Comments on TooManyClicks: EHR's should help clinician users manage the whirl...

Jeff - great post, and great blog. We at Axolotl a...

2009-10-22T13:31:24.247-05:00

Jeff - great post, and great blog. We at Axolotl are trying to address the problem to the extent we can. As an HIE vendor, we are able to aggregate and move data. So we've been able to develop a gateway that can send immunization data to state registries. Not the complete solution as you've laid out, but an important piece in the puzzle. We've been particularly concerned about this since it impacts young lives more than any other.

-Anand Shroff
VP, Products @ Axolotl

csledbetter said "If Physicians like yourself...

2009-07-12T20:27:40.928-05:00

csledbetter said "If Physicians like yourself could lobby the CDC to provide a web service API...".

I say, "If physicians like you and me....

Who at CDC? Find out where we start with that challenge, and I'll follow you there. Thanks for your comment.

In your post you lamented the frequency with which...

2009-07-09T14:18:36.033-05:00

In your post you lamented the frequency with which immunization recommendations changed. As a human you had to re-memorize the new recommendations. A computer would need a source for those rules, in a fomat it understands, so that it could apply them at run time.
I could build my own Immunization Recommendation application based on the current CDC recommendations, but I do not want to sign up for maintaining that application every time the rules change. CDC publishes the rules in human-readable form in the MMWR periodical, so you can read and re-memorize them. My application would need me to translate them into code in order to keep up, every time the recommendations changed. If I failed to do that, my application would become dangerous. If I had to do that, I would need to charge maintenance fees to everyone who used it.
If Physicians like yourself could lobby the CDC to provide a web service API that provided the immunization rule set in some standardized format, then my application could check with the CDC once a day to refresh its rule set, and always be up to date. THAT is a shovel-ready project for the CDC. Otherwise, keep taking your Ginkgo Biloba, because you are going to need to keep memorizing.

Anon, You make a number of good points. I've n...

2009-07-09T13:52:54.990-05:00

Anon,
You make a number of good points. I've not been following the CCHIT criteria about vaccine dosing schedules. I like your idea of capitalizing on the CDC's expertise and tools, but I don't want to run every immunization choice through 2 tools either.

The other twist is, the CDC schedule offers flexibility in how a clinician bundles component vaccines. So, I still have some decisions to make.

Maybe an API from the CDC's scheduler tool would allow other EMRs to use the CDC algorithms in those EMRs. Your thoughts?

I agree with everything you said. This is a very ...

2009-07-09T13:10:52.535-05:00

I agree with everything you said. This is a very dangerous area where without the proper guidance from those in the know mistakes can happen. I agree the EHRs should help the user to make the most well informed and safe decision when it comes to immunizations and that all immunization should be exported and imported to and from community registries in the community and perhaps nationally similar to the national advanced directives bank.
My new concern as a clinician working for a vendor is that CCHIT has added a new 2009 criteria: IP 12.41 - The system shall provide the ability to enter new vaccine dosing schedules into the system in advance of official CDC schedule updates."
Why would I want to do this? This sounds like the EHR in 2009 needs to have built its own “Analysis of Needs” schedule based on what the CDC says, but then be able to change it before the CDC makes their recommended changes available in their schedulers (found on their web site). This is fraught with possible errors. I want our system to seamlessly send a patient’s immunization record to the downloaded scheduler found on the CDC site and let the CDC approved scheduler send back results to our system for the appropriate immunizations that are due and a catch up scheduler for those that may have been missed. Once I get back their results I can run them through my own decision support tools to check for any disease, lab or clinical data alerts based on the products I have in my formulary. The algorithm the CDC is takes in to account the compatibility of Immunizations in creating a catch-up schedule. So the printed catch up schedule I give the patient and the PCP is meeting national standards. I have been told that the team who created this schedule in partnership with the CDC is in the process of creating an Adult Catch Up Scheduler for the USA and for other countries.
So while the CDC is requiring my system to show that it has a scheduler and that I can manipulate it in 2009, it is not until 2010 the CCHIT expects ends users to actually benefit from Immunization schedules where they are requiring the following 2 criteria be met:
IP 12.42 - the system shall provide the ability for the system to inform the clinician when immunizations are recommended according to the CDC or other schedules.
IP 12.44 - The system shall provide the ability to update the analysis-of-needs mechanism (based on immunizations missing or due next) on demand for reasons including but not limited to updates to external guidelines.
I want our system to help users make the right immunization choices without them having to think about (I love the book “Don’t Make Me Think” to), but I don’t want to second guess what the CDC or other national immunization standards bodies are doing. This stuff is complicated – let the people who know the data best help the clinicians. The EHRs can act as a conduit to the true Immunization Schedule Knowledge representatives– the CDC.
Any thoughts on interpreting the CCHIT criteria for this year related to vaccine dosing schedules?