Using Information Technology to Improve Adult Immunizations

Background:
Influenza and pneumococcal immunization are top ranked prevention services for adults with the potential to decrease disease burden and costs. Efforts are needed to improve adult immunization rates using innovative methods. Information technology can support efficient delivery of adult immunizations.

Setting:
From 2005-2007 Denver Health, Colorado Clinical Guidelines Collaborative (CCGC), and Colorado Health Outcomes (COHO) collaborated to improve adult immunizations in a large, integrated, safety net healthcare system.

Population:
Denver Health serves a culturally and economically diverse, urban population.

Project Description:
A clinical decision support tool (CDST) for influenza, pneumococcal, and tetanus immunization was developed and imbedded into the electronic record system. Medical diagnoses from patient charts and immunization history from the vaccine registry were used in the CDST. In addition, a new standing order procedure that allowed medical assistants to use the tool and administer immunizations without a written order was introduced into community health centers. The CDST was tested in two community health centers and one inpatient unit using a rapid cycle feedback process and staff education, and then introduced throughout the institution.

Results/Lessons Learned:
After the introduction of the CDST PPV rates increased in adults >=65 by more than 10% in both the inpatient units and community health centers, and the increases were sustained nine months beyond the end of the project. In addition to the implementation of the CDST, standardization of the process for immunization delivery and documentation improved in the inpatient and community health center settings. The CDST resulted in more eligible patients being immunized than the typical paper standing order, and demonstrates how technology along with a standardized protocol can improve immunization delivery. In addition, an electronic CDST can be fairly easily updated to respond to changes in immunization recommendations.