three stages of meaningful use is the electronic exchange of data between an EHR and an IIS.[6] This electronic exchange of data is referred to as interoperability. According to the Healthcare Information and Management Systems Society (HIMSS), “interoperability is the ability of different information technology systems … to … exchange data, and use the information that has been exchanged.”[7]
References
- ↑ "About Immunization Information Systems". Centers for Disease Control and Prevention. 15 May 2012. http://www.cdc.gov/vaccines/programs/iis/about.html. Retrieved 23 November 2015.
- ↑ 2.0 2.1 National Vaccine Advisory Committee (5 February 2007). "Immunization Information Systems, NVAC Progress Report, February 2007" (PDF). U.S. Department of Health and Human Services. http://www.hhs.gov/sites/default/files/nvpo/nvac/reports/nvaciisreport20070911.pdf. Retrieved 23 November 2015.
- ↑ 3.0 3.1 "IIS Recommended Core Data Elements". Centers for Disease Control and Prevention. 18 December 2012. http://www.cdc.gov/vaccines/programs/iis/core-data-elements.html. Retrieved 23 November 2015.
- ↑ "Immunization Information System (IIS) Functional Standards". Centers for Disease Control and Prevention. 18 December 2012. http://www.cdc.gov/vaccines/programs/iis/func-stds.html. Retrieved 23 November 2015.
- ↑ "Electronic Health Records (EHR) Incentive Programs". Regulations and Guidance. Centers for Medicare & Medicaid Services. 29 October 2015. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Retrieved 23 November 2015.
- ↑ "Meaningful Use and Immunization Information Systems". Centers for Disease Control and Prevention. 5 September 2012. http://www.cdc.gov/vaccines/programs/iis/meaningful-use/index.html. Retrieved 23 November 2015.
- ↑ "What is Interoperability?". HIMSS. 5 April 2013. http://www.himss.org/library/interoperability-standards/what-is-interoperability. Retrieved 13 June 2016.
Notes
This presentation is faithful to the original, with only a few minor changes to presentation. In some cases important information was missing from the references, and that information was added.
