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Susan J. Kressly, MD, FAAP, a board certified pediatrician at Kressly Pediatrics, PC in Warrington, PA, shared how her practice is using health IT to monitor and improve their infant immunization rates.

According to Dr. Kressly, immunizations are an integral part of high quality pediatric care.  In a mobile patient population immunizations may be delivered in more than one delivery setting.  "A recurrent challenge we faced was having an accurate vaccine record for our patients so that appropriate immunizations could be provided at every opportunity," said Dr. Kressly.  "Parents' records of their child's vaccines are often incomplete.  Attempts by our staff to get immunization records from prior practices often resulted in significant delays and additional barriers including parent consent forms being faxed between offices."  Dr. Kressly also said that new patients often arrive for well visits with no history of immunizations, and newborns may or may not have received Hepatitis B vaccines in Kressly's office.  "During the H1N1 outbreak, knowing which patients received vaccines in our office or at other sites within the community was virtually impossible.  Having incomplete information is a barrier to delivery of good care."  

 

Kressly Pediatrics looks at immunization rates and continually searches for ways to improve their performance. "Having inadequate immunization information was impeding the delivery of quality care," said Dr. Kressly.

To overcome these barriers, Kressly Pediatrics established workflows around best practices and harnessing the power of the PA Immunization Information System (PA-SIIS).  At the beginning of this journey, Pennsylvania was challenged with relatively low buy-in by the physician/practice community. "It has always been my contention that if you design a system that has minimal impact on practice workload with a real benefit to patient care, physicians will willingly adopt," shared Dr. Kressly

Working with a willing EHR vendor, Kressly Pediatrics beta-tested and was able to prove out proof of concept for bidirectional, real-time interface with the PA-SIIS. This was implemented with a couple of key premises:

• Vaccines delivered in Kressly's office automatically got transmitted to the PA-SIIS with no work from the practice (a service on the server transmits any administered vaccines/changes to vaccine history once per hour)
• A real-time call to the IIS can get immunization information with one click of a button inside the EHR
• Immunizations are displayed visually to show the difference between the information that the IIS has and the practice has
• Immunizations are imported directly into the EHR with one click

Dr. Kressly shared that now whenever they get a new patient (new baby or new patient), someone from their nursing staff will import immunization histories from the IIS the day before the appointment. According to Dr. Kressly, "We have the right information in front of the right person at the right time. The nurse knows the immunization history is incomplete and reaches out to the family prior to the appointment. The physician can give all appropriate vaccines at the time of the visit without delay. As more and more practices are also interfacing with the PA-SIIS we have begun to see the benefits of having more robust and complete data on our patients."

Dr. Kressly reported that her practice has also implemented a patient portal where families can view their immunizations online and print them off to give to their school/daycare to meet requirements or to view them on their mobile device in an emergency department while away on vacation. The practice has run recalls based on vaccine forecasting to recall patients who are due/overdue for immunizations and reached out to them by their preferred method of contact. 

"Since we have implemented our bidirectional real-time interface with the PA-SIIS we have increased our infant immunization rates (using the "Every Child By Two" criteria) to be consistently greater than 95 percent. We have used the immunization forecasting logic within our EHR to identify immunizations that were previously given incorrectly (minimal intervals not met, time between live vaccine doses not satisfied) and made clinical decisions to make sure our patients are appropriately protected. Having accurate information in a timely fashion with appropriate clinical decision support has made us improve the quality of care we deliver," said Dr. Kressly.

This experience with using health IT to improve care has reinforced Dr. Kressly's belief that:

1. Health IT, if implemented WITH physician input from the outset and with thoughtful respect for workflow, can add benefit without significant burden to the practice
2. Technology can improve the quality of medical care if designed and implemented well
3. Physicians MUST be involved in the design and implementation of Health IT if it is to achieve it's goals. Physicians cannot sit by and wait for the technical folks to give us what they think we need. We have to envision what we need and partner with them to deliver it.

EHR technology has definitely made a positive impact on the quality of care that Kressly Pediatric can deliver to their patients.  While Dr. Kressly is among the approximately 50 percent of pediatricians who do not get any funding for EHR Meaningful Use because her practice does not meet the 20 percent Medicaid threshold, Dr. Kressly's practice has implemented it's EHR in a truly meaningful way. "It has allowed me to improve care for my patients, exchange valuable information and engage patients/families in their own health care," said Dr. Kressly.