The Progression of Immunization - Episode 7
The Importance of Immunization Registries
Key opinion leaders discuss the importance of immunization registries and data surveys for pharmacists and technicians in identifying and reaching target populations.
Troy Trygstad, PharmD, MBA, PhD: So you’re with STC [Scientific Technologies Corp]?
Michael Popovich: Yes.
Troy Trygstad, PharmD, MBA, PhD: You’re in the business of data liquidity and decision support. Right?
Michael Popovich: Yes.
Troy Trygstad, PharmD, MBA, PhD: Walk me through some of these data points. When a person walks in, what’s the first interaction with data at the pharmacy level?
Michael Popovich: It can vary, but let me start on the back end of public health. Public health has been building immunization registries for over 20 years. They started with children’s records.
Troy Trygstad, PharmD, MBA, PhD: Right, a great idea. We want a registry so we know, but we need people to use it.
Michael Popovich: Yeah, you’ve got to use it. And kids get old, and now they’re 18, they’re 20. Some of the early children are 40 years old and have records in these systems. But information has been flowing into these public health registries for 2 decades.
Troy Trygstad, PharmD, MBA, PhD: They’re usually state based.
Michael Popovich: State-based registries.
Troy Trygstad, PharmD, MBA, PhD: And some states’ registries are better than others.
Michael Popovich: There’s a bell curve on those, but they’re moving to third-generation technology systems, and they’re a huge health data asset being underutilized. OK, so the patient now has a record in 1 of these registries, and probably over 80% of the population will have an information record in 1 of these systems. And they’re scattered around the county. They’re all standardized, but they don’t talk to one another. But there is an immunization event in there. They walk into a pharmacy. The pharmacist may or may not have access to that data, and what we try to do is facilitate that and bring that data alive into the pharmacies. And they’ll get there. But the information is flowing. When the pharmacist actually gives the immunization, they report in real time, or certainly in the next day, that immunization event, and it flows into the appropriate state registry. So the individual maybe is traveling, ends up in an ER [emergency] department somewhere. That ER doc has access to those immunization records.
Troy Trygstad, PharmD, MBA, PhD: And a pharmacy is good at anything as a profession, as an industry, it’s record keeping.
Michael Popovich: It is, and reporting. They’re very good, they’re very diligent, and they understand risk. They understand that. And public health traditionally has always had to request require from policy for physicians to report, and they never gave them any data back. Well, times have changed. Data now are flowing electronically, and all these immunization records are flowing in. Now public health has a mind-set that we have to give information back to empower and engage the folks who use it.
Troy Trygstad, PharmD, MBA, PhD: You’re saying it’s certainly possible—a patient walks in the door, I run their prescription for lisinopril, something happens in the background with an algorithm, a data request goes out to some number of registries, comes back, it might consider conditions, it might consider age, it might consider a whole host of factors. I might, rather than having to interpret the ACIP [Advisory Committee on Immunization Practices] guidelines out of my pocket, I could conceive of a time when I have decisions for what this says—this patient [needs] these 3 vaccinations along with flu.
Michael Popovich: Yes. Now, all these systems are not taking into account yet the disease states of individuals.
Troy Trygstad, PharmD, MBA, PhD: We’ll get there. Do you think?
Michael Popovich: But we’re getting there. And that is just meshing this information that exists. I’m lucky enough to live in a state where my records are online, and I can pull them down and look on my phone. Before I came here, I looked at my immunization records, saw I needed certain immunizations, walked into a pharmacy, and showed the pharmacist that. And they said, “Oh, yeah, we have all those.” And I said, “OK,” and I got an immunization. Then I looked on my phone, and the next day that record had been reported to the state registry, and my phone now will tell me what I need and when I need it. So it encouraged me to go into a store, talk to a pharmacist, and engage with them, and then they provided a service, and I really enjoyed the discussion around it—you know, it’s that trusted service there. And it balked around watching the data flow and then empowering me to then go back when my next dose is due and things like that. That’s where we’re at.
Troy Trygstad, PharmD, MBA, PhD: A patient walks in. I can tap in the data sources to figure out what they’ve had, what they need.
Michael Popovich: Yes.
Troy Trygstad, PharmD, MBA, PhD: I provide that vaccine. My system is now contributing to that registry, either manually or through some automated way. Automated is great. Let’s keep pushing automated, right?
Michael Popovich: Yes.
Troy Trygstad, PharmD, MBA, PhD: It’s not just the pharmacy now that knows, but the next pharmacy, the next physician, the next whoever else you have in mind. In the next pandemic, somebody can now screen through that database for what they need as a public health benefit.
Michael Popovich: Yup. In 5 years this will all be seamless, simple, electronic-built workflows.
Troy Trygstad, PharmD, MBA, PhD: You’re trying an assisted workflow, identification, decision port. And Emily, you’re in the sort of reporting and quality business. Your data are coming from claims.
Emily Endres: Correct, from a health plan.
Troy Trygstad, PharmD, MBA, PhD: From a plan perspective saying, the plan is screaming, “Hey, we like pharmacies and pharmacists now too. Let us show you who’s missing in our data, because we want to help you help us and fill these gaps.” What does that look like from a data and workflow perspective?
Emily Endres: From a data and managed care perspective too, plans are coming to us saying, “We have a real challenge. Maybe it’s a regional challenge. It could be a state-specific challenge.” We’ve seen Texas really hit hard with influenza over the last couple of years.
Troy Trygstad, PharmD, MBA, PhD: And the plans may be at risk too.
Emily Endres: Absolutely.
Troy Trygstad, PharmD, MBA, PhD: It’s not just: We’re doing this because we want to be a public health—oriented company. They may have some withholding with a state, or it might hurt their measures from a scoring perspective.
Emily Endres: Exactly.
Troy Trygstad, PharmD, MBA, PhD: They’re motivated both by a public health need but also a real business need as well.
Emily Endres: Absolutely, and it’s definitely 2-fold from a plan’s perspective. They are coming to us saying, “Hey, can you help us kind of fill in this gap? Can we engage the pharmacies with these targeted member opportunities? Help them to track their progress month over month and immunizations that they’re providing?” And then can we also tell the pharmacies and use them—and to your point, Troy, we think about the stars program and we think about CAHPS [Consumer Assessment of Healthcare Providers and Systems] and plans’ responsibilities to the CAHPS survey. What if we tell the pharmacy, “Hey, is there a way you can thank your patients? Not just those who haven’t received immunization, but those who are taking their health into their own hands. Can’t you remind them and thank them for doing that?” Hopefully that helps disperse some recognition in March and April when that CAHPS survey comes out.
Troy Trygstad, PharmD, MBA, PhD: And the CAHPS survey is, for the audience?
Emily Endres: The CAHPS survey is for the health plans, right.
Troy Trygstad, PharmD, MBA, PhD: And it’s a patient satisfaction.
Emily Endres: Exactly.
Troy Trygstad, PharmD, MBA, PhD: So hey, convenience, ease, trust. If I can, as a plan, show my members that I’m providing this easy, accessible, trusted care, then those CAHPS scores are really important from an overall plan-scoring perspective and patient satisfaction, right?
Emily Endres: Yup, absolutely.
Troy Trygstad, PharmD, MBA, PhD: What does that experience look like, interacting with a PQS [Pharmaceutical Quality System] if I’m Tana and her pharmacy?
Emily Endres: Tana, in your pharmacy you log in to your EQuIPP [Electronic Quality Improvement Platform for Plans & Pharmacies] dashboard. If you’re going to track immunizations, there’s going to be a separate tab regarding the influenza vaccination measure. It’s a unique measurement period, right, as we’re looking to track the flu season. You’re going to click on this tab, and for all the health plans that are providing us with not only pharmacy claims data but medical claims data too, we want to make sure we’re marrying all applicable data together. We’re going to show you how you’re tracking month over month during that flu season. And then also give you member-level opportunities for those patients who are still in need of a vaccination. We’re doing this for influenza and also for pneumococcal as well for select health plans, and we’ve seen great results from the pharmacies—we know you can do it.
Troy Trygstad, PharmD, MBA, PhD: Mike, have you toyed around with the idea of empowering patients? Can I have a kiosk when I walk up to the pharmacy that says, “Hey, check your own immunization registry,” or to download this app and ask your pharmacist about 3 that the app tells you that are overdue or when you type your own name in a registry.
Michael Popovich: Sure, yes.
Troy Trygstad, PharmD, MBA, PhD: Is there a way of prompting patients or reinforcing with patients that information? It’s not always us selling them on this on the back of the counter. It’s also them coming to us and saying, “Hey this widget told me,” or “Your screen over there told me that I’m overdue for a booster.”
Michael Popovich: That’s exactly where we’re headed. That’s where we’ll be in short order. Empowering that consumer with access to their information, so that they’re the 1 who is engaging to have these conversations, so they know that they’re coming in for this booster, and so they have access to those records. Whether it’s a kiosk, whether it’s on an app, whether it’s imbedded in there just a reminder in their Apple Watch that, you know, you’re due for the second dose. The technology now is right there to implement these things. It’s just a matter of pushing this information out.
As an individual, I want my pharmacist to be just like my vet, right? I rely on my vet every year to tell me to get my dog in here and get the right immunization. I want my pharmacist who has all my immunization records—who has access to it whether I go there or not—to remind me, “Come on in, you’re ready for your booster, your second dose,” or “We have this, we have the flu vaccine now, you can be the first to get it,” or whatever.
Troy Trygstad, PharmD, MBA, PhD: This is part of this larger movement toward population health and moving from passive to active.
Michael Popovich: Right.
Troy Trygstad, PharmD, MBA, PhD: Passive is: Hey, if they ask for lisinopril 40 mg, we’ll fill it, versus, “Uh oh, their proportion of days covered is low. We need to figure out. We need to get them in here and make sure proactively they’re getting this.” Right? And that’s what you’re speaking to—this larger movement toward population management. I’m responsible for these folks whether they’re in my pharmacy or not, and even if they get a vaccination somewhere else, great, at least my panel of folks that I have a responsibility to take care of are covered at that point. Right?
Michael Popovich: Yes. I’m excited about this opportunity. It hasn’t happened yet, but it will by partnering with public health. The public health folks can tell a particular pharmacy—maybe within 2 or 3 miles of their location—the immunization care gaps of that population that lives there. Whatever the characteristics are, they can identify that from this information that’s available. And a strong partnership with that pharmacy would say, “You know, here’s where you ought to concentrate,” whether you put out your billboards or the messaging, or as people come into the store the pharmacist knows that this is the area that we need to go after.
Troy Trygstad, PharmD, MBA, PhD: You’re identifying a public health practice and business opportunity. If I’m a pharmacy in an area with low vaccination rates, I can partner with my public health department and have more people walking in, a higher percentage of folks walking into my health care setting who need more vaccinations. If I’m in an area of low vaccination, that’s not a scenario where I look at that and say, “Well, it’s not part of practice here.” I should be looking at that as, this is 2 or 3 times the opportunity as some other pharmacies, where vaccination rates are high.
Michael Popovich: Oh, yeah. I want to whack the guy down the street on my immunization rates because they’re better. And you know, stuff like that.
Troy Trygstad, PharmD, MBA, PhD: And if you’re able to produce it better than the pharmacies or the health care system around you, then all the better for you and that $100 margin that comes with the non-flu vaccinations.
Michael Popovich: Everybody wins.