Improving Immunization Workflow for Providers – Bulk Query Functionality

Providers who want to make sure their patients are up to date on their immunizations and have complete vaccination records in their electronic health record (EHR) frequently face a challenge—how do they know if their patients received any immunizations elsewhere, outside the providers' practice or healthcare system? Is there a way to efficiently query immunization information systems (IIS) and receive this information to make accurate clinical decisions?

This is not necessarily a new issue—patients may bring in vaccine administration records from other locations or verbally self-report what they have received, hopefully accurately. This information is then manually entered into the EHR, which can be time-consuming and prone to errors. This issue has taken on added significance with COVID-19 vaccines that have been administered at pharmacies, health department clinics, mass immunization events, and other sites outside the patient’s medical home.

If a provider's EHR is set up to exchange data with IIS, it should be possible to query the  IIS from within the EHR, receive a response in real-time that lists all of the vaccines the IIS has for that patient, determine any vaccines that have been given elsewhere not currently in the EHR, and add them to the patient’s vaccination record. Ideally, all the available data associated with the vaccinations—such as the specific product, lot number, location given—will be accurately and quickly transferred.

This process still leaves room for improvement. If a provider is preparing for an upcoming full schedule of patients and wants to make sure their vaccination records are updated, is it necessary to go into each patient's chart to click on a button to query the IIS? If a provider wants to send out reminders to patients to make sure they have received an influenza or COVID-19 vaccine, how can they avoid sending those reminders to patients who have already received them elsewhere? Does this also require first querying the IIS on individual patients one by one?

The answer is a functionality called bulk query, and it can be a tremendous timesaver for providers who want to reduce unnecessary clicks and improve their workflow. As the name implies, this functionality allows for multiple patients to be queried for at once. Even better, such a query across hundreds, or even thousands, of patients can potentially (and preferably) be scheduled to run automatically at night, requiring no interaction from providers. For the busy provider with the full schedule, the immunization information retrieved from the IIS will already be there and ready for review. For the provider wanting to contact patients about getting vaccines, the outside immunization information will help more accurately target the audience that needs reminders.

Several EHRs have this capability, but it is up to providers to be aware of it and ask for it to be implemented. A successful implementation may depend on the capabilities of the IIS to handle bulk queries. To help facilitate this process, a Bulk Query Toolkit has been developed by the Immunization Integration Program (IIP), a collaboration among multiple stakeholders to improve EHR-IIS interoperability by developing best practices for several identified issues.