SINC: Synchronized Immunization Notifications (New York)

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Summary:

National immunization rates have consistently fallen short of Healthy People 2010 and 2020 goals and have remained relatively stagnant over the past few years. One important group with lower immunization rates is children with chronic medical conditions (CMCs), who also are at increased risk of serious morbidity and even death from vaccine-preventable diseases. Moreover, some children with CMCs require extra immunizations that are condition-specific, or require a general immunization on an earlier schedule. Key to improving rates of immunization is to provide immunizations whenever an individual enters the health care system--not only during preventive-care visits. However, clinicians focused on other aspects of care may not think to consider the need for immunizations, resulting in missed opportunities for vaccination.

The use of clinical decision support (CDS) to generate immunization reminders to providers reduces these missed opportunities. One limitation of these reminders is that they generally depend on data in the electronic health record (EHR), which can be incomplete, leading to inaccurate reminders. Another challenge is that pediatric and adolescent immunization schedules are complex, and many EHRs may not have or maintain comprehensive immunization decision rules. Finally, most immunization CDS systems do not take into account an individual child’s medical conditions.

This project will couple data from an Immunization Information System (IIS) with patient-level medical history from the EHR to deliver accurate, patient-specific EHR immunization reminders. An IIS, also known as an immunization registry, is a population-based system that collects immunization data primarily for children and adolescents from providers at a regional or State level. Harnessing data in the IIS can help overcome the limitations of a traditional CDS because the IIS consolidates patient’s immunization data across providers, no matter where the immunization was administered.

The specific aims of this project are as follows:

  • Assess the impact of EHR reminders integrated with immunization data and forecasting from a regional IIS on receipt of generally recommended immunizations in a low-income, urban, pediatric, and adolescent population 
  • Assess the impact of integrated EHR reminders that also incorporate patient’s medical conditions on receipt of immunizations specifically recommended for children and adolescents with CMCs. 

The project team will conduct a randomized cluster crossover clinical trial to assess immunization outcomes during periods when patient-specific EHR immunization reminders are “on” versus “off”. The study will assess outcomes for all children and children with CMCs.

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