Improving Immunization Health Care Data Quality using Two-Dimensional Barcoding and Barcode Scanning Practices

Abstract

Background Manual data entry is time-consuming, inefficient, and error prone. In contrast, leveraging two-dimensional (2D) barcodes and barcode scanning tools is a rapid and effective practice for automatically entering vaccine data accurately and completely. CDC pilots documented clinical and public health impacts of 2D barcode scanning practices on data quality and completeness, time savings, workflow efficiencies, and staff experience.

Objectives Data entry practices and entered records from routine and mass vaccination settings were analyzed. Data quality improvement opportunities were identified.

Methods A sample of 50 million emergency use authorization (EUA) coronavirus disease 2019 (COVID-19) vaccine records were analyzed for accuracy and completeness across three data fields: lot number, expiration date, and National Drug Code (NDC). The EUA COVID-19 vaccines lacked a 2D barcode containing these data fields, which necessitated manual data entry at administration. A CDC pilot at clinic compared scanned and manually entered data for routine vaccines across these same data fields.

Results Analysis of 50 million manually entered EUA COVID-19 vaccine administration records indicated significant gaps in data accuracy and completeness across three data fields. Over half of the analyzed EUA vaccine NDCs (53%) and one-third of the expiration dates (35%) had missing or inaccurate data recorded. Pilot data also showed many errors when manually entered. However, when the pilot's routine vaccines were scanned (out of 71,969 records), nearly all entries were complete and accurate across all three data fields (ranging from 99.7% to 99.999% accurate).

Conclusion Vaccine 2D barcode scanning practices increased data accuracy and completeness (up to 99.999% accurate) across data fields assessed. When used consistently, vaccine 2D barcode scanning can resolve issues demonstrated in manually entered data. To realize these benefits, the immunization community should widely use scanning practices. To increase use, CDC developed a Vaccine 2D Barcode National Adoption Strategy and implementation resources.

Keywords

public health - vaccines - data quality - immunization - vaccination - health records - population health - registries

• References

• 1 Pereira JA, Quach S, Hamid JS. et al; Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Vaccine Coverage Theme Group. Exploring the feasibility of integrating barcode scanning technology into vaccine inventory recording in seasonal influenza vaccination clinics. Vaccine 2012; 30 (04) 794-802
• 2 O'Connor AC, Kennedy ED, Loomis RJ. et al. Prospective cost-benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking. Vaccine 2013; 31 (31) 3179-3186
• 3 US Centers for Disease Control and Prevention. Findings Report: 2D Vaccine Barcode Scanning Pilot. Atlanta, GA: National Center for Immunization and Respiratory Diseases; ; May 2018. Accessed January 12, 2023 at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/downloads/2D-Findings-Report-508.pdf
• 4 Reed JH, Evanson HV, Cox R. et al. Improving utilization of vaccine two-dimensional (2D) barcode scanning technology maximizes accuracy benefits. J Healthc Qual 2021; 43 (01) 39-47
• 5 Chaudhry B, Wang J, Wu S. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742-752
• 6 Khammarnia M, Kassani A, Eslahi M. The efficacy of patients' wristband bar-code on prevention of medical errors: a meta-analysis study. Appl Clin Inform 2015; 6 (04) 716-727
• 7 Evanson HV, Reed JH, Cox R. et al. Improving staff experience with vaccine data entry with 2D barcode scanning. J Nurs Care Qual 2021; 36 (02) 143-148
• 8 US Food and Drug Administration. Product Identifiers Under the Drug Supply Chain Security Act: Questions and Answers Guidance for Industry. Silver Spring, MD: Center for Drug Evaluation and Research and Center for Biologics Evaluation and Research; ; June 2021. Accessed January 12, 2023 at: https://www.fda.gov/media/116304/download
• 9 Bundy DG, Shore AD, Morlock LL, Miller MR. Pediatric vaccination errors: application of the “5 rights” framework to a national error reporting database. Vaccine 2009; 27 (29) 3890-3896
• 10 Pereira JA, Quach S, Hamid JS. et al; Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Program Delivery and Evaluation Group. The integration of barcode scanning technology into Canadian public health immunization settings. Vaccine 2014; 32 (23) 2748-2755
• 11 Daily A, Kennedy ED, Fierro LA. et al. Evaluation of scanning 2D barcoded vaccines to improve data accuracy of vaccines administered. Vaccine 2016; 34 (47) 5802-5807
• 12 US Centers for Disease Control and Prevention. Vaccine Two-Dimensional (2D) Barcodes. Atlanta, GA: National Center for Immunization and Respiratory Diseases; ; January 19, 2021. Accessed January 12, 2023 at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/index.html
• 13 Reza F, Jones C, Olson R. et al. Improving Data Quality and Completeness in Immunization Records with Vaccine 2D Barcodes Enabled Automation and Interoperation. Presented at: AMIA Clinical Informatics Conference 2022; May 24, 2022; Houston, TX. Accessed January 12, 2023 at: https://s4.goeshow.com/amia/cic/2022/schedule_at_a_glance.cfm?session_key=BB7EE5B2-D292-79C8-2E44-F862B3689E42&session_date=Tuesday
• 14 US Centers for Disease Control and Prevention. Vaccine 2D Barcodes Landscape Assessment. Atlanta, GA: National Center for Immunization and Respiratory Diseases CDC Vaccine 2D Barcodes Team Internal Unpublished Report; ; February 2021
• 15 US Centers for Disease Control and Prevention. CDC Vaccine 2D Barcode Scanning Functionality Testing Resource. Atlanta, GA: National Center for Immunization and Respiratory Diseases; ; August 9, 2022. Accessed January 12, 2023 at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/downloads/CDC-IISSB-Vaccine-2DBC-UoU-and-VIS-Barcode-Testing-Resource-508.pdf
• 16 US Centers for Disease Control and Prevention. CDC Vaccine 2D Barcode Scanning Implementation Toolkit. Atlanta, GA: National Center for Immunization and Respiratory Diseases; ; January 19, 2021. Accessed January 12, 2023 at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/implementation-toolkit.html
• 17 US Centers for Disease Control and Prevention. CDC EHR/IIS 2D Barcode Functional Capabilities Guide. Atlanta, GA: National Center for Immunization and Respiratory Diseases; ; September 2022. Accessed January 12, 2023 at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/downloads/barcode-functional-capabilities.pdf
• 18 Reza F, Jones C, Olson R, Shimek A, Shimek H, Bruhn H. Innovative 2D barcoding workaround enhances vaccination best practices in a public health crisis. Presented at: National Association of Community Health Centers 2022 Community Health Institute & Expo. August 28, 2022; Chicago, IL. Accessed January 12, 2023 at: https://www.nachc.org/wp-content/uploads/2022/07/2022CHI-Poster-Program-FINAL-07-18-2022.pdf