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How Michigan’s HIE facilitates immunization lookups

Clinicians find value in having access to patients’ immunization records, but the process for sharing that information traditionally has been ponderous and manual.

That’s changing in Michigan, where the state’s information exchange, Great Lakes Health Connect, in the past year has enabled providers to directly query the HIE’s immunization records through their electronic health records systems, thus enabling them to do so as clinicians are delivering care to patients.

It’s the latest in what has been a slow, steady march toward improving record sharing in the state.

In 1996, Michigan lawmakers established a childhood immunization registry to enable physicians to access to immunization records held in what became the Michigan Care Improvement Registry (MCIR). Some 10 years later, the registry expanded to include records from all citizens; physicians were required to submit immunization records to MCIR.

Great Lakes Health Connect now aids physicians in transmitting their immunization records to the MCIR and has more than 1,400 practices doing so. However, the records initially were not automatically transmitted into physician electronic health record systems, causing workflow issues.

The new approach enables two-way communication between a provider EHR and the MCIR. A small number of early adopter hospitals and physician practices are using the immunization query capability; several other provider organizations are now in the pipeline to use the service.

When a patient checks in for an appointment, Great Lakes Health Connect sends over immunization records that are placed into the patient chart and also indicates what information in the records are new.

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Kenny O’Neill, vice president of clinical integration at three-hospital Lakeland Health System, a client of the HIE since 2010 and serving southwest Michigan, says the integration of immunization records and EHRs is important.

“The Centers for Disease Control and Prevention recommends that adults over the age of 65 receive an annual vaccine to protect against pneumonia,” he says. “There are two competing vaccines in this class, but they cannot be administered within 12 months of each other. A patient may remember whether or not they have had a pneumonia vaccine in the past, but they are not likely to know which one they were given. If this information doesn’t already reside in their electronic health record, the information can be found in the state repository.

“Prior to having the ability to query MCIR through our electronic health record, a provider would have to exit the EHR, launch a separate browser to get to the MCIR web site, log into the database, search for the necessary information, then copy and paste it into the patient’s record back in the EHR system. This may seem like a relatively minor issue, but it interrupts the interaction with the patient at the point of care. Multiplied across many patients, that can add up to a significant waste of time. Great Lakes Health Connect’s immunization query functionality allows more time and greater attention to be focused on patient care.”

Integrating immunization records is pretty seamless now, but the HIE and Lakeland Health System, the pilot site, had to work out some technical issues to speed up the connection and response times with the registry, says George Bosnjak, director of business development at Great Lakes. Additional interface testing with the registry also was needed to make it all work, says Kenneth Lomonaco, EHR manager at Great Lakes.

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