Advancing Population and Public Health Reporting and Outcomes With Vaccination Data Exchange (APPROVE)

Project Final Report (PDF, 428.15 KB) Disclaimer

Facilitating data exchange between public health and clinical care information systems and across information systems within public health leads to efficiencies in vaccination data access and staff effort resulting in cost savings, which can lead to improved data-informed decision making and surveillance of vaccine-preventable diseases.

Project Details -
Completed

Grant Number

R03 HS028693
Funding Mechanism(s)

AHRQ Small Research Grant Program (R03)
AHRQ Funded Amount

$99,606
Principal Investigator(s)

Rajamani, Sripriya
Organization

University of Minnesota
Location

Minneapolis

Minnesota
Project Dates

09/30/2021 - 09/29/2023
Technology

Electronic Health Record/Electronic Medical Record

Health Information Exchange

Public Health Informatics

Public Health Reporting System
Care Setting

Ambulatory Setting

Health Department

Hospital

Long-Term Care Facility

Pharmacy
Medical Condition

Infectious Disease
Population

Clinical Staff/Clinician

IT Staff

Public Health Worker
Type of Care

Primary Care

Specialty Care
Health Care Theme

Interoperability

The COVID-19 response in the United States underscored the urgent need for a robust public health infrastructure amidst increasing reportable infectious diseases. Disease surveillance is complex due to fragmented information systems and organizations, despite technological advancements. The Minnesota Department of Health oversees the Minnesota Electronic Disease Surveillance System (MEDSS) and the Minnesota Immunization Information Connection (MIIC), pivotal systems storing vaccination data for nearly 6,000 healthcare organizations and containing records of approximately 110 million immunizations for 6.5 million individuals.

While MEDSS manages case reports and electronic laboratory data for infectious conditions, its interoperability with widely used electronic health records (EHRs) remains limited, hindering comprehensive data analysis. To address these challenges, the research team investigated two interoperability tools: one using nationally recommended standards for electronic vaccination data exchange across MEDSS and MIIC, and another employing bidirectional exchange to retrieve vaccination history from MIIC and offer clinical decision support for immunizations from EHRs.

The specific aims of the research were as follows:

Characterize the enablers and barriers to using a novel interoperability tool for electronic vaccination data exchange within public health systems.
Evaluate the use of an evolving interoperability tool for electronic vaccination data exchange across public health and EHRs in clinical care.

Mixed methods were employed to evaluate the tools, including observations and semi-structured interviews. The interoperability tool between MEDSS and MIIC demonstrated significant efficiencies by streamlining processes, clicks, and manual data entry, consequently minimizing errors, reducing the data access burden for individual vaccination records by 8 seconds and decreasing overall effort from 5 hours per week to approximately 17 minutes per week, resulting in cost savings through decreased staff time. Despite integration rates of 83 percent of MIIC within EHRs and frequent EHR queries of approximately 6 million per month to MIIC by healthcare systems and public health clinics, barriers were identified including limited resources and the need for standardization. Nonetheless, these findings highlight the potential statewide and national benefits of improving public health systems' interoperability and enhancing data-driven decision making and surveillance.

Development and implementation of an interoperability tool across state public health agency's disease surveillance and immunization information systems.

Citation: Rajamani S, Chakoian H, Bieringer A, Lintelmann A, Sanders J, Ostadkar R, Saupe A, Grilli G, White K, Solarz S, Melton GB. Development and implementation of an interoperability tool across state public health agency's disease surveillance and immunization information systems. JAMIA Open. 2023 Aug 3;6(3):ooad055. doi: 10.1093/jamiaopen/ooad055. PMID: 37545982; PMCID: PMC10400481.

Link: https://pubmed.ncbi.nlm.nih.gov/37545982/

Principal Investigator: Rajamani, Sripriya

Project Name: Advancing Population and Public Health Reporting and Outcomes With Vaccination Data Exchange (APPROVE)

Document Type: Journal Publication

Research Method: Pre-Post Study, Quantitative

Technology: Health Information Exchange, Public Health Informatics, Public Health Reporting System

Advancing Population and Public Health Reporting and Outcomes with Vaccination Data Exchange (APPROVE) – Final Report

Citation: Rajamani S. Advancing Population and Public Health Reporting and Outcomes with Vaccination Data Exchange (APPROVE) – Final Report. (Prepared by the University of Minnesota under Grant No. R03 HS028693). Rockville, MD: Agency for Healthcare Research and Quality, 2023.

Link: r03hs028693-rajamani-final-report-2023.pdf (428.15 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Principal Investigator: Rajamani, Sripriya

Project Name: Advancing Population and Public Health Reporting and Outcomes With Vaccination Data Exchange (APPROVE)

Document Type: Report

Research Method: Mixed Methods, Observational Study, Pre-Post Study, Structured/Semi-Structured Interview

Technology: Electronic Health Record/Electronic Medical Record, Health Information Exchange, Public Health Informatics, Public Health Reporting System

Population: Clinical Staff/Clinician, IT Staff, Public Health Worker

Advancing Public Health with Interoperable Data Exchange

Theme:

Supporting Health Systems in Advancing Care Delivery

Subtheme:

Optimizing Data Exchange Through Health Information Exchange

Facilitating data exchange between public health and clinical care information systems leads to efficiencies in vaccination data access and staff effort, resulting in cost savings, improved data informed decision making, and better surveillance of vaccine-preventable diseases.

Technology limitations can impact critical public health data exchange

Infectious disease surveillance and vaccinations are critical public health services that have directly led to the decline of many infectious diseases, such as measles and polio. Surveillance enables public health officials to identify and quickly respond to infectious disease outbreaks. The power of vaccinations during the COVID-19 pandemic was evident; they enabled the transition from isolation at the start of the pandemic to resuming normal activities.

Surveillance of reportable infectious diseases and vaccination coverage are coordinated public health activities, but they are not seamless due to fragmented information systems and a lack of interoperable data exchange. There is a critical need to better leverage electronic data exchange across health information systems for disease surveillance, vaccinations, and clinical care.

Investigating novel tools to facilitate interoperable data exchange

Dr. Sripriya Rajamani, a public health informaticist from the University of Minnesota, aims to enhance data-driven decision making by facilitating data exchange between health systems within public health and across public health and clinical care.

In Minnesota, the state disease surveillance system (Minnesota Electronic Disease Surveillance System, or MEDSS) and the state immunization information system (Minnesota Immunization Information Connection, or MIIC) are pivotal public health information systems. The MEDSS system has approximately 12 million total reportable events. The MIIC system stores vaccination data from nearly 6,000 healthcare organizations and contains records of approximately 130 million immunizations for 6.5 million people. However, interoperability between these systems for vaccination information exchange is limited.

Additionally, the interoperability between MIIC and widely used electronic health records (EHRs) at healthcare systems in the state had evolved over time and needed an up-to-date assessment. The electronic data exchange between MIIC and EHRs is crucial so that providers can quickly query and access patients’ vaccination records. This is especially important since many patients receive flu, COVID-19, and other vaccines at commercial pharmacies, not a doctor’s office.

To address these challenges, Dr. Rajamani and her research team investigated two interoperability tools. The first tool, a novel one, uses nationally recommended standards for electronic vaccination data exchange across MEDSS and MIIC. The second is an evolving tool for bidirectional exchange to retrieve vaccination history from MIIC through EHRs and offer clinical decision support for immunizations. This decision support allows providers not only to access patient vaccination records but would also identify any vaccines for which a patient is due.

“It is important that data is dynamic and is shared across programs and institutions to support data-driven decision making and influence outcomes positively. This is even more important in the context of public health, as decisions have an impact at a population level.” — Dr. Sripriya Rajamani

Improving timely access to information and to enhance data-driven decision making

The interoperability tool between MEDSS and MIIC demonstrated significant efficiencies by streamlining processes, reducing clicks, and eliminating manual data entry, and thus data entry errors. Before the tool was implemented, it took an average of 134 seconds to find and retrieve an individual’s vaccination record and an average of 50 clicks to complete the process of getting vaccination data from MIIC and entering the data into MEDSS. After implementation, this process took just 8 seconds and an average of only 4 clicks, reducing staff time from 5 hours per week to approximately 17 minutes per week.

Of the healthcare systems studied, 83 percent had MIIC access integrated into their EHRs with an average of 6 million queries to MIIC per month. Even so, there were still numerous organizational and technical barriers identified, including data harmonization and limited resources. This shows that interoperability is an ongoing effort, not a “turn on the switch and move on” process, Dr. Rajamani said. Nonetheless, the findings highlight the potential statewide and national benefits of improving public health systems’ interoperability and enhancing data-driven decision making and surveillance.