SINC: Synchronized Immunization Notifications

National immunization coverage rates fall below Healthy People 2020 goals. Gaps in immunization coverage exist across healthy pediatric populations and in children with chronic medical conditions (CMCs). The latter may have additional immunization recommendations or require immunizations outside of the standard immunization schedule. One strategy to increase coverage rates is to offer vaccines whenever an individual enters the healthcare system. However, clinicians focused on other aspects of care may not consider the need for immunizations outside of well-child visits. This can result 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 depend on data in the electronic health record (EHR), which if incomplete leads 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 do not take into account an individual child’s medical conditions.

This project combined data from an immunization information system (IIS) registry with patient-level medical history from the EHR to deliver accurate, patient-specific EHR immunization reminders. An IIS is a population-based system that collects immunization data 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 patients' immunization data across providers, no matter where the immunization was administered.

The specific aims of the research were 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 patients' medical conditions on receipt of immunizations specifically recommended for children and adolescents with CMCs. 

The investigators found that while immunization CDS did result in an increase in vaccinations received by individual patients, the use of CDS did not impact rates in the study population. This may be due to very high baseline immunization rates at the study sites and thus immunizations already being a well-established and important part of the practice’s workflow. The alert may be helpful at practices not routinely checking for needed immunizations at all visits. The alert did not have an impact on condition-specific immunizations for children with CMCs. This indicates more precise coding may be needed to be able to launch sensitive and specific alerts that are more actionable for the end users.