Effects of automated immunization registry reporting via an electronic health record deployed in community practice settings.
BACKGROUND: Among the expected benefits of electronic health records (EHRs) is increased reporting of public health information- such as immunization status. State and local immunization registries aid control of vaccine-preventable diseases and help offset fragmentation in healthcare- but reporting is often slow and incomplete. The Primary Care Information Project (PCIP)- an initiative of the NYC Department of Health and Mental Hygiene- has implemented EHRs with immunization reporting capability in community settings. OBJECTIVE AND METHODS: To evaluate the effect of automated reporting via an EHR on use and efficiency of reporting to the NY Citywide Immunization Registry- we conducted a secondary analysis of 1.7 million de-identified records submitted between January 2007 and June 2011 by 217 primary care practices enrolled in PCIP- pre and post launch of automated reporting via an EHR. We examined differences in records submitted per day- lag time- and documentation of eligibility for subsidized vaccines. RESULTS: Mean submissions per day did not change. Automated submissions of new and historical records increased by 18% and 98% respectively. Submissions within 14 days increased from 84% to 87%- and within 2 days increased from 60% to 77%. Median lag time decreased from 13 to 10 days. Documentation of eligibility decreased. Results are significant at p<0.001. CONCLUSIONS: Significant improvements in registry use and efficiency of reporting were found after launch of automated reporting via an EHR. A decrease in eligibility documentation was attributed to EHR workflow. The limitations to comprehensive evaluation found in these data- which were extracted from a registry initiated prior to widespread EHR implementation suggests that reliable evaluation of immunization reporting via the EHR may require modifications to legacy registry databases.