Michigan researchers call for more robust EHR data sharing

U-M researchers are calling for the Centers for Medicare and Medicaid Services to encourage a more seamless exchange of information between electronic health records and immunization registries.

This means the criteria by which doctors’ offices qualify for Meaningful Use incentive payments would include an emphasis on synchronizing electronic health records and immunization registries.

Currently, providers receive credit toward incentive payments if their electronic health records are able to send information electronically to immunization registries. However, the incentives have no language at this point that would also provide a corresponding capability to share data from immunization registries to electronic health registries.

This is a problem because doctors will continue to be challenged by incomplete vaccination history information for their patients and may have several undesirable effects:

• Doctors will need to spend time looking at information using a completely separate system (registry) to see whether the patient has received other doses. This is extra work and many practices don’t routinely do it.

• Absent the complete vaccination history, providers may choose to administer doses that are apparently needed – but in reality are not. This is an unnecessary use of resources.

• Many practices spend a lot of time and effort sending reminders (phone, post cards, etc.) to patients that need doses – these are wasted resources if the kids don’t need the doses. It can also be very confusing to parents who are under the impression that their kid is up to date, but their doctor is sending them notices saying they are not.

The authors argue that until it is required that electronic health records receive and incorporate registry information back into electronic health records to earn incentives, vendors will have little motivation to address the technical issues necessary to make this a reality.

These viewpoints appear online in the February issue of the American Journal of Preventive Medicine. Authors are Kevin J. Dombkowski, DrPH, M.S., research associate professor and Sarah Clark, associate research scientist with the Child Health Evaluation and Research (CHEAR) Unit.

“Over 100,000 practices have signed on to participate in the Centers for Medicare and Medicaid Services Meaningful Use program,” says Dombkowski. The Meaningful Use program, established under the Health Information Technology Economic and Clinical Health (HITECH) Act of 2009, includes three successive stages, each with certain objectives that must be met to receive incentive payments.

“This broad electronic health record adoption across the country is falling short of its potential to ensure that health care providers have a complete immunization history for every child, including vaccines given at other locations,” says Dombkowski.

The authors’ insights are the result of discussions at a conference convened by the National Vaccine Program Office that brought key national stakeholders together at the University of Michigan to address issues pertaining to the exchange of data between electronic health records and immunization registries.

“The Centers for Medicare and Medicaid Services has an opportunity to align Meaningful Use incentives with functions that will enable real-time bi-directional data exchange between electronic health records and immunization registries,” Dombkowski says.

“Thousands of practices are currently making significant investments in electronic health records systems but may not be able to realize their full potential,” he adds. “If those electronic health records cannot be synchronized with immunization registries, the practices could experience significant time and resource demands to ensure that their immunization records are complete.”

“The technology necessary to achieve bi-directional exchange between electronic health records and immunization registries is not far-fetched,” says Dombkowski. “Most of what is necessary already exists. Several state immunization registries, such as Wisconsin and Colorado, have already demonstrated this capability.”

“The key steps at this time are for Meaningful Use criteria to require bidirectional exchange, and for a national immunization leader – such as the Centers for Disease Control and Prevention (CDC) – to be proactive with immunization registries to determine the best way to make this happen across all electronic health records vendors,” Dombkowski adds.