Becker's Hospital Review

54 Executive Briefing Sponsored by: D espite the well-documented success of vaccines in helping to improve public health, vaccination rates remain lower than Healthy People 2020 goals.a Healthy People is an initiative launched by the US Department of Health and Human Services (HHS) to improve the health of Americans through evidence-based, 10-year objectives, one of which includes the reduction of preventable infectious disease through the improvement of nationwide vaccination rates. In 2015, national benchmarks for certain vaccine categories remained well below Healthy People 2020 goals. While vaccination rates remain below Healthy People 2020 goals for certain infectious diseases, health systems and hospitals have resources and initiatives they can use to boost vaccination rates. One such resource is the electronic health record (EHR). EHRs have the potential to help physicians promote patient care through vaccination, according to Joe Vasey, PhD, principal data analyst for health care technology company Practice Fusion: "By relying on structured, coded health data and dates, an EHR can systematically identify eligible patients on the basis of objective criteria in compliance with CDC guidelines." Cleveland-based MetroHealth System provides a model for health care leaders looking to launch HER and other health IT- driven vaccination improvement initiatives. MetroHealth was the first safety-net health system to implement Epic's EHR platform in 1999. By 2014, the health system achieved HIMSS Electronic Medical Record Adoption Model Stage 7 for all of its ambulatory clinics and hospitals. In 2015, Metro earned HIMSS' Davies Award for outstanding achievement in leveraging health IT solutions to improve patient care outcomes. David Kaelber, MD, PhD, chief medical informatics officer and vice president of health informatics at MetroHealth System, describes the culture in each department across MetroHealth as focused on using health IT solutions to improve care. Over the last 5 years, the health care system placed a particular emphasis on improving vaccination rates through the use of an EHR and other health IT solutions. The systemwide effort aligns with MetroHealth's general emphasis on population health management and eliminating gaps in care. MetroHealth implemented 4 health IT-focused strategies to boost vaccination rates. 1. Create EHR reminders for every vaccine and update reminders regularly. While providing vaccines at every patient contact point on the MetroHealth care continuum is a systemwide standard, care gaps can still arise. To eliminate potential care gaps, MetroHealth implemented vaccine-specific health IT interventions. These interventions included EHR alerts for all vaccine schedules recommended by the Advisory Committee on Immunization Practices (ACIP). "Using standard Epic clinical decision support tools, I implemented reminders and alerts for all ACIP-approved vaccines," said David Bar-Shain, MD, director of informatics for clinical decision support at MetroHealth. "These reminders and alerts have resulted in a significant improvement in our vaccination rates across the MetroHealth System and are a model for Epic customers on how to do vaccination decision support." Additionally, the health system updates the EHR with any new ACIP vaccine schedule recommendations in a timely fashion. 2. Engage patients through smartphones and electronic patient portals. As a safety-net provider, MetroHealth serves many individuals without access to home Internet services. However, a majority of their patients own smartphones. For this reason, most of the health system's patient engagement and vaccination improvement solutions are designed with smartphone technology in mind. Among these solutions is a wellness registry that incorporates the system's entire patient population and notifies patients and their caregivers of specific wellness needs. MetroHealth uses the health IT solution to identify and notify patients in need of a particular vaccine before scheduled appointments and after missed appointments. As for the latter, MetroHealth also deploys automated messaging to encourage patients who missed appointments for vaccine administration to reschedule and return to their care facility to be vaccinated as soon as possible. Automated messaging solutions were particularly effective for MetroHealth's adolescent patient population. The system launched an outreach program to notify adolescents' parents and guardians when their children, aged 11 to 18 years, were scheduled for a vaccine. The outreach program notified parents via phone calls, text messages, and direct mail. The initiative delivered more than 7,000 vaccine reminder messages — 3,334 automated voice messages, 2,631 text messages, and 1,129 postcards — over the span of 24 weeks. In that period, 1,324 vaccinations occurred in 959 patient visits. Among the adolescents whose parents received messages, 25.5% received How this Ohio safety-net system tapped into EHRs, health IT to improve vaccination rates SPONSORED BY: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., has paid for and provided editorial input on this material.

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