IIS Interoperability EHR Issue

Here’s some background about the CDSi logic issue…

Talk to you on Friday!

From: Jeffrey Panzer
Sent: Tuesday, July 6, 2021 8:34 AM
To: 'Ginger Pape' <Ginger.Pape@cedargate.com>; Shannon Pohl <spohl@alliancechicago.org>
Subject: Issue with the display of CDSi immunization data in real-world use

Hi Ginger and Shannon,

As promised, here’s a little bit of information about the challenges with the display of immunization data with the Cedargate/Enli form that uses the CDC’s CDSi logic (clinical decision support for immunization). Shannon, feel free to add to this blurb.

As you can see in the email from the user below (who also happens to be the CEO of that organization), users are confused as to why our forms (powered by CDSi logic) are showing that an adult patient is due for a vaccine (such as Tdap) after they’ve already received their recommended adult dose (i.e. every 10 years for Tdap). As you know, this issue is not a not a bug (the logic is working as intended) but it is nonetheless a user experience problem and one that other users have voiced as well.

In order for tetanus vaccination to be complete, the CDC’s algorithm requires documentation of a full lifetime series, not just one tetanus vaccine. The problem for those of us who care for adults is that we often don’t have childhood immunizations records available and/or it’s not the highest priority to try to track them down (compared to other competing priorities). It is my understanding that the CDC in conversations with Cedargate/Enli was concerned about the idea of modifying the CDSi logic. I can see that perspective, but I wonder if there is a middle ground that will allow users to know they still don’t have complete documentation of vaccination information on their patients but they have completed adult vaccinations (for those patients who provide a reliable history of receiving childhood immunizations).

Perhaps, for example, there could be a way to click a button “patient reports up to date on all childhood immunizations”
or alternatively, there could be a way to differentiate childhood and adult immunizations on the form so a user can know that they have completed all adult immunizations but records for childhood ones are deficient.

Given that Lee was the 4^th user in 1 week that voiced this issue, we think it is worth going back to CDC and sharing the frontline user experience challenges that their CDSi logic (and its requirement to have all vaccine records in hand) has lead to, in the hopes to find a creative solution to meet the needs of all. We obviously all want to have complete vaccine records but perhaps that is better achieved on a larger public health and health information exchange level than at the level of individual primary care practices, who are already seeing record levels of burnout and may not have the capacity to track down old records. Another reason we advocate for a more creative solution for this situation is because we fear users will ignore the clinical decision support if it doesn’t meet their needs and will lead to less vaccination for those patients who haven’t received Tdap in the past 10 years, for example.

Just to share an example from our content, in the test patient in the screenshot below, she has Tdap documented from 5/16/21 and it looks like she will be due again on 6/13/21, which would not be the case if she is up to date on childhood tetanus vaccines.

Please let me know if you have questions, and feel free to modify my response prior to sending to your contacts at CDC.

Best, Jeff

From: Lee Francis, MD, MPH <lfrancis@eriefamilyhealth.org>
Sent: Monday, May 17, 2021 9:30 AM
To: Jeffrey Panzer <jpanzer@alliancechicago.org>
Subject: RE: CareGap Manager

Hi Jeff,

I am not sure that Tdap (adult) works in the care gap manager. It seems like it is always red even if documentation exists of Tdap within the last 10 years.

Lee