The exchange of immunization data between a centralized city immunization registry and provider electronic health records led to significant improvements in pediatric immunization coverage, a reduction in over-immunization for adolescents, and more complete immunization records.

Rates for on-schedule vaccination rates jumped significantly, according to a study conducted at Columbia University’s Mailman School of Public Health, Columbia University Medical Center, NewYork-Presbyterian, and the New York City Department of Health and Mental Hygiene’s Citywide Immunization Registry.

The study, funded by the Agency for Healthcare Research and Quality, compared the percentage of children who were up-to-date with their age-appropriate immunizations and those who received extra unnecessary immunizations before and after the implementation of two-way data exchange at point of care.

Melissa Stockwell
Melissa Stockwell

Up-to-date vaccination rates increased from 75 percent to 82 percent and were significant for all age groups, while over-immunization decreased significantly for adolescents, researchers discovered. The results of the study support the public health benefits of information exchange between immunization information systems (IIS), or registries, with electronic health record systems to better track vaccinations.

“Our findings demonstrated that data exchange can improve child and adolescent immunization status, allowing scarce resources to be targeted to those who are truly under-immunized,” said Melissa Stockwell, MD, associate professor of population and family health at the Mailman School of Public Health and associate professor of pediatrics at the Medical Center.

Traditionally, pediatricians wanting to access patient immunization information had to manually look up the patient data on a state or local IIS website. However, the New York Citywide Immunization Registry was one of the first registries in the country to enable clinicians to download immunization information into their local EHR, and NewYork-Presbyterian was the first user of this service.

Researchers credit this IIS-to-EHR information exchange for significantly increasing immunizations for all age groups for a series of vaccines, including those against diphtheria, tetanus, pertussis, polio, measles, mumps and rubella, among others.

“One potential explanation as to why immunization data exchange increased coverage is that, prior to taking action to address missing immunizations a clinician, who may be unsure if the immunization is really missing, may opt to wait for a family to return with a paper immunization record rather than vaccinate,” Stockwell said.

“While parent-held immunization records are valuable, parents may not always remember to bring them to every care visit, underscoring the importance of having immunization information readily available in the online registry in a way that is easy to access at point of care,” he added.

According to the American Immunization Registry Association, real-time data exchange between immunization information systems and EHRs is increasing, thanks in part to federal initiatives such as the Medicare and Medicaid EHR Incentive Programs, which provide financial incentives for IIS-EHR interoperability. Nonetheless, one of the challenges is getting providers to commit to contributing to and using the data from their regional or state IIS.

“It is important to promote further development of the technology to support bidirectional immunization exchange as well as continued focus on local, state and federal policies to support such exchanges,” concluded Stockwell.

The results of the study, published in the journal Pediatrics, can be found here.

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