This clinical workflow includes sending a request for immunization information to a public health registry (IIS) for one or more patients, receiving past immunization history, and comparing and reconciling history with what is already present in the EHR or other clinical software system.
This workflow assumes the ability to distinguish among multiple patients in the EHR. However, it does include the ability for an EHR or other clinical software system to communicate with the public health registry if there are no patient matches, incorrect matches, or multiple matches result from the request.
Software Capabilities Within This Workflow
2.1: Batch Request/Receive Patient Immunization History/Histories
2.2: Real Time Request/Receipt of Patient Immunization History
2.4: Request/Receive Patient Immunization Data and Identify Source
2.5: Store Immunization Registry Vaccine History and Forecast (Audit Data)
Who Performs This Workflow
- Clinicians (physicians, nurses and other personnel who assist with providing immunizations)
Examples of Work Related to This Workflow
- Exchanging health information among two or more systems, and the ability of those systems to use the information, is defined as interoperability.[1] Much work in this area is already underway.
- The Office of the National Coordinator for Health IT (ONC) has applied considerable effort to address interoperability among EHRs and between EHRs and registries.
- ONC is currently developing an Interoperability Roadmap.[2],[3],[4]
- Earlier efforts addressed communication among EHRs and specialized or public health registries.[5],[6],[7]
- The Meaningful Use program, Stage 2, specifically addressed immunization registries requiring submission of information to public health registries. It did not require the EHR to receive patient immunization history from such registries.[8]
- Two organizations, the American Immunization Registry Association (AIRA) and the Association of Immunization Managers (AIM), address requirements for immunization registries and enable collaboration among registry organizations and managers.[9],[10],[11],[12]
- Although the vision and goals are aligned, the level to which each registry currently achieves those goals may be addressed on different time schedules.
- Differences in funding and state regulations also may affect the extent to which each registry can support query and response with EHRs and other clinical software for citizens of all ages.
- Some registries do not yet accept immunization information for adults (individuals 19 years of age or greater); others allow opt-out for adults.
- While common standards exist that address methods to send and receive electronic information, all are not yet using those standards due to funding or state regulatory requirements.
[1] Fridsma D. Interoperability Vs Health Information Exchange: Setting the Record Straight, HealthITBuzz. January 9, 2013. Available at: http://www.healthit.gov/buzz-blog/meaningful-use/interoperability-health-information-exchange-setting-record-straight/. Accessed 30 November 2014.
[2] DeSalvo K, Galvez E. ONC’s Interoperability Roadmap update, HealthITBuzz. October 15, 2014. Available at: http://www.healthit.gov/buzz-blog/from-the-onc-desk/onc-interoperability-roadmap-update/. Accessed November 30, 2014.
[3] Basch P. ONC’s 10-Year Roadmap Towards Interoperability Requires Changes to The Meaningful Use Program, Health Affairs Blog. November 3, 2014. Available at: http://healthaffairs.org/blog/2014/11/03/oncs-10-year-roadmap-towards-interoperability-requires-changes-to-the-meaningful-use-program/. Accessed 30 November 2014.
[4] Office of the National Coordinator for Health Information Technology. Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure. June 5, 2014. Available at: http://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf. Accessed 30 November 2014.
[5] Centers for Disease Control and Prevention. Meaningful Use and Immunization Information Systems: Meaningful Use of Electronic Health Record Systems. September 5, 2012. Available at: http://www.cdc.gov/vaccines/programs/iis/meaningful-use/index.html. Accessed 30 November 2014.
[6] Office of the National Coordinator for Health Information Technology. Proposal for the ONC S&I Framework Public Health Reporting Initiative Center. September 21, 2011. Available at: http://wiki.siframework.org/PH+Reporting+Charter. Accessed 30 November 2014.
[7] Centers for Disease Control and Prevention. Meaningful Use: Specialized Registry. May 23, 2014. Available at: http://www.cdc.gov/ehrmeaningfuluse/specialized_registry.html. Accessed 30 November 2014.
[8] Center for Medicare and Medicaid Services. Stage 2 Eligible Professional Meaningful Use Core Measures: Measure 16 of 17. October 2012. Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_16_ImmunizationRegistriesDataSubmission.pdf. Accessed 30 November 2014.
[9] American Immunization Registry Association. Modeling of Immunization Registry Operations Workgroup (MIROW) Best Practices. Available at: http://www.immregistries.org/resources/aira-mirow. Accessed 30 November 2014.
[10] American Immunization Registry Association. Immunization Registry Operational Guidelines Evaluation: Final Report. Available at: http://www.immregistries.org/AIRA_MIROW_Evaluation_Final_Report_2014.pdf. Accessed 30 November 2014.
[11] Association of Immunization Managers. Policies and Position Statements. Updated July 2014. Available at: http://www.immunizationmanagers.org/?page=PoliciesResolutions. Accessed 30 November 2014.
[12] Association of Immunization Managers. Immunization Program Characteristics. 2014. Available at: http://www.immunizationmanagers.org/?page=ImmunizationMaps14. Accessed 30 November 2014.