Leveraging Immunization Information Systems: Emerging Data Sources to Drive Vaccination Rates

Pharmacists are changing the face of public health, and the nation’s thought leaders have taken notice. As pharmacist practice authority has expanded to include vaccinations, there has been an accompanying increase in patients who receive their vaccines in community pharmacies. According to CDC survey data, pharmacists administered just 6% of total influenza vaccinations in the 2005-2006 flu season,¹ but the percentage jumped to nearly 25% in the 2015-2016 season.² In a move that runs parallel to the growing numbers of patients who look to their community pharmacists to take ownership of the care needed to protect them from vaccine-preventable illness, expansions made by lawmakers, regulatory bodies, and payers are allowing pharmacists to manage a growing number of immunization-related responsibilities.

Poor vaccination rates among the adult population have played a major role in the calls to action for pharmacies.³ One of the challenges to this vaccination gap closure, especially for adults, is gaining easy access to a comprehensive vaccination record. It is challenging to identify individual patient immunization gaps at the point of care. This is where immunization information systems (IIS) can be a useful part of the solution.

IIS are state or jurisdictional data repositories of patient immunization histories. Each of the 50 states, the US territories, and some individual metropolitan areas have their own IIS.⁴ Also referred to as immunization registries, IIS are confidential, population-based, computerized databases that record all immunization doses administered by providers.

IIS that are rich in data can provide consolidated immunization histories at the point of care for pharmacists to use in determining appropriate patient vaccination status and needs. They can be used to support pharmacists in vaccination decision making in a number of ways. Many allow for health care providers to perform a query of the registry to pull down patient immunization histories through online portals. This functionality has been adopted into several pharmacy management systems within national, regional, and independent community pharmacies, as well as in a growing number of clinical workflow management platforms managed by third-party vendors. These technological integrations allow pharmacy staff to stay within workflow when performing IIS queries for patient vaccination histories. And when used with decision support algorithms based on the CDC’s Advisory Committee on Immunization Practices Adult Vaccination Schedule, IIS allow pharmacists to forecast both present and pending vaccination needs for their patients.

Because IIS collect data from all vaccination providers, they represent significant resources for every health care profession that administers vaccines. For example, some pharmacies are using IIS to identify instances when patients haven’t yet received their seasonal influenza vaccine elsewhere. According to Scientific Technologies Corporation data, one national community pharmacy organization saw a difference of over 30% in influenza rates for their pharmacies that were highly engaged in IIS query (performing 100 or more queries per season) compared with those that were not. Community pharmacies are also using IIS to identify missing pneumococcal vaccinations for high-risk patients, to initiate age-appropriate regimens for patients who have not started them yet, and to complete regimens for patients who have only had 1 of the 2 recommended pneumococcal vaccines. IIS can also be used to identify vaccine series that patients either have not initiated or initiated elsewhere and need to complete.

The closure of vaccination gaps, particularly in the adult population, represents a tremendous opportunity for community pharmacists. From the patient-value perspective, pharmacists can deepen the contributions they are making in meeting public health goals related to vaccine-preventable disease. For pharmacy’s bottom line, relatively strong profit margins associated with vaccines continue to help pharmacies remain viable in a competitive health care marketplace. Utilization of IIS—both for reporting administered vaccines and querying patient immunization histories—is important for driving strong pharmacy-based vaccination programs and deepening community pharmacist integration into the emerging public health immunization ecosystem.

Samuel F. Stolpe, PharmD, is vice president, private sector, Scientific Technologies Corporation.

References

• Wick JY. Pharmacy-based immunization programs make an impact. Pharmacy Times^® website. pharmacytimes.com/publications/issue/2006/2006-04/2006-04-5476. Published April 1, 2006. Accessed February 9, 2017.
• CDC. National early season flu vaccination coverage, United States, November 2015. CDC website. cdc.gov/flu/fluvaxview/nifs-estimates-nov2015.htm#place. Updated October 25, 2016. Accessed February 9, 2017.
• Williams WW, Lu PJ, O’Halloran A, et al. Morbidity and Mortality Weekly Report (MMWR): surveillance of vaccination coverage among adult populations — United States, 2014. CDC website. cdc.gov/mmwr/volumes/65/ss/ss6501a1.htm. Updated February 4, 2016. Accessed February 9, 2017.
• Kempe A, Hurley LP, Cardemil CV, et al. Use of immunization information systems in primary care. Am J Prev Med. 2017;52(2):173-182. doi: 10.1016/j. amepre.2016.07.029.