Education/Quality Improvement
Kenneth Izuora, MD, MBA, FACE
Chief, Division of Endocrinology and
Program Director, Endocrinology Fellowship Training Program
University of Nevada Las Vegas
Las Vegas, Nevada, United States
Nancy Delcid
Clinic Supervisor
UNLV Health
Lack of documentation of vaccination status in the electronic medical records (EMR) limits the ability to identify patients who need vaccination assessment, a key step in the Centers for Disease Control and Prevention’s Standards for Adult Immunization Practice. Despite the capability of the EMR to communicate with the state immunization information system (IIS) to update vaccination information, we observed our patient’s vaccination status was often missing despite receiving vaccines from outside our system. The purpose of this project was to identify reasons for absent vaccination information in our EMR which will guide interventions to optimize the accuracy of vaccine information in our EMR.
Methods:
We identified our patients with diabetes without documentation of influenza and COVID-19 vaccination in the EMR. Using a questionnaire administered by our clinic staff, we assessed the vaccinations status of the first 52 of these patients presenting for out-patient visit over a six-week period. Those reporting that they received neither vaccine were considered to have accurate records and were flagged for follow up. For the rest of the patients that indicated they received the vaccines, we refreshed their EMR to reconcile it with the IIS. After this, those that still did not have their vaccination information updated were asked to provide the date and locations of vaccination. Their records were manually verified by logging in to the IIS and were recorded as historical entries in the EMR.
Results:
Our population included 31 female and 21 male patients with mean age 58.8 years (SD = 13.3). Out of the 52 patients, 16 (31%) reported they had received neither vaccine while 36 (69%) reported receiving both vaccines. Of this, 32 vaccination records (62%) were reconcilable from the IIS by refreshing the EMR while 4 (7%) records were retrieved manually by logging in to the IIS and were then entered into the EMR. Of note, all 36 patients that reported receiving the vaccines had their records available in the IIS. By the end of the QI intervention period, all 52 included patients had up-to-date and accurate vaccination information in the EMR.
Discussion/Conclusion:
Among our patients without documented influenza and COVID-19 vaccination, we found that the Information in the IIS accurately reflected their current vaccination status and that a majority had received both vaccines. The key reason for vaccination information not being updated in our EMR was the inability of the EMR to automatically reconcile information from the IIS.
Routinely refreshing the EMR and establishing real-time communication between the EMR and IIS will improve access to up-to-date vaccinations information. This in turn will facilitate interventions to improve vaccination uptake.