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40% More Vaccinations. Bang.

How Using Bi-Directional State Registry Data Changes Immunization Rates

By Dale Dauten, Syndicated Columnist

“Data! Data! Data! I can’t make bricks without clay!”

Sherlock Holmes (Arthur Conan Doyle)

We all know that bit about information being power, and we now know the horsepower of the information available in a state immunization registry: a 40% increase in additional vaccinations given at the time of flu shots.

That 40% represented so profound a multiple over traditional expectations, so far beyond mere triple or quadruple, that I had to go to five sources to even find the proper word: it’s a viguple increase:

The lead author of the new study, Ben Bluml, said of the results, “The current industry data says that an additional 1-2% of vaccinations occur at the point of a flu shot. So think about that – if you doubled that level and went from 2-4%, you’d have accomplished something. You’d be delighted. But we went from 2% to 40% — a 20-fold increase!”

And that’s what sent me searching for the right uple for a twenty-fold increase, a viguple.

 

Ben Bluml, APhA foundation, American Pharmacy Association, Pharmacy Research, Community Pharmacy

Ben Bluml, Senior VP, American Pharmacists Association Foundation

 

The research in question was undertaken by the American Pharmacists Association Foundation and the findings were published in a Population Health Management article authored by Benjamin Bluml, Kelly Brock, Scott Hamstra and Lisa Tonrey. A summary:

 


 

DESIGN. The study was conducted in eight community pharmacies in Washington state last fall and winter.

 

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Quality Food Centers pharmacists at one of the research locations

When customer-patients asked for a flu shot, the pharmacist checked with the state Immunization Information System (IIS), using STC’s ImmsLink data, to identify additional vaccination needs.

immslink, immunization reporting, STC, STC home, scientific technologies corporation, intelligent solutions, pharmacy solutions, pharmacy immunization reporting, pharmacy compliance

Immslink

THE SAMPLE. A total of 1,080 patients were included in the study. Of those, the pharmacists found 1,334 eligible vaccinations that were due.

THE RESULTS. Of the 1,344 additional vaccinations needed, a total of 447 were given during the course of the study, nearly all (just over 95%) administered by the pharmacist at the point of that initial flu shot and conversation.

That’s a 41.4% increase in the number of vaccinations over the flu shots alone.

 


 

HOW’D THEY DO THAT?

To help explain the findings, we went back to an earlier study conducted among pharmacists in Washington state. That study, in 2014, was undertaken by STC and Bartell Drugs.

Although the Bartell study was much smaller, with a sample size of 66 patients, the design was similar – patients were coming in for flu shots and, after a check of registry data, told of needed immunizations. In that study, 14% of the patients agreed to and received an additional vaccine, an exciting result. (Remember that 1-2% number.) Still, that 14% fell far below the big number in the new study, the 41%. However, it’s instructive to consider this prescient statement from discussions of the earlier 14% result:

Todd Watkins, President of STC says, “We believe that as we expand the pharmacists’ knowledge of the registry, the percentage of customers who will accept additional vaccinations will quickly double or triple — to 30 or 40% — and continue to climb from there.”

kroger pharmacy, pharmacy immunizations, pharmacy vaccines, pharmacy services, immunizations, health care, provider status, QFC, QFC pharmacy, research study

Quality Food Centers pharmacists who participated in the research

It seems likely that the passage of time has allowed the expanded registry familiarity that Watkins predicted. Further, while the pharmacists in the Bartell study had no training on how to have the conversation with the patient, the pharmacists in the new study had much more involvement in the planning and execution of the conversion process. Bluml added this:

 

“We had detailed discussions with the pharmacists about doing the right thing for patients, but the magic is in the tech, bringing the information to the pharmacists so they can have informed conversations about unmet needs.”

(How does finding that conversation-starter information fit into workflow? The earlier study found that adding the information lookup took just 84 seconds, on average.)

WHERE DO WE GO NOW?

Scott Hamstra, provider, indian health services, pharmacy, writer, author, study design, pharmacy research, pharmacy researcher

Dr. Scott Hamstra

Dr. Scott Hamstra, who was involved in both studies, was divided in his thinking about the results and what they mean for the future, saying, “In one sense, the people in the study are the cream of the crop. They were people already popping in for the flu shot, so they are already vax-friendly, or at least vax-open. However, given what we knew going in, we were thinking that 10 or 20% would be great and we were double that. Everyone was excited about 40%. Now though, I keep thinking it’s sad – you offer this to 100%, why wouldn’t everyone say yes?”

How do we get closer to everyone saying “yes”? It seems likely that some training beyond use of IIS data and Immslink might discover what will take the vax percentage higher – one likely possibility is experimentation with the conversation to persuade patients to accept the recommended additional vaccines, perhaps to include brochures or other support materials.

THE BIGGER-PICTURE CONCLUSION

For now, Dr. Hamstra put the study in the broader context of adult vaccinations:

“We got to the point where we were doing pretty well with children’s vaccines and then we woke up to the fact that adults are at risk, too. We’re at a mind-shift, where pharmacists will be the front-line vaccinators for adults. Most people between 20 and 60 are not going to the doctor’s office. Plus, come Fall, when it’s time for flu shots, there’s no way to run all those people through the doctor’s office. Pharmacists are more accessible, more convenient and less expensive. We now know that if we deliver to them the Registry information they need, they will deliver on additional vaccinations.”

 

References:

The American Pharmacists Association Foundation study report is available at:

http://online.liebertpub.com/doi/pdfplus/10.1089/pop.2017.0049

 


 

INNOVATION BONUS SECTION

 

Ben Bluml and the folks at the American Pharmacists Association Foundation shared with us their PDF showing where this recent study fits into their plans and into what they call the Innovation Arc. Notice their next step: expanding the study from 8 locations to 50.

 

Project IMPact Immunizations

Health Information Technology Empowers Consumers to Improve Their Immunization Rates

SCOTTSDALE, AZ (PRUnderground) April 3rd, 2017

Scientific Technologies Corporation (STC) will present at this year’s American Immunization Registries Association (AIRA) meeting on the power of giving individuals access to their immunization histories from medical record systems.

STC partners with members of the public health community to implement a consumer engagement tool known as MyIR (My Immunization Record). The free service allows individuals to enroll and authenticate on-line for access to their records. MyIR provides not only the past immunization events to the individual but also evaluates their history and identifies uniquely for each individual what immunizations they are past or currently due for.

Michael L. Popovich, CEO of STC indicated “in reviewing the demographics of over 50,000 individuals who have signed up to access to their family’s immunization events, we found that 72% were women and 60% in the age range of 25-44. We also uncovered that the public is learning to request this information from three key sources: their child’s school, their state health department and provider communities including pharmacies. ” Mr. Popovich indicated “34% of the individuals that enrolled for this services were referrals from schools with 13% each from state health web sites and the immunization provider community.”

Whether it is this year’s influenza shot or the second dose of a pneumonia series MyIR empowers the individual with actionable information to encourage them to protect themselves from disease. Health information technology is accelerating secure data exchanges from these valuable public health data assets directly to the consumer. Dr. Scott Hamstra, a well-respected pediatric physician, added “the ability to push out notifications and collect information specific to recent vaccines for individuals is a new capability that offers significant value and benefit to the lives and families of individuals.” Dr. Hamstra added “technology, data, immunization intelligence and engagement are the four keys to reducing the impact of diseases that are vaccine preventable.”

About Scientific Technologies Corporation

There are tens of thousands of deaths each year from the flu. There are new measles cases occurring when it had been all but eradicated. Whooping cough still kills the young. The impact of pneumonia, cervical cancer, and many more diseases are diminished through the use of vaccines, public health prevention programs, and data intelligence. The battle is fought every day to ensure that individuals are prepared, proactive, and empowered for any event or outbreak — from bioterrorism and newly emerging disease, such as the Zika virus, to the old diseases that never left. Scientific Technologies Corporation (STC), a health technology innovation and services company, is on the front line of this battle with its mission to advance population health outcomes through information technology.

Sheldon’s was one of the first pharmacies in Indiana to connect electronically to the state Indiana Immunization Registry.

SCOTTSDALE, AZ (PRUnderground) April 27th, 2017

Sheldon’s Express, an ImmsLink pharmacy partner, named a “High Flyer” for their successful immunization program in Indiana.

In the annual Indiana Immunization Awards Dinner on Wednesday, Sheldon’s Express Pharmacy was presented with a “High Flyer award for their “willingness to partner with the community and educate on behalf of public health”.  The dinner was hosted by the Indiana Immunization Action Coalition (IIAC), an organization whose mission is to reduce the spread of vaccine-preventable diseases through immunization education, advocacy, promotion, and statewide collaborative partnerships.”

Sheldon’s was one of the first community pharmacies in Indiana to connect electronically to the state  immunization registry, CHIRP. This data exchange is  bi-directional integrated seamlessly with their pharmacy management system, provided by their premiere partner, PioneerRx.

This secure immunization data exchange allows the pharmacists to report administered immunizations while the patient is receiving services and to review the  patient’s immunization history as provided by the state registry along with an immunization forecast showing the current immunization status and identifying if they are due for a needed vaccine. All this occurs rapidly and embedded within the pharmacy workflow.

When public private partnership come together for a common goal like programs that help prevent disease in populations everybody wins. At STC we consider it a privilege to be able to work with the Indiana public health department, Pioneer RX, and Sheldon’s Express pharmacy”, explains CEO Michael Popovich.

Since they started in January of 2016 they have provided over 3000 immunizations to their patients with this information being added to the state registry available for all providers in the state. They continue to access this information reviewing  patient histories all designed to increase the protection of their customers to vaccine preventable disease. Many of the shots have been flu, but in part thanks to their bi-directional connection and their excellent staff, they have also given many Pneumococcal, Zoster, Meningitis and Tdap shots. 

To learn more about IIAC, visit vaccinateindiana.org

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About Sheldon’s Express

Sheldon’s Express Pharmacy was founded in Bowling Green, KY in 1988 by Steve and Terri Sheldon. Since then they have grown to 7 locations in KY and IN. Walk into any Sheldon’s Express Pharmacy and see what simply can be described as amazing. The Sheldon’s operate one of the largest single Independent drug stores in the country and while national averages range about 180 prescriptions daily, the Fairview branch in Bowling Green fills well over 1000 prescriptions in the 9 hours they are open daily.

About PioneerRX

Developed with the experience of over 35 years of pharmacy software development and support, PioneerRx was built from scratch to provide the pharmacy community with a solution that can grow as the industry changes for the next 35 years and beyond.  PioneerRx delivers weekly improvements and cutting edge features that are designed to provide speed, simplicity, consistency and flexibility, however, their ultimate goal of development is to help pharmacies make more money. Leading the industry in first to market functionality in one seamlessly integrated package, PioneerRx Pharmacy Software has become one of the most successful and frequently talked about pharmacy systems in the United States.

About Scientific Technologies Corporation

There are tens of thousands of deaths each year from the flu. There are new measles cases occurring when it had been all but eradicated. Whooping cough still kills the young. The impact of pneumonia, cervical cancer, and many more diseases are diminished through the use of vaccines, public health prevention programs, and data intelligence. The battle is fought every day to ensure that individuals are prepared, proactive, and empowered for any event or outbreak — from bioterrorism and newly emerging disease, such as the Zika virus, to the old diseases that never left. Scientific Technologies Corporation (STC), a health technology innovation and services company, is on the front line of this battle with its mission to advance population health outcomes through information technology.