title: Characterizing the Access of Clinical Decision Support Offered by Immunization Information System in Minnesota.
abstract: BACKGROUND
  Healthy People 2020 aims to improve population health by increasing immunization rates to decrease vaccine-preventable infectious diseases. Amongst the many strategies, role of immunization information systems (IIS) are recognized by studies and taskforce reports. IIS are unique in their offering of clinical decision support for immunizations (CDSi) which are utilized by healthcare providers. Federal initiatives such as Meaningful Use (MU) and Affordable Care Act (ACA) aim to improve immunization rates through use of technology and expanding access to immunization services respectively. MU, the Electronic Health Record (EHR) incentive program includes use of IIS CDSi functionality as part of Stage 3. It is essential to understand access and use patterns of IIS CDSi, so as to utilize it better to improve immunization services.
  
  
  OBJECTIVE
  To understand the utilization of clinical decision support for immunizations (CDSi) offered by immunization information system in Minnesota and to analyze the variability of its use across providers and EHR implementations.
  
  
  METHODS
  IIS in Minnesota (Minnesota Immunization Information Connection: MIIC) offers CDSi that is accessed through EHRs and branded as Alternate Access (AA). Data from MIIC and technical documents were reviewed to create details on organizations which implemented AA functionality. Data on EHR adoption in clinics and local health departments was obtained from Minnesota eHealth assessment reports. Data on access were tracked from January 2015 through mid-October 2015 through weekly specialized reports to track the queries by organization, volume and day of the week. Data were analyzed, findings were synthesized and reviewed with subject matter experts.
  
  
  RESULTS
  Currently 25 healthcare systems/organizations which represent 599 individual provider sites have implemented the AA functionality. Analysis of their EHR platform pointed to two EHRs (Epic and PH-Doc) as dominant products in Minnesota for private and public providers respectively. Use of this function was even across study time period. The query volume correlated to size of the organization, with the exception of an outlier organization with huge query count. Query was able to successfully locate a single matching record for 59% of searches, could not find a record for 5% and 31% resulted in blank/error and the match rates varied across health systems.
  
  
  CONCLUSIONS
  High EHR adoption offers a great opportunity to promote use of IIS CDSi at point of care. Analysis did not track use at individual clinic level and how the queries were being generated. Additional research is needed to understand the provider level use of this CDSi and other organizational and technical factors which influence access to IIS. This is essential for IIS as they execute projects to improve population-level immunization rates, plan provider outreach and prioritize their system enhancements to meet federal requirements.
authors.affiliation: Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sripriya
authors.initials: S
authors.lastname: Rajamani
authors.affiliation: Minnesota Immunization Information Connection (MIIC), Immunization Program, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Aaron
authors.initials: A
authors.lastname: Bieringer
authors.affiliation: Minnesota Immunization Information Connection (MIIC), Immunization Program, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Miriam
authors.initials: M
authors.lastname: Muscoplat
keywords: bidirectional; clinical decision support; electronic health records (EHRs); immunization information systems (IIS); immunizations; public health informatics