Characterizing the Access of Clinical Decision Support Offered by Immunization Information System in Minnesota

Background: Healthy People 2020 aims to improve population health by increasingimmunization rates to decrease vaccine-preventable infectious diseases. Amongstthe many strategies, role of immunization information systems (IIS) arerecognized by studies and taskforce reports. IIS are unique in their offering ofclinical decision support for immunizations (CDSi) which are utilized byhealthcare providers. Federal initiatives such as Meaningful Use (MU) andAffordable Care Act (ACA) aim to improve immunization rates through use oftechnology and expanding access to immunization services respectively. MU, theElectronic Health Record (EHR) incentive program includes use of IIS CDSifunctionality as part of Stage 3. It is essential to understand access and usepatterns of IIS CDSi, so as to utilize it better to improve immunizationservices.Objectives: To understand the utilization of clinical decision support forimmunizations (CDSi) offered by immunization information system in Minnesota andto analyze the variability of its use across providers and EHRimplementations.Methods: IIS in Minnesota (Minnesota Immunization Information Connection: MIIC)offers CDSi that is accessed through EHRs and branded as Alternate Access (AA).Data from MIIC and technical documents were reviewed to create details onorganizations which implemented AA functionality. Data on EHR adoption inclinics and local health departments was obtained from Minnesota eHealthassessment reports. Data on access were tracked from January 2015 throughmid-October 2015 through weekly specialized reports to track the queries byorganization, volume and day of the week. Data were analyzed, findings weresynthesized and reviewed with subject matter experts.Results: Currently 25 healthcare systems/organizations which represent 599individual provider sites have implemented the AA functionality. Analysis oftheir EHR platform pointed to two EHRs (Epic and PH-Doc) as dominant products inMinnesota for private and public providers respectively. Use of this functionwas even across study time period. The query volume correlated to size of theorganization, with the exception of an outlier organization with huge querycount. Query was able to successfully locate a single matching record for 59% ofsearches, could not find a record for 5% and 31% resulted in blank/error and thematch rates varied across health systems.Conclusion: High EHR adoption offers a great opportunity to promote use of IISCDSi at point of care. Analysis did not track use at individual clinic level andhow the queries were being generated. Additional research is needed tounderstand the provider level use of this CDSi and other organizational andtechnical factors which influence access to IIS. This is essential for IIS asthey execute projects to improve population-level immunization rates, planprovider outreach and prioritize their system enhancements to meet federalrequirements.