Integrating Electronic Information to Improve Documentation of Immunization Rates for a Low-Income, Minority Population

Background: Urban low-income, minority children are at high risk for underimmunization, partially due to fragmented records from multiple providers. Having complete immunization information readily available in the electronic health record (EHR) is important.  The NewYork-Presbyterian Hospital (NYPH) Immunization Registry, EzVAC, which is accessed at the point-of-care, recently began importing immunization data from the New York Citywide Immunization Registry(CIR) for their patients.

Objectives: To assess the impact on immunization record completeness and coverage rates of integrating data from a public immunization registry into a hospital information system.

Methods: Immunization information from EzVAC was reviewed for a random sample of 2529 children seen at one of four NYPH community health centers in the last 12 months.  Patients were 7-23 months old (n=950), 24-36 months (n=960) or adolescents 13-18 years old (n=619).  Using Stata/SE 9.1, the contribution of each source (EzVAC, CIR) to immunization record completeness was assessed, along with impact of integration on age-appropriate immunization coverage according to the 4:3:1:3:3:1 series (DTaP, IPV, MMR, Hib, HepB, varicella) or adolescent immunizations (TdaP, MCV4 and first HPV).

Results: Patients were primarily Latino and publicly insured.  For children 7-23 months old, 90% of immunizations were reported to EzVAC, and 10% from CIR.  Immunization rates increased from 79.3% to 85.6% when immunizations from CIR were included(p<.001).  For children 24-36 months old, 94% of immunizations were from EzVAC, and 6% from CIR; coverage rates increased from 78.6% to 86.1%(p<.0001).  Finally, for adolescents, 78% of immunizations came from EzVAC, and 22% from CIR, with an increase of 74.5% to 79.3% for Tdap(p<.05), 69.8% to 76.4% MCV4(p<.01), and 61.1% to 68.0% HPV1(p<.05).

Conclusions: Integrating public immunization records into a hospital information system significantly increased completeness of records and improved documentation of immunization coverage rates.  Two-way communication regarding immunizations between public and private information systems should be implemented.