“You actually do that?”

The Surprising New Reality of Immunization Data

By Dale Dauten, syndicated columnist

“Are you really a pharmacist?”

 “Do you really do all this [immunization information] stuff?”

Those were frequent questions provoked by presentation on immunization data at the annual HIMSS19 Global Conference. (That’s the Healthcare Information and Management Systems Society, over 50K members strong, meeting in Orlando earlier this year.)

Three Walmart pharmacists took turns joining in for a demonstration of how they can use immunization data, following a mythical young woman’s vaccination experience from birth till adulthood.

To answer one frequent question, yes, all three are working pharmacists.

The second question (“you really do this?”) makes sense — after all, many tech demonstrations are practically mythical, explaining some “what if?” future.   Not here – all the data use cases presented are actually happening and available – really real.

We talked with one of the three pharmacists, Ashley Luck, who’s a Walmart PCSM, a Pharmacy Clinical Services Manager. (Her job is to travel to other Walmart pharmacies and make sure they are “clinically compliant” with state law and company policies. However, as she happily pointed out, she still “works the bench” once or twice a week.)

Reflecting back on how bi-directional data from the state registry has changed her job as a vaccinating pharmacist, she said:

“Prior to the bi-directional data, our biggest struggle was trying to figure out what vaccinations the patients needed. Now we can see the answer — we look and say, ‘Hey, they got their pneumonia vax six months ago but haven’t had their flu shot.’  So now the biggest barriers are cultural. Now we can focus on educating patients.”

Asked for an example of how the data comes into play at her work, she pointed out that Orlando has many recent immigrants and added, “We have people come through the Port of Entry and they receive vaccinations but don’t remember or don’t understand them. Just last night, on the bench, I had someone who told me, ‘I went through immigration last year and I don’t know what I got.’ I was able to look and make sure she was up to date.”

She also has patients who are temporary residents and she tells them they can go to any Walmart and they can see the immunization history. She can say that because Walmart is the first national chain to have bi-directional registry data in all pharmacies where it’s available.

As for her day at HIMSS, many of the attendees were surprised by the data available. That’s when she heard those “Do you actually do all this?” we mentioned earlier. “One person asked me,” she recalled, “how long it took to get the data into the system. I told him, ‘If you get a vaccination at your doctor’s office and then come straight to the pharmacy, we’ll already see the record.’”  

There are two chances to be surprised by all that vax data can do.

• Review the following summary of the HIMSS presentation.
• Or, you can go here to watch the video version https://www.youtube.com/watch?v=Xbzc2wZzG6A

Use Case Title: Immunization Evaluation & Integration

Short Description: Follow Aria from early childhood into adulthood as she moves through multiple care locations and receives immunizations over time. Immunization schedules have become more complex as more vaccines have been added to the routine schedule, especially for adolescents and adults. Clinical decision support for immunizations is becoming increasingly available both within local EHR systems and in response to queries to immunization information systems at the local and state levels.  Throughout the care process, workflows that are demonstrated reflect the clinical capabilities tested in the HIMSS Immunization Integration Program (IIP). 

Value:  Improved access to comprehensive vaccine history and vaccine forecasts can improve immunization rates and decrease the incidence of vaccine-preventable disease. Interoperable systems place EMRs on a convergent path with immunization registries, enhancing data quality by capturing accurate data at the point of care, and streamlining workflow to increase productivity and reduce re-work.

Scheduled times: This demonstration occurs 45 minutes past the hour.

Logos: Cerner, DSS, Epic, HLN, Hyland, STC, Surescripts

PDF Version of Article>>

Herd Immunization:

The Challenge of Achieving 95% Coverage

By Bill Davenhall, Geomedicine Analyst

Examining the five-year forward (2023) projections of population growth of children under 9 years of age revels a startling trend – 95% of all children under nine years of age will reside in approximately 56% (or 520) of the Census Bureau’s defined metropolitan areas (MSA’s), while the remaining 5% of children under nine will be widely distributed across the remaining 413 MSA’s.

Estimating the need for immunization will likely become the analytical responsibility of “regional” health department collaboration and not solely the responsibility of any single public health jurisdiction. Traditionally, states and counties have assumed this responsibility with support  from the US Centers for Disease Control and Prevention (CDC).

The map below reveals just where child immunization will become an imperative – if herd immunization remains the de facto strategy to reduce the incidence of infectious disease (e.g. measles, polio, rubella, etc.). The MSAs colored RED must strive to meet the 95% coverage rate in order for the nation to achieve a 95% coverage rate in 2023.  More specifically, the thirty-three (33) metropolitan areas listed below will need to administer about 50% of the all the vaccines intended for children under 9 years of age, nationwide. Notice that there are eleven (11) MSAs (hi-lighted) that will be required to address meeting 95% coverage goals across several state and local public health jurisdictions. Looking at the recent measles vaccine coverage challenges by MSAs may help us see the organizational challenges that immunizers might face, today and in the future.

It is likely that health service arrangements that desire to achieve the widest “local” geographical coverage of immunizations for children, will require multi-jurisdictional (state and county) demographic analysis and a more efficient way to monitor, in a timely manner, changes across a broad geographical region. Setting priorities about which “herds” will likely present serious challenges in achieving desirable coverage rates across a large metropolitan area will become a critical analytical and operational endeavor.