Using Health Information Technology to Improve Pediatric Vaccination Rates

Melissa Stockwell, M.D., M.P.H.

Columbia University Vagelos College of Physicians and

Surgeons/Mailman School of Public Health

"Wide implementation of health information technology has made it possible for providers to track and improve immunization delivery rates among underserved populations. AHRQ’s funding of practice-based research projects helped us gain knowledge and create technological solutions that have immediate impact in the health outcomes of patients from underrepresented populations."

Research shows that vaccines can prevent or reduce the severity of diseases, including seasonal flu. But research also shows that even when the flu vaccine is widely available, rates of vaccination at pediatric clinics are low, especially among patients from underrepresented populations, according to Melissa Stockwell, M.D., M.P.H. Dr. Stockwell is an AHRQ grantee, who is chief of the Division of Child and Adolescent Health at Columbia University Vagelos College of Physicians and Surgeons in New York.

Dr. Stockwell began her AHRQ research in 2009 by investigating how point-of-care technology could be used to improve the delivery of immunizations for pediatric and adolescent patients, particularly those from underrepresented communities. She was awarded her first AHRQ grant to address this problem.

Dr. Stockwell devised an approach to tailor, implement, and evaluate automatic flu shot alerts in the electronic health records (EHRs) used by four community health centers that primarily served publicly insured Latino patients. These "FluAlerts" reminded providers at the point of care to offer flu shots to their pediatric patients. "Incorporating the flu alert reminder messages in the EHR contributed to increased vaccine delivery rates and supported decision-making at the point of care," said Dr. Stockwell, who is also an associate professor of pediatrics and population and family health at Columbia University.

Expanding this research in her second AHRQ-funded project, Dr. Stockwell moved beyond flu alerts to reminders for all age-appropriate immunizations. Her team linked centralized immunization data from New York City’s Immunization Information System to the local clinic’s EHR, making it easier for clinicians to have this information at their fingertips while accessing patients/ records. With this instant access, local providers could quickly determine the immunization status of their patients and avoid over- or under- immunization, which is common when patients see multiple providers, have incomplete medical records, and lack overall continuity in care. This intervention helped improve the immunization status for all age groups. Details of Dr. Stockwell’s AHRQ-funded study, DEVISE: Data Exchange of Vaccine Information, were published in a 2016 issue of Pediatrics.

When it comes to immunizations, children with chronic health conditions may require additional vaccines beyond the normal age-appropriate vaccines delivered to other pediatric patients, according to Dr. Stockwell. She used additional AHRQ funding to test the integration of immunization data with clinical decision support at local clinics serving more than 12,000 patients. This model provided front-line clinicians with instant information on not only routine immunizations, but also condition-specific immunizations, ensuring that each child received the vaccinations that were appropriate for their health condition.

Continuing to see promise in the use of technology to improve vaccinations, Dr. Stockwell began looking at using mobile technologies, such as text messaging, to increase vaccination rates. This time, she used AHRQ funding to investigate how to improve completion of the human papillomavirus (HPV) immunization series among predominantly Latino adolescents. Dr. Stockwell's team compared conventional text messages with brief information about vaccine due dates and site walk-in hours with text messages enhanced with educational information. The team learned that using text messages was effective at increasing completion of the HPV vaccine series among nine to 17-year-olds. “The research shows that basic text messages are a cost-efficient intervention that can be scaled up for wider use and implementation to improve vaccination rates,” Dr. Stockwell noted.

Dr. Stockwell serves on the editorial board of Academic Pediatrics. She is also a member of the American Pediatric Society, Society for Pediatric Research, and the Academic Pediatric Association. She is a Fellow of the American Academy of Pediatrics, where she also serves as the Associate Director of Pediatric Research in Office Settings.

Principal Investigator: Melissa Stockwell, M.D., M.P.H.
Institution: Columbia University Vagelos College of Physicians and Surgeons/Mailman School of Public Health
Grantee Since: 2009
Type of Grant: Various