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CC BY-NC-ND 4.0 · Appl Clin Inform 2025; 16(01): 101-110
DOI: 10.1055/a-2434-5112
Research Article

The Effect of Electronic Health Record and Immunization Information System Interoperability on Medical Practice Vaccination Workflow

Kevin J. Dombkowski
1   Department of Pediatrics, Susan B Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, United States
,
Pooja N. Patel
1   Department of Pediatrics, Susan B Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, United States
,
Hannah K. Peng
1   Department of Pediatrics, Susan B Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, United States
,
Anne E. Cowan
1   Department of Pediatrics, Susan B Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, United States
› Author Affiliations Funding This research was funded by Centers for Disease Control and Prevention, Joint initiative in Vaccine Economics, Phase 6 U01IP001104. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Abstract

Background Interoperability between electronic health records (EHR) and immunization information systems (IIS) may positively influence data quality, affecting timeliness, completeness, and accuracy of these data. However, the extent to which EHR/IIS interoperability may influence the day-to-day vaccination workflow and related recordkeeping tasks performed at medical practices is unclear.

Objective This study aimed to assess how EHR/IIS interoperability may influence the vaccination workflow at medical practices and to identify related impacts on clinical and administrative activities.

Methods We identified practices (family medicine, pediatrics, internal medicine, local health departments) from the Michigan Care Improvement Registry (MCIR), the statewide IIS in Michigan, representing each of the three HL7 interoperability levels (non-HL7, unidirectional, bidirectional). We conducted semi-structured interviews to assess how practices interact with the MCIR throughout the vaccination workflow. Transcripts were reviewed and coded to characterize practices' use of EHRs, MCIR, and other related technologies across the vaccination workflow.

Results Practices completed Phase 1 (n = 45) and Phase 2 (n = 42) interviews, representing a range of medical specialties, geographic locations, and sizes. HL7 connectivity expanded among the participating practices; by the conclusion of the study, all practices had initiated at least unidirectional HL7 capability. Providers and staff relied heavily upon both their EHRs and MCIR throughout a wide range of vaccination-related activities. Most practices relied on MCIR as their primary source of vaccination history information, and nearly all practices also reported use of paper forms, documentation, and other summaries throughout the vaccination workflow.

Conclusion Practices employed both their EHRs and IIS throughout the entire vaccination workflow, although the use of each relied heavily on paper-based processes. While benefits of adopting EHR/IIS interoperability were reported by practices, this may require staff to learn and implement new workflow processes that can be time consuming and may introduce new challenges.

Keywords

vaccination - workflow - electronic health records - registries - health information exchange

Protection of Human and Animal Subjects

Approval for this study was obtained from the University of Michigan (HUM00157276, 12/19/2018) and the Michigan Department of Health and Human Services (201902-09-NR-(R1), 3/25/2019). This study was reviewed and was determined to be not regulated by the University of Michigan Institutional Review Board.


Supplementary Material



Publication History

Received: 15 March 2024

Accepted: 28 September 2024

Article published online:
05 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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