Improving Immunizations in Office Practice Settings

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Improving Immunizations in Office Practice
Settings

• Through Optimization of your
• Electronic Health Record (EHR)

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Speaker

• Trish Manning, BPS,RN
• Manager, Core Prevention and MCMP Services
• Masspro

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Disclosures

• The following speakers/faculty have indicated
  their financial interests and/or relationships
  with commercial manufacturer below

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Program Objectives

• Describe two examples of EHR functionality that
  can be used to improve immunization rates
• Describe how the EHR can be used to manage your
  at risk populations for immunizations
• List two resources to support immunization
  services in the office practice setting

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Todays Agenda

• Optimizing Your EHR to Improve Immunization Rates
• A group practices experience of implementing an
  EHR to promote and track preventive care services
• Case studies that highlight reporting as a
  catalyst for workflow redesign and quality
  improvement activities

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• Coverage rates average less than 70 nationally
  for vaccines recommended for adolescents and
  adults, and far greater racial and ethnic
  disparities occur in adolescent and adult
  coverage rates than in pediatric rates. Even
  among patients who see providers at similar
  rates, African Americans and Latinos are less
  likely than whites to be vaccinated.
• Roadmaps for Clinical Practice Case Studies in
  Disease Prevention and Health Promotion. December
  2004

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Pneumonia Vaccination -2008
http//apps.nccd.cdc.gov/brfss/race.asp?catIMyr
2008qkey4408stateMA
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Flu Shot - 2008
http//apps.nccd.cdc.gov/brfss/race.asp?catIMyr
2008qkey4407stateMA
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• You cant manage what you dont measure!

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Measure to Manage Improvement

• Decide what you will measure
• Determine how you will measure it
• Communicate improvement measures to the team
• Post/share the results
• Use the results to guide decisions
• And, begin again

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Strategies

• For High Immunization Levels
• Recordkeeping
• Recommendations and reinforcement
• Reminder and recall to patients
• Reminder and recall to providers
• Reduction of missed opportunities
• Reduction of barriers to immunization
• http//www.cdc.gov/vaccines/pubs/pinkbook/downlo
  ads/strat-508.pdf

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Recordkeeping

• Available
• Easy to read
• Accurate/complete
• Reportable
• Data entry links functionality to clinical
  decision support alerts/reminders, recall
  systems, and order sets

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Data Entry - Think Backwards!

• Jump ahead 1 wk, 1 mo, 1 year, 10 years
• What information will you need to
• determine patients that are eligible for
  immunizations,
• manage patients that are at risk, and
• identify populations with specific needs?

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Essential Patient Information

• Demographics
• Age/Gender
• Education Level
• Race/Ethnicity
• Language Read/Language Spoken
• Problem List/Diagnoses
• Allergies
• Medications
• Pertinent Medical, Family, Social History

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System Set-up

• Configuration/Customization/Mapping
• Letters/Forms
• Templates/Flow Sheets
• Recall/Registry Reports

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Recommendation
The recommendation of a health care provider is
the single most important determinant of whether
or not someone gets vaccinated.
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Reinforcement

• Verbal encouragement by the clinicians
• Printed schedule of immunizations/preventive
  schedule
• Handout of age appropriate tests/immunizations
• Electronic Preventive Services Selector
• http//epss.ahrq.gov/ePSS/GetResults.do?ne
  wtrue

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Reminder and Recalls to Patients

• Reminders (due)
• Postcards, letters, e-mails, calls
• Vaccination assessment
• Recalls (past due)
• Reminder system for office support staff to
  contact patient and schedule appointment

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Assess Needs/Prompt Discussion
Give this form to all patients when they check
in. Use it to assess immunization needs and
prompt discussion with the clinician.
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Reminder and Recall to Providers

• Prompt provider at point of care for due and past
  due preventive services.
• Can be generic or patient specific
• Benefit limited to patients seen in the office

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Reduction of Missed Opportunities

• Several studies have shown that eliminating
  missed opportunities could increase vaccination
  coverage by up to 20.
• http//www.cdc.gov/vaccines/pubs/pinkbook/downlo
  ads/strat-508.pdf

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Reasons for Missed Opportunities

• Immunization record availability
• Office Policy
• Reimbursement Issues
• Other

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Reduction of Barriers to Immunization

• Practice setting
• Access
• Waiting time
• Distance
• Cost
• Fears/misconceptions
• Safety concerns

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Getting Started

• Get the Patient to the Vaccine
• Implement office policy/standing orders
• Implement reminder/recall systems
• Document Vaccinations and Refusals
• Keep accurate/complete records
• Use flow sheets (reportable data)

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Getting Started (cont.)

• Monitor and track vaccination performance
• Manage Your at Risk Populations
• Engage Patients in their Care

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Getting Started (cont.)

• Provide patient education specific to
• Language
• Culture
• Age
• Partner with the community to reach target
  populations

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Standing Orders and Workflows
Alerts and notifications can be sent to
multiple members of the office practice, instead
of the clinician only, if you apply standing
orders and create an efficient workflow around it.
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Wallet Card
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Risk Management Strategies

• Diagnose and address reasons for non-adherence
• Document all interactions including informed
  refusal
• Maintain systems to identify non-adherence early
• Risk Managers Offer Tips for Working with
  Difficult Patients by Eric Berman (online
  CME/Risk Manger Tips/ MMS)
• The Physicians Corner by Henry Tulgan, MD, FACP

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More Ideas for Improving Rates

• Ask patients to fill in an immunization
  assessment form prior to a visit
• Administer appropriate immunizations prior to the
  physicians portion of the visit (standing
  orders)
• Give patients a preventive care sheet that lists
  age-appropriate tests and immunizations and when
  they are due (AHRQ Adult Preventive Timeline)

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Masspro Public Flu Clinic Finder

• http//flu.masspro.org/

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In Review

• Describe two examples of EHR functionality that
  can be used to improve immunization rates
• Describe how the EHR can be used to manage your
  at risk populations for immunizations
• List two resources to support immunization
  services in your practice

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Web resources

• The Pink Book
• http//www.cdc.gov/vaccines/pubs/pinkbook/default.
  htm
• MDPH Flu Website
• www.mass.gov/dph/flu
• CDC Website http//www.cdc.gov/vaccines/
• Advisory Committee on Immunization Practices
• http//www.cdc.gov/vaccines/recs/acip/default.htm

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• BRFSS Prevalence and Trend Data
• http//apps.nccd.cdc.gov/brfss/
• Immunization Action Coalition
• http//immunize.org/
• Electronic Preventive Services Selector
• http//epss.ahrq.gov/ePSS/GetResults.do?newtrue

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Contact Information - Masspro

• Trish Manning, RN, BPS
• Manager Core Prevention and MCMP Services,
• Masspro
• [phone]
• pmanning_at_maqio.sdps.org