Costs and Benefits of Interoperability between Provider Practice Electronic Health Records and a Statewide Immunization Registry

Project start date and end date: September 2018 – August 2021

Background:
Electronic health record systems (EHRs) are in use in the vast majority of medical practices across the U.S. and often are connected to their respective state and local public health registries such as immunization information systems (IIS). There has been widespread adoption of the HL7 messaging standard for either unidirectional (i.e., vaccination doses reported to IIS) or bidirectional (i.e., EHR ability to query the IIS). Although HL7 reporting and querying by EHRs has now been incorporated into many practices’ patient workflows, little is known about the costs to practices associated with adopting these linkages and the benefits to practices and their patients.

Objectives:
The objective of this project is to evaluate the costs and benefits of interoperability between provider practice EHRs and a statewide IIS. This will be done by:

• Developing metrics for quantifying costs and benefits associated with immunization record keeping and decision support at provider practices;
• Measuring associated practice-level costs and benefits via primary data collection among a diverse sample of providers; and
• Estimating provider- and state-level associated costs and benefits of interoperability using a simulation modeling approach.

Research Topics & Methods:
In order to comprehensively evaluate costs and benefits of interoperability between provider practice EHRs, first, primary data must be collected from a diverse sample of providers including:

• Interoperability capabilities (bidirectional, unidirectional, or none);
• Vaccination workflow and record keeping of practice;
• Variable costs and fixed costs of interoperability at a practice level, including time costs; and
• Practice-level vaccination metrics.

The evaluation of the costs and benefits associated with HL7 interoperability will then incorporate the primary data collected to utilize a budget impact analysis framework from two perspectives: the provider perspective and at the state level. After a review and validation of the model, the model will allow for the prediction of system-level outcomes to characterize costs and benefits of interoperability.

Implications:
This study will provide crucial information on the return on the investment into interoperability between IIS and EHRs, how these vary by provider type and immunization volume, and the projected health benefits of additional vaccination. This information will be used to more clearly describe the impact of EHR/IIS interoperability on various provider practices, through articulating the quantified time costs/savings and associated health improvements.

Funder:
This project is funded by the Center for Disease Control and Prevention (CDC).