Encouraging Immunization Information System Use in Community Pharmacy Practice

Technology has permeated and revolutionized almost every industry, transforming the way we capture and organize massive amounts of information to be converted into valuable, actionable data. Perhaps no sector has benefited more from technological advancement than health care, and within that world, community pharmacy is among the biggest beneficiaries. Wide and affordable access is now available to efficient communication platforms that can connect community pharmacists with other health care providers, empowered and positioned to play a meaningful role in maintaining population health. One of the most impactful ways that community pharmacists can fulfill this role is through administering and properly reporting vaccinations.

An estimated 42,000 child deaths could be prevented each year in the United States through the appropriate administration of vaccines.¹ Although physicians and medical researchers are front and center in the movement to improve vaccination uptake, pharmacists have also taken up the cause. Serving as national vaccine advocates, pharmacists are stationed on the front lines in their local community pharmacies. As a community’s most accessible caregivers, pharmacists play a vital role in not only providing patients with the immunizations they need but also providing education during face-to-face encounters with patients. In addition, community pharmacists can educate those who are on the fence about the importance of vaccinations.

The impact of the community pharmacist extends further than their local community when they are able to share immunization records nationally by utilizing immunization information systems (IISs). IISs are a prime example of transformative health care technology, as they allow for the capture and organization of comprehensive immunization data that directly lead to improved population health.

Pharmacy immunization record reporting is mandated in more than 30 states,^2,3 and it is highly encouraged in the other states where integration is available but not yet required. Although the first IIS database was implemented in 1997,⁴ reporting requirements vary by state and not all require immunization providers to participate in data exchange. Pharmacists, however, are estimated to administer more than 6.2 million influenza and 3.5 million pneumococcal vaccines annually,⁵ and as such, immunization record—reporting should be a vital part of pharmacy operations, regardless of legislative mandate, for public health purposes.

WHAT IS AN IIS REGISTRY?

Maintained and provided by the state’s Department of Health, an IIS registry houses patient immunization history reported by vaccine providers. These consolidated data are then used to achieve 3 core objectives:

1. Ensure patient adherence to Advisory Committee on Immunization Practices (ACIP)—recommended immunization schedules;

2. Provide individuals with access to their vaccination records; and

3. Deliver public health data on immunization trends.⁶

IISs are strictly confidential and secure, providing patient privacy through state-implemented regulations. However, it should be noted that IISs are exempt from the Health Insurance Portability and Accountability Act of 1996 because the CDC classifies reporting as a public health activity.⁷

Not all IISs are created equal. IIS registries are binary and designed as either unidirectional or bidirectional databases. A unidirectional IIS collects only patient immunization information, whereas its bidirectional counterpart also communicates patient immunization history back to the provider, making it a valuable asset for delivering comprehensive and effective patient care. Currently, more than 40 states support bidirectional IIS communication.³

However, immunization data reporting does not automatically commence once a pharmacy enrolls with the state IIS. Rather, once the enrollment and credentialing processes have been completed, pharmacies can start to manually report every immunization through the database, and if the feature is available, look up patient history by logging into the online IIS portal. This process is slow, tedious, and inefficient, unduly burdening pharmacists’ workflow.

THIRD-PARTY VENDORS

Automation is a much-welcomed remedy to manual documentation and reporting that not only improves efficiency but also can result in other downstream benefits. The pharmacy IIS vaccination reporting process is no different. Third-party vendors such as PrescribeWellness, a Tabula Rasa HealthCare company, employ solutions to electronically submit and retrieve immunization records on behalf of the pharmacy. PrescribeWellness originally created its cloud-based solution, VaccineComplete, to identify patients and alert pharmacists about missed vaccination opportunities for disease prevention. VaccineComplete enables the documentation of each administered immunization; this documentation is then automatically sent to the local IIS registry through an electronic HL7 interface. VaccineComplete synchronizes, analyzes, and transmits patient data overnight on behalf of the pharmacy, eliminating manual data entry.

In those instances where bidirectional data are available, VaccineComplete will pull and deliver patient immunization history directly from the state IIS registry and send it to the pharmacy. When a pharmacy contracts with a third-party vendor to connect to a state registry, that pharmacy must first undergo an integration process along with data-delivery testing to ensure that patient information is translated correctly. Some vendors, such as PrescribeWellness, also deliver historical vaccine administration data, which can greatly benefit both providers and patients accessing their records. Many third-party vendors, like PrescribeWellness, also offer comprehensive on-boarding support, helping pharmacies to comply with local IIS registration requirements and ensuring that they stay compliant when registry demands change.

PATIENT AND PHARMACIST BENEFITS

Immunization registries benefit both patients and pharmacists for 2 very different reasons. For patients, simply having access to their vaccination records is valuable. Although this information is generally required to enroll in school and at certain places of employment, it is often misplaced or forgotten. Providing patient access to immunization history is also beneficial during vaccine-preventable disease outbreaks. Using the measles outbreak that is currently sweeping the nation, as an example,⁸ the CDC advises individuals without evidence of immunity to receive at least 1 dose of the measles, mumps, and rubella vaccine.⁹ Providing patients with the ability to access their immunization history via an IIS registry can save considerable time, expense, and emotional distress that accompany a health scare, which could be a matter of life or death.

Meanwhile, IIS registries can identify past-due and upcoming vaccines based on ACIP recommendations, empowering phar- macists (and other providers) to take a proactive approach to vaccination health. By analyzing their patients’ immunization status, pharmacists can act upon current and missed opportunities. IIS registries can even recognize and identify missed doses when a patient fails to complete a vaccination series needed to achieve optimal immunity. And because the names of vaccine manufacturers and vaccine lot numbers are a part of the reporting requirements, recalls that may result in a patient’s suboptimal therapeutic response are also identified. Additionally, registry reporting mitigates the administration of unnecessary duplicate doses.¹⁰

IIS reporting is a valuable tool that inspires and enhances interprofessional communication among providers, leading to improved patient health and quality of life. IIS reporting even promotes revenue generation by enhancing inventory management. Finally, as a sheer policy matter, IIS registries are in the best interest of the public health trust. By gathering patient immunization data, public health entities can continually assess and analyze vaccination trends and take a proactive, rather than reactive, approach to developing programs that reduce the occur- rence of vaccine-preventable diseases.⁶

THE FUTURE IS BRIGHT

IISs play an integral part in raising national immunity thresholds. By empowering community pharmacies to operate in a primary care role, these continuously evolving entities serve as another prime example of how technology integration can transform the way patients receive daily care. Add in an automation solution procured through a third-party vendor, state reporting processes are instantly streamlined, allowing pharmacists to spend more time providing quality care, such as complete immunization services, that improve the health of the communities they serve.

REFERENCES

• Outbreaks of vaccine preventable diseases. Infectious Disease Society of America website. idsociety.org/globalassets/idsa/policy--advocacy/current_top- ics_and_issues/immunizations_and_vaccines/adult_and_adolescent_immuniza- tion/vaccine-advocacy-toolkit/outbreaks-of-vaccine-preventable-diseases.pdf. Published 2018. Accessed September 5, 2019.
• Survey of state immunization information system legislation. CDC website. www2a.cdc.gov/vaccines/iis/iissurvey/Legislation-survey.asp. Reviewed August 24, 2018. Accessed September 5, 2019.
• Data on file. PrescribeWellness. 2019.
• Immunization Information System (IIS) Functional Standards, v4.0. CDC website. cdc.gov/vaccines/programs/iis/functional-standards/func-stds-v4-0.html. Reviewed February 14, 2018. Accessed September 5, 2019.
• D’Arrigo T. Pharmacy-based immunization services increase influenza, pneu- mococcal vaccination rates. American Pharmacists Association website. pharma- cist.com/article/pharmacy-based-immunization-services-increase-influenza-pneu- mococcal-vaccination-rates. Published May 21, 2018. Accessed September 5, 2019.
• About immunization information systems. CDC website. cdc.gov/vaccines/ programs/iis/about.html. Reviewed June 7, 2019. Accessed September 5, 2019.
• IIS frequently asked questions. CDC website. cdc.gov/vaccines/programs/ iis/resources-refs/faq.html#Q4. Reviewed June 7, 2019. Accessed September 5, 2019.
• Measles cases and outbreaks. CDC website. cdc.gov/measles/cases-outbreaks. html. Reviewed October 11, 2019. Accessed October 18, 2019.
• Measles, mumps, and rubella (MMR) vaccination: what everyone should know. cdc.gov/vaccines/vpd/mmr/public/index.html. Reviewed March 28, 2019. Accessed September 5, 2019.
• Immunization Information System Functional Standards, 2013-2018. CDC website. cdc.gov/vaccines/programs/iis/func-stds.pdf. Reviewed February 2016. Accessed September 5, 2019.