Tracking Immunizations In
Your Practice and Community
October 22, 2012
Stuart T. Weinberg, MD, FAAP
Vice Chair, AAP Council on Clinical Information Technology (COCIT)
Assistant Professor
Departments of Biomedical Informatics and Pediatrics
Vanderbilt University School of Medicine
stuart.weinberg@vanderbilt.edu
Faculty Disclosure Information
 In the past 12 months, I have no relevant
financial relationships with the
manufacturer(s) of any commercial product(s)
and/or provider(s) of commercial services
discussed in this CME activity.
 I do not intend to discuss an
unapproved/investigative use of a commercial
product/device in my presentation
Objectives
 Understand how recent efforts to bar-code vaccine products
will assist in recording patient information.
 Describe how vaccine data is shared through importing from
and exporting to existing immunization registries.
 Visualize methods to reconcile vaccine data from multiple
sources.
 Describe examples of practice workflow where vaccine data
is compiled and assessed prior to a visit.
 Learn about immunization assessment/forecasting web
services and the potential role they can play in adding
functionality to electronic medical records.
Definition of Biomedical Informatics
 “The scientific field that deals with biomedical
information, data, and knowledge—their storage,
retrieval and optimal use for problem-solving and
decision making.” (Shortliffe)
 The discipline dealing with the structure,
organization, utilization, and communication of
health-related information.
 Pertinent to clinical care, research, education, and
administration.
What is Bioinformatics?
“Bioinformatics is the study of how information is
represented and transmitted in biological systems starting
at the molecular level”--Altman
Bioinformatics
Medical Informatics
Information Technology and Informatics
 Information technology centers on the technical
tools – hardware and software
 Clinical informatics highlights people, process,
technology.
 There are several peer-reviewed journals AND on
Sep 22, 2011, Clinical Informatics became a
Board-Certified Medical Subspecialty, sponsored
by the American Board of Preventive Medicine.
Vaccine Barcodes – What is the Workflow?
 A CDC 2D Vaccine Barcode Pilot began in August, 2012, involving
10+ States/CDC immunization program grantees, 220 Immunizers
(public, private, and commercial), and 1-3 vaccine manufacturers .
More info at: www.2dbarcodepilot.com
 As of August, 2D barcoded vaccines currently shipping were
Menactra, Pediatric DT, and adult HAVRIX.
 Future distribution was planned for Adacel, Fluzone, Daptacel,
Tenivac, IPOL, and Pentacel.
 Barcodes are on the vials, *not* the packages. May have
implications for vaccine inventory.
 Different workflows for practices with and without EHRs?
Vaccine Barcodes – The Pilot Process
 Participating manufacturers will place a 2D barcode, containing the
vaccine type (GTIN/NDC), the expiration date, and the lot number,
onto a vaccine vial’s primary packaging (label);
 Upon vaccine administration, immunizers will scan the vaccine
barcodes;
 Immunizers’ electronic medical record system, or other records
system, will be automatically populated with the three vaccine data
items, and;
 Data will be transmitted to the participating grantee immunization
information systems (IIS) using the existing transmission method.
Data that is transmitted will be used to assess the ability to
improve the efficiency of immunization record keeping, as well as
the availability and accuracy of immunization information in the
IIS.
 Source: www.2dbarcodepilot.com/pilot_overview/
Immunization Registries
 July, 2010: The Task Force on Community Preventive Services
recommends immunization information systems on the basis of
strong evidence of effectiveness in increasing vaccination rates.
 Evidence is considered strong based on the findings from 71
published papers and 123 conference abstracts showing that IIS
are directly related to increasing vaccination rates and reducing
vaccine-preventable disease.
FOR PROVIDERS:
 Communication with immunization registries could provide a more
complete vaccination history
 Access may be an issue. Is it through a portal or is immunization
information integrated with your site’s existing EHR?
Tennessee Immunization Registry Overview
 ‘TWIS’ (Tennessee Web Immunization System) technically refers to the
web portal for the ‘SIIS’ (State Immunization Information System)
 Overseen by the Tennessee Immunization Program (TIP), located in the
Communicable and Environmental Disease Services (CEDS) section of the
Bureau of Health Services in the TN Department of Health.
 Medical Director of TIP is Kelly Moore, MD, MPH.
 Established in 1994
 TN birth certificates automatically uploaded to create a demographic record
(low birth weight, preterm births, sealed birth certificates excluded).
 State law specifically authorizes voluntary participation by healthcare
providers (allows them to share these data with the state)
 Opt out provision for parents who notify TDH to remove or block child’s
record.
TN Registry HL7 Message Exchange Status
 At present, the following methods are available
for data exchange with the registry:
- Batch (2,000 messages or less)
- Fast Batch (negotiable)
- [not real-time]
 GSA Contractor is creating a method to convert
flat files to HL7 message to assist nontraditional
providers who would not have or be expected to
have HL7 established (or those who would not
benefit from meaningful use, e.g., pharmacists).
Current Vanderbilt – TN Registry Process
 Overnight, a batch request is electronically sent to the state for all
patients scheduled in selected clinics for the next *3* days (whose
records have not already been requested). This request is processed by
the state and the results are retrieved by Vanderbilt and stored
*separately* from Vanderbilt’s electronic immunization records.
 During the day, at 20-minute intervals, small batches of requests (no
more than 20) are electronically sent to the state to handle newlyscheduled and walk-in patients. Responses are usually available within
20 minutes – by the time the next request is made.
 The status of the immunization request from the state is displayed on
an electronic outpatient whiteboard for each clinic. [P- pending; n/m –
no match; D – done successfully; H – hold on administering vaccines as
there are records from the state that do not match any in our system]
 Clicking on the status in the whiteboard will display an integrated view
of imm records from both Vanderbilt’s EHR and the state registry.
Interfacing with Immunization Registries

Interoperability and Reuse of Data….

Medical Communication Standards:
----

HL7 (Health Level 7)
DICOM (Digital Imaging and Communications in Medicine)
CCD (Continuing Care Documentation)
HITECH was passed by Congress in 2009 to support the adoption and use of Electronic
Health Records (EHRs) to achieve significant improvements in care through
meaningful use of EHRs by health care providers. Interoperability is a key component
of ‘meaningful use’.
FOR HOSPITALISTS:

Can external charts be incorporated not only in an electronic form but a *computable*
form. Example: Importing lab results not as a PDF but as discrete elements that can
be graphed among existing lab work?

Can preparations for transport include a mechanism to generate documents and
images that can be electronically sent to the receiving facility?
The Electronic Outpatient Whiteboard
 Developed in-house, initially for Pediatric and Adult
Cancer Centers to facilitate workflow and
communication. Placed in production Summer, 2005.
 Pediatric Primary Care was an early adopter and has
used the OPWB since October, 2005.
 Apache/MySQL/PHP app which lives within the EMR
environment and is integrated w/ other apps
 Sep 2012 statistics: ~2,400 users per day across
130+ clinics in the Vanderbilt enterprise, tracking
room movements of as many as 5,500+ patients per
day.
Vendor’s Consortium: 18 People From 11 Vendors:
 Allscripts (2)
 Athenahealth (2)
 Cerner Corporation (1) – 1 MD
 e-MDs (2) – 1 MD
 Epic Systems Corporation (1) – 1 MD
 GE Healthcare (1)
 McKesson (1) – 1 MD
 NextGen (2)
 OptumInsight (3) – 1 MD
 Physician’s Computer Company (2)
 Sage Software (1)
CDC Survey Assessing Variability Among Immunization
Information System (IIS) Vaccine Forecasting Algorithms
 Presented at the National Immunization Conference,
April 21, 2010
 9 test cases submitted to 44 of 56 IIS grantees which
met forecasting functional standard
 Response rate: 36/44
 Of the 36 IIS forecasting algorithm tools testing the
nine cases, 19 (53%) IIS forecasted the next dose due
> 5 days before the minimum age for at least one test
case or more.
Objectives - Revisited
 Understand how recent efforts to bar-code vaccine products
will assist in recording patient information.
 Describe how vaccine data is shared through importing from
and exporting to existing immunization registries.
 Visualize methods to reconcile vaccine data from multiple
sources.
 Describe examples of practice workflow where vaccine data
is compiled and assessed prior to a visit.
 Learn about immunization assessment/forecasting web
services and the potential role they can play in adding
functionality to electronic medical records.
Questions?
Contact Information:
Stuart T. Weinberg, MD FAAP
615-936-4239
stuart.weinberg@vanderbilt.edu
http://medschool.vanderbilt.edu/dbmi/people/weinberg