Article Commentary: Clinical Decision Support for Immunizations (CDSi): A Comprehensive, Collaborative Strategy

Arzt, Noam H.

doi:10.4137/bii.s40204

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…A fair amount of work is needed to keep rules up-to-date highlighting the potential for open-source centralized rule-based engine such as these; if EHR vendors used such engines, they could reduce redundancies and more easily ensure they are always using the most up-to-date rules. 8 It would be important that systems are in place to ensure updates are not missed. Such rule-based engines are helpful for routine immunizations but may be more limited for immunizations needed for high-risk conditions.…”

Section: Discussionmentioning

confidence: 99%

“…6 Catch-up doses for children with delayed immunizations present an even greater challenge, as there are changes to both the dosage intervals and the number of immunizations needed. 7 8…”

Section: Background and Significancementioning

confidence: 99%

“…Frontline care providers are most likely to benefit when accurate data and forecasting reminders from the IIS fit within their current EHR workflow. 8…”

Section: Background and Significancementioning

confidence: 99%

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Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

et al. 2021

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Background Immunization reminders in electronic health records (EHR) provide clinical decision support (CDS) that can reduce missed immunization opportunities. Little is known about using CDS rules from a regional immunization information system (IIS) to power local EHR immunization reminders. Objective This study aimed to assess the impact of EHR reminders using regional IIS CDS-provided rules on receipt of immunizations in a low-income, urban population for both routine immunizations and those recommended for patients with chronic medical conditions (CMCs). Methods We built an EHR-based immunization reminder using the open-source resource used by the New York City IIS in which we overlaid logic regarding immunizations needed for CMCs. Using a randomized cluster-cross-over pragmatic clinical trial in four academic-affiliated clinics, we compared captured immunization opportunities during patient visits when the reminder was “on” versus “off” for the primary immunization series, school-age boosters, and adolescents. We also assessed coverage of CMC-specific immunizations. Up-to-date immunization was measured by end of quarter. Rates were compared using chi square tests. Results Overall, 15,343 unique patients were seen for 26,647 visits. The alert significantly impacted captured opportunities to complete the primary series in both well-child and acute care visits (57.6% on vs. 54.3% off, p = 0.001, and 15.3% on vs. 10.1% off, p = 0.02, respectively), among most age groups, and several immunization types. Captured opportunities for CMC-specific immunizations remained low regardless of alert status. The alert did not have an effect on up-to-date immunization overall (89.1 vs. 88.3%). Conclusion CDS in this population improved captured immunization opportunities. Baseline high rates may have blunted an up-to-date population effect. Converting Centers for Disease Control and Prevention (CDC) rules to generate sufficiently sensitive and specific alerts for CMC-specific immunizations proved challenging, and the alert did not have an impact on CMC-specific immunizations, potentially highlighting need for more work in this area.

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Section: Discussionmentioning

confidence: 99%

“…6 Catch-up doses for children with delayed immunizations present an even greater challenge, as there are changes to both the dosage intervals and the number of immunizations needed. 7 8…”

Section: Background and Significancementioning

confidence: 99%

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Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

et al. 2021

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“…68 Algorithmic forecasting functions most easily for age-based recommendations. 69 Algorithms based on medical conditions do not function as effectively. Few state registries have the resources needed, and few health care systems have the incentives, to collect diagnoses and generate forecasts for medically indicated vaccines.…”

Section: Lists 4 Of the Nvac's Standards For Adult Immunizationmentioning

confidence: 99%

Vaccination of Adults in General Medical Practice

Hunter

Fryhofer

Szilâgyi

2020

Mayo Clinic Proceedings

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In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.

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“…The following is an excerpt from a previously published background article (with original references) by this same author which explains much of the background, philosophy, and use of this product. 2 "A key element of preventive care is the provision of immunizations for vaccine-preventable diseases. Over time, however, the immunization schedule * that clinicians consult has become more complex, and routine immunizations have become more numerous across a patient's life span.…”

Section: Introductionmentioning

confidence: 99%

Immunization calculation engine: An open source immunization evaluation and forecasting system

Arzt

Chertcoff

Nicolary

et al. 2021

Learning Health Systems

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Introduction:The immunization calculation engine (ICE) is a free, open-source immunization forecasting evaluation and software system whose default immunization schedule supports all routine childhood, adolescent, and adult immunizations based on the recommendations of the Advisory Committee on Immunization Practices (ACIP). ICE utilizes its immunization rules and patient data to evaluate and return the validity of each immunization in the patient's history along with one or more evaluation reasons. It also returns a recommendation for each vaccine group along with one or more recommendation reasons.Methods: In January 2020, ICE was first released as a Docker image along with the traditional zip archive file which had been used up to that point. Docker enables software providers to easily distribute their software so that it can be run "out of the box" in the user's local environment. Software running in Docker containers drastically reduces the complexity of software distribution and set up.Results: Clinical systems of many types use ICE. The project began within the public health arena as a feature of Immunization Information Systems (IIS), but electronic health records (EHR) and personal health records (PHR) have also deployed ICE. While it is not possible to identify the specific impact of ICE on clinical care without additional research, it should be pointed out that once deployed within an IIS, EHR, or PHR the display of ICE results is performed for every patient viewed by a user and often for every patient appearing on a report. In a typical month, thousands if not millions of evaluations and forecasts are performed by ICE and displayed to the users. Conclusions:The ICE Project believes in minimizing the barriers to installing and using ICE anywhere. To that end, there is no registration required to download the source code or runtime code for the ICE service and its default rule. Similarly, the Project created a Docker image of ICE to facilitate easy and seamless implementation.

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Article Commentary: Clinical Decision Support for Immunizations (CDSi): A Comprehensive, Collaborative Strategy

Cited by 4 publications

References 9 publications

Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

Vaccination of Adults in General Medical Practice

Immunization calculation engine: An open source immunization evaluation and forecasting system

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