title: Use of Immunization Information Systems in Primary Care.
abstract: BACKGROUND
  Immunization information systems (IISs) are highly effective for increasing vaccination rates but information about how primary care physicians use them is limited.
  
  
  METHODS
  Pediatricians, family physicians (FPs), and general internists (GIMs) were surveyed by e-mail and mail from January 2015 to April 2015 from all states with an existing IIS. Providers were recruited to be representative of national provider organization memberships. Multivariable log binomial regression examined factors associated with IIS use (October 2015-April 2016).
  
  
  RESULTS
  Response rates among pediatricians, FPs, and GIMs, respectively, were 75% (325/435), 68% (310/459), and 63% (272/431). A proportion of pediatricians (5%), FPs (14%), and GIMs (48%) did not know there was a state/local IIS; 81%, 72%, and 27% reported using an IIS (p<0.0001). Among those who used IISs, 64% of pediatricians, 61% of FPs, and 22% of GIMs thought the IIS could tell them a patient's immunization needs; 22%, 29%, and 51% did not know. The most frequently reported major barriers to use included the IIS not updating the electronic medical record (29%, 28%, 35%) and lack of ability to submit data electronically (22%, 27%, 31%). Factors associated with lower IIS use included FP (adjusted risk ratio=0.85; 95% CI=0.75, 0.97) or GIM (adjusted risk ratio=0.33; 95% CI=0.25, 0.42) versus pediatric specialty and older versus younger provider age (adjusted risk ratio=0.96; 95 CI%=0.94, 0.98).
  
  
  CONCLUSIONS
  There are substantial gaps in knowledge of IIS capabilities, especially among GIMs; barriers to interoperability between IISs and electronic medical records affect all specialties. Closing these gaps may increase use of proven IIS functions including decision support and reminder/recall.
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: allison.kempe@childrenscolorado.org.
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; Division of General Internal Medicine, Denver Health, Denver, Colorado.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Hurley
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cristina V
authors.initials: CV
authors.lastname: Cardemil
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Mandy A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; Community and Behavioral Health, Colorado School of Public Health, Denver, Colorado.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Michaela
authors.initials: M
authors.lastname: Brtnikova
authors.affiliation: Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Pabst
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
mesh_terms: D000328:Adult; D000367:Age Factors; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records / Q000706:statistics & numerical data; D034742:Electronic Mail; D005260:Female; D058005:General Practitioners; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007256:Information Systems / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D000072143:Pediatricians; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*; D000071836:Professional Practice Gaps / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*