Due Diligence Decreases Disease Outbreaks

Family physicians provide health care to millions of Americans, and it's fair to assume that every one of those FPs understands the role vaccinations play in disease prevention.

According to an AAFP CME Bulletin, steady increases in immunization rates in the United States during the past 50 years have led to a steep decline -- more than 95 percent -- in preventable diseases such as measles, influenza, hepatitis A and B, and herpes zoster.

But could America do better?

Immunizations are among the federal Healthy People 2010 initiative's leading health indicators, with specific target vaccination rates for both children and adults. But obstacles to meeting these goals abound. The frequent introduction of new vaccines and vaccine combinations, complex administration schedules, incomplete patient records, and loss of continuity of care between doctor and patient have made it increasingly difficult for family physicians to ensure timely and complete immunization coverage for their patients.

State and regional immunization registries could hold the key to ensuring that the United States continues to enjoy what the American Immunization Registry Association, or AIRA, calls "the highest immunization rates and lowest disease levels in (America's) history."

AIRA is a national organization that works with immunization information systems across the country. AIRA Executive Director Cindy Sutliff said every state has an immunization registry either in operation or under development.

The past decade has seen tremendous growth in the number of state and regional systems, as well as a dramatic shift from paper-based to electronic systems. Sutliff said many of the state registries are Web-based "so doctors have access via the Internet to do their reporting and to access their records to see who has which immunizations."

But registries have moved beyond just serving as data repositories waiting for physician input. Most immunization registries now allow physicians to extract reports that provide statistics on physicians' immunization coverage rates and allow them to see specifics, such as where they are both under- and overimmunizing.

Through the registries, physicians also have ready access to the latest guidance from the CDC's Advisory Committee on Immunization Practices, or ACIP, on new vaccines, vaccine combinations and immunization schedules.

Registries have become increasingly beneficial to physicians, said Sutliff. "Now it's really a useful tool for them in terms of the clinical decision support piece. They can have that (information) at their fingertips."

"The key to acceptance by providers is having an easy-to-use system," said Sherry Riddick, president of the AIRA board of directors and the immunization registry operations manager for Child Profile, Washington's state registry.

In Washington's Web-based system "physicians can log on, look up a record and see what shots are due. We have an incredible number of tools to make (physicians') lives easier and offer several methods for them to get their data to us. For those who input the information manually, we've done everything we can to streamline that process with the fewest number of key strokes possible," she said.

Riddick said Washington's immunization registry is working on eliminating the "dual data entry problem" by providing interfaces with a number of billing systems, and has even secured a real-time interface with a few physicians' EHR systems. But it's a work in progress, she noted.

Indeed, creating a seamless data flow between practice-based EHR systems and immunization registries remains a huge hurdle that must be overcome before immunization registries become mainstream among America's primary care physicians.

Time-pressed physicians and their office staff members aren't keen on entering patient immunization data twice -- once into their own EHR system and then again into the state immunization registry.

Jeffrey Susman, M.D., professor and chair of the department of family medicine at the University of Cincinnati, supports the concept of immunization registries and understands their role in preventing infectious diseases. He's also aware of the wealth of data such registries can provide physicians.

However, the lack of a seamless electronic exchange of information prevents Susman from participating in a registry.

"We have an EHR, and right now, the data link (to the state's immunization registry) is not there," said Susman, who also is a member of the AAFP's Commission on Quality. "As long as inputting data is an added step for the physician, state or regional immunization registries are never going to gain the dissemination they deserve."

Susman said immunization registries hold great promise and could provide patients with a "more robust medical home." However, in a true medical home, "information comes in and goes out seamlessly. You have to have the ability to enter and extract data as part of the workflow, as well as portability of data across different systems," he noted.

Still, Susman expressed optimism for the future of nationwide state and regional immunization registries. "We're not there yet, but we're on the way," he said.