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Mike Popovich, CEO of STC, a company that provides technology and electronic medical record exchanges for immunization information and decision support, talks with ComputerTalk’s Will Lockwood about the current trends in immunization data management. Find out how market and regulatory currents are driving the push for better reporting of and wider access to immunization records, with real benefits both for public health and for health providers such as pharmacists.

ComputerTalk: Mike, immunizations can be an important part of a pharmacy’s clinical practice, and significant to its business as well. What are the current trends you are seeing?

Mike Popovich: Some of the national policies that are in place around meaningful use and incentives for compliance with those meaningful use rules are really powerful drivers that are very positive for this entire community. They really are allowing the challenges to be solved quickly and the opportunities to be taken advantage of. That’s rare. Often, you see a lot of opportunity, but then there are a lot of technical, policy, and educational challenges that get in your way and become barriers. In the market we have now for providing immunizations, this whole world is being fast-tracked because people are really working toward the ultimate goal.

CT: What are some of the specific drivers?

Popovich: For example, say you give an immunization in your clinic or in your pharmacy; you need to report that to the state public health immunization registries. Every state has a registry now. There are some other territories and jurisdictions that have registries also. These are significant health data assets that people have been reporting to for a long time. There’s variance across the country in terms of what immunizations you have to report, but for the pharmacist it’s easier to send all immunization records than to single out certain subsets. A pharmacist typically is going to send you everything he’s got. By default, the public health departments are getting huge wins because there’s significant information flowing into them from pharmacists that they never had before. They don’t have to go out and write new rules and policies to make that happen.

Previous challenges around policies that require people to report specific sets of data no longer exist. Pharmacists are reporting because that’s a best practice, and it’s easier now. Technology is really helping do that. The pharmacists we see and that we work with are attempting to integrate into their pharmacy systems electronic links to capture data and send it. There are a few vendors like STC and Surescripts that are helping do that. These tools have really become more robust at the point of care in a pharmacy. As soon as the pharmacist provides an immunization, that data will get sent to a state immunization registry.

CT: This offers a great opportunity from the public health perspective. What about opportunity for the pharmacy, to improve on and build its immunization practice, for example?

Popovich: The opportunity is significant. It comes from when you can implement technology that creates a two-way connection, so you not only can send data, but you can retrieve information in real time when that individual is at your counter. You can then have decision support from the trusted source of the registry. With consistent reporting into the registry, pharmacists then have a reliable way to know what immunizations patients have currently and what is recommended to the patient then at the point of care. That’s significant.

CT: Is there data on the impact this has?

Popovich: Yes. We’ve done studies and observations in various pharmacies where we’ve established these two-way connections. We can identify that well over 80% of the individuals have a record in the state registry. There is some information for these patients, and you can still apply decision support, make age-appropriate calculations, and then make a recommendation to an individual about the immunizations that are due, or coming due soon. We have seen significant uptake of adult immunizations from having those two-way connections at that point of care.
The power of that is, obviously, that there’s a great benefit to public health from reducing the potential of vaccine-preventable diseases in significant populations. Then pharmacists are happy because they can create further loyalty in their customers by having an added service. There is also a revenue component. And as the registry records become more and more complete, the individual wins, too, because they can get access to all their records and print out reports, for instance for their kid’s school.

CT: How important is pharmacy’s role in this?

Popovich: The pharmacy world is groundbreaking in this new immunization space. We as a country have achieved certain goals in terms of our ability to immunize a certain number of individuals, but we’re stuck at certain numbers. We’ve plateaued. Pharmacists are going to help us take that next step, and these numbers are going to start increasing. We will see rates of vaccine-preventable disease in the near future beginning to drop down again. And then there are new vaccines all the time. Much like a few years ago with H1N1, it was the pharmacist who really helped protect communities, simply because they can also handle the volume. So pharmacy’s role is huge.

CT: You mentioned some different technologies — STC and Surescripts — that are helping facilitate this exchange. How are pharmacies successfully incorporating the technology for reporting into workflow? And what do you think the future is in terms of integration and a really strong efficient workflow around immunizations?

Popovich: Workflow is one of those immediate challenges you run into when you start talking to pharmacists. Obviously, you don’t want to impact that or minimize the impact of a new process on it. The solution to that, and everybody recognizes this, is to put the electronic link directly into the system that pharmacists are using throughout the day. They don’t have to go to a separate system. They don’t have to sign on. They don’t have to re-log in. When they sign in and they put John Doe’s name into their normal system, that would trigger, right then and there, a query of that particular state’s immunization registry. Then the pharmacy system displays the immunization records and recommendations seamlessly. With one click, pharmacists would see that and have that available. That’s the ideal.
I think the good thing here is that the pharmacy system vendors are recognizing that this is the kind of system that needs to be put in place. Fortunately, these are fairly easy things to integrate within these systems. What happens with that workflow issue over the course of the next year or two depends on how fast the pharmacy system vendors bring the registry query and response integration on board. There is a huge ROI [return on investment] for the pharmacists, and that’s what we try to illustrate.

CT: What’s the rationale as you present it? What’s the data that helps pharmacies and their vendors see the opportunity?

Popovich: Well, for one example, you can look at populations and when they’re getting their immunizations within a pharmacy. I was looking at some data recently from a large pharmacy chain and you could see the adult immunization volume by day. On Monday, it’s really high, on Wednesday it’s not, and on the weekends it is really low. This organization can begin to look for patterns in this traffic and think about how it can market for the down times. This information repository that pharmacists are beginning to build not only allows them to give more immunizations at the appropriate time, but to target marketing and integrate into their MTM [medication therapy management] programs as well. And they can look at how to use technology such as IVR [interactive voice response] for patient reminders and scheduling.

And then there’s an impact for pharmacies providing onsite immunization programs for local employers. With easy access to the registry data, we’ll see significant upticks in the number of flu immunizations they give, and then their ability then to give other adult immunizations while they’re at the employer’s site. It begins to tell that ROI story of why they want to do this. In fact, the stories are so compelling that it’s often okay if there’s a little bit of impact on workflow, as long as it’s temporary. And the technology is really going to solve all those problems in fairly short order.

CT: How rapidly?

Popovich: I’ve seen a lot of technology applied to practice, and often, it takes years to really get it integrated. But in this case, I think pharmacists and pharmacies are so focused on the immunization program being a significant component of their business, that it’s moving along much faster than usual. And then in many cases this is leading to thinking about other clinical services that can benefit from an ability to have these exchanges with public health, such as rapid diagnostic testing. There’s any number of things that a clinical environment in a pharmacy will begin to drive and empower a lot of creativity and innovation much faster than the traditional health information technology solutions that we typically see.

CT: When something like this is being used, and pharmacists are seeing practical and clinical benefits, that’s when it’s really going to be brought into the mainstream workflow.

Popovich: Right. I had a conversation the other day with a group. The challenge I had was I was trying to illustrate the ROI on being able to exchange data with the state immunization registry and get data back and apply decision support. But they really wanted to integrate it into their electronic health record (EHR) system. I tried to say, look, that will happen. We can work with your vendor to make that happen, but in the interim, we can also provide these other tools that yes, cause a few workflow issues — we’re only talking about a couple minutes here — but the ROI is so significant that it might be worth it. And then, based on lessons you learn, you can make your EHR smarter.

I couldn’t really convince them. There still is a significant education process in many locations, but they’re going to get it or they’re going to get left behind.

CT: What do you see as trends we should keep an eye on for the future?

There’s one significant thing that I think is huge. We’ve been building immunization registries in HIT [health information technology] environments for public health for a long time. And there’s always been this idea that if we had a national immunization registry, then anybody anywhere could get access to their records or their family’s records. But that has just never been feasible.

What is feasible are that states are slowly beginning to link their immunization registries and create the ability to exchange data across them. It’s going to take five to 10 years before that occurs. But pharmacists are a big part of what’s creating that dynamic. You get a large chain that has an immunization program, and it’s sending immunization records to the appropriate states. In effect, they are creating a demand for nationally available immunization registry information for their patients. If you are in Florida on vacation and you walk into the pharmacy you use there, there’s a need then to get access to your immunization records that you have out in California or Oregon. You will be able to do that because pharmacies will create these bidirectional links with each state.

Pharmacy becomes a facilitator for creating a health information technology change that really begins to get to that national vision of a single immunization registry, but in a practical and politically feasible way. CT