Pharmacists reporting to state immunization registries
Barriers in technology still exist
Like many states, Washington has no mandate for pharmacists to report immunizations to the state’s Immunization Information System (IIS), where records are kept. But nearly 4 years ago, the Washington State Department of Health and other pharmacy stakeholders sought to establish it as a best practice.
“We felt pharmacists were taking more of a role in providing vaccines, but an important missing piece was getting that information into the record,” Jennifer Arnold, PharmD, BCPS, Director of Pharmacy Practice Development at the Washington State Pharmacy Association, told Pharmacy Today.
Since the Washington state initiative began, one-half of all community pharmacies in the state have begun reporting to the IIS, and results have been impressive.
According to Arnold, they’ve seen doses increase from 114,535 during the baseline year, which was from August 2010 to July 2011, to 495,222 doses administered from August 2013 to July 2014.
Although more attention is being placed on the reporting aspect for pharmacists who administer immunizations, barriers still exist with IIS technology—primarily the pharmacist’s capability to have bidirectional capacity, in which they can both see and contribute to the patient’s immunization records.
“We’ve found that when pharmacists go into the registry and can look at the information, they see about four other immunizations people are lacking,” said Lisa Tonrey, BSPharm, MHA, PhC, FAPhA, who was APhA President from 2003–2004.
She said that presents an important opportunity for pharmacists to expand their services by giving people—especially adults—the immunizations they are not up to date on.
Mitch Rothholz, BSPharm, MBA, APhA’s Chief Strategy Officer, said the 2013 update on Standards for Adult Immunization Practices from the National Vaccine Advisory Committee are likely to help fuel reporting capabilities for pharmacists by including them as a main immunizer.
The recommendations say that all providers, including pharmacists, who interact with adult patients have to assess their immunization history and either administer immunization updates or refer them to someone who can, and they say an IIS should be referenced as a source of data about the patient’s vaccine history.
While pharmacists are certainly capable of administering all types of vaccines for both children and adults, laws vary in each U.S. state and territory for what pharmacists can give and to whom. In addition, only about one-half of all jurisdictions require pharmacists to report immunizations to an IIS.
Based on results from a December 2013 American Immunization Registry Association survey, 42 of the 45 states and territories that responded indicated that they allowed pharmacists to administer immunizations. Of those jurisdictions, 49% are required to report to an IIS but 80% do—meaning many do it voluntarily, like Washington.
According to Tonrey, three states are setting the precedent by requiring bidirectional reporting for pharmacists. Those states are North Carolina, Oregon, and Iowa.
In general, pharmacy management systems are not able to accept or consume IIS response files. If a pharmacist wants to see a report, extra time and effort are needed.
But some health information technology companies, like Scientific Technologies Corporation (STC), Surescripts, and RelayHealth, have been working on solutions to overcome these problems.
STC’s CEO, Mike Popovich, said that as pharmacies nationwide continue to expand their immunization programs, there will be an increasing demand for pharmacies to develop their reporting to registries. And systems, like STCs, will need to be bidirectional and offer real-time forecasting, decision support, and patient accessibility.
Many large pharmacy chains, like Walgreens, CVS Health, and Rite Aid, work with Surescripts. The company is able to send messages in HL7 format where it can be read by IIS systems, and they can manage the day-to-day operations of the pharmacy–IIS interfaces in compliance with state requirements.
Capabilities for pharmacists to interface at this level are still in early stages, however.
“Over the next couple of years it will evolve and clean up,” said Popovich.