Dombkowski Kevin J, Patel Pooja N, Peng Hannah K, Cowan Anne E
Department of Pediatrics, Susan B Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, United States.
Appl Clin Inform. 2025 Jan;16(1):101-110. doi: 10.1055/a-2434-5112. Epub 2025 Feb 5.
Interoperability between electronic health records (EHR) and immunization information systems (IIS) may positively influence data quality, affecting timeliness, completeness, and accuracy of these data. However, the extent to which EHR/IIS interoperability may influence the day-to-day vaccination workflow and related recordkeeping tasks performed at medical practices is unclear.
This study aimed to assess how EHR/IIS interoperability may influence the vaccination workflow at medical practices and to identify related impacts on clinical and administrative activities.
We identified practices (family medicine, pediatrics, internal medicine, local health departments) from the Michigan Care Improvement Registry (MCIR), the statewide IIS in Michigan, representing each of the three HL7 interoperability levels (non-HL7, unidirectional, bidirectional). We conducted semi-structured interviews to assess how practices interact with the MCIR throughout the vaccination workflow. Transcripts were reviewed and coded to characterize practices' use of EHRs, MCIR, and other related technologies across the vaccination workflow.
Practices completed Phase 1 ( = 45) and Phase 2 ( = 42) interviews, representing a range of medical specialties, geographic locations, and sizes. HL7 connectivity expanded among the participating practices; by the conclusion of the study, all practices had initiated at least unidirectional HL7 capability. Providers and staff relied heavily upon both their EHRs and MCIR throughout a wide range of vaccination-related activities. Most practices relied on MCIR as their primary source of vaccination history information, and nearly all practices also reported use of paper forms, documentation, and other summaries throughout the vaccination workflow.
Practices employed both their EHRs and IIS throughout the entire vaccination workflow, although the use of each relied heavily on paper-based processes. While benefits of adopting EHR/IIS interoperability were reported by practices, this may require staff to learn and implement new workflow processes that can be time consuming and may introduce new challenges.
电子健康记录（EHR）与免疫接种信息系统（IIS）之间的互操作性可能会对数据质量产生积极影响，进而影响这些数据的及时性、完整性和准确性。然而，EHR/IIS互操作性在多大程度上会影响医疗实践中的日常疫苗接种工作流程以及相关记录保存任务尚不清楚。
本研究旨在评估EHR/IIS互操作性如何影响医疗实践中的疫苗接种工作流程，并确定对临床和管理活动的相关影响。
我们从密歇根州护理改进登记处（MCIR）（密歇根州的全州性IIS）中确定了一些医疗机构（家庭医学、儿科、内科、地方卫生部门），这些机构代表了HL7的三个互操作性级别（非HL7、单向、双向）。我们进行了半结构化访谈，以评估医疗机构在整个疫苗接种工作流程中与MCIR的交互方式。对访谈记录进行了审查和编码，以描述医疗机构在整个疫苗接种工作流程中对EHR、MCIR和其他相关技术的使用情况。
医疗机构完成了第一阶段（n = 45）和第二阶段（n = 42）的访谈，这些访谈代表了一系列医学专业、地理位置和规模。HL7连接性在参与的医疗机构中有所扩展；到研究结束时，所有医疗机构都至少启动了单向HL7功能。在广泛的与疫苗接种相关的活动中，医护人员和工作人员严重依赖他们的EHR和MCIR。大多数医疗机构将MCIR作为疫苗接种历史信息的主要来源，几乎所有医疗机构还报告在整个疫苗接种工作流程中使用纸质表格、文档和其他摘要。
医疗机构在整个疫苗接种工作流程中同时使用了EHR和IIS，尽管每种系统的使用都严重依赖纸质流程。虽然医疗机构报告了采用EHR/IIS互操作性的好处，但这可能需要工作人员学习和实施新的工作流程，这可能很耗时，并可能带来新的挑战。
