Electronic medical records system improved vaccine coverage

A multifaceted electronic medical records-based plan implemented at Charles B. Wang Community Health Center in New York City improved staff satisfaction levels and increased the number of 24-month-old patients who were up to date with their vaccines.

This plan demonstrated “that electronic medical records have great potential and ability to transform vaccine delivery to children,” according to the researchers, who presented the findings during a poster session at the American Academy of Pediatrics 2009 National Conference and Exhibition in Washington this weekend.

Beginning in October 2008, an electronic medical record inbox replaced paper logs and clinicians at the center received monthly reports with children who were not up to date with their recommended vaccines. Program features included clinician access to electronic templates that were preloaded with patient vaccine records, computer-generated prompts that reminded staff to order and administer recommended vaccines and an automatic coding system to facilitate easier billing.

From the program’s inception through March 2009, up-to-date vaccine status improved among separate groups of patients by the time they reached age 24 months as follows:

Increased from 20% to 63% (n=30), January to February.
Increased from 25% to 81% (n=20), February to March.
Increased from 54% to 82% (n=24), April to May.
Increased from 43% to 76% (n=21), May to June.

Nurse satisfaction rates increased from 17% to 83% among those who completed a self-administered questionnaire. Survey responses revealed that nurses felt the system was easy to use, increased efficiency, accuracy and patient face time.

Additionally, barcode technology helped reduce the amount of time needed to properly document vaccine administration. Instead of manually entering information into electronic medical records, vaccine lot numbers were scanned directly from the vial into the computer and printed out an index card that nurses would scan to complete database entries every time a vaccine was given — reducing clerical time from two minutes to less than 30 seconds while achieving 100% accuracy.

"Through the use of information technology, we can significantly improve the quality of care that we provide. Alerts, reminders and recalls are just a few of the many tools that this technology offers,” Joseph H. Schneider, MD, chief medical information officer and medical director at Baylor Health and Hospital System in Houston, told Infectious Diseases in Children. Schneider moderated the AAP’s Council on Clinical Information Technology Program, during which this data was presented.

But he noted that despite the advantages, electronic medical record programs cost in excess of $50,000 per doctor. “Physicians don't have the ability to recover these costs as their rates are fixed by insurance companies and Medicare or Medicaid."

Schneider also warned about the potential for over-alerting with these systems. "Just like any other change that is made technology implementation can be done well or done poorly. We need to be careful in how we move forward with this because technology alone won't improve care,” he said. “It's how we adapt our physician practices and how we involve our patients that will make the difference." – by Nicole Blazek

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