1. Time Flow Analysis of the Impact of an Immunization Registry on Vaccine Documentation
M. Irigoyen, S. Findley, D. See,
O. Peña, S. Chen, E. Mendonça
Columbia University, New York, NY

2. Background
Manual documentation of vaccine administration involves recording data in multiple locations, including chart notes, flow sheets, encounter forms, and parent’s cards.
The use of an immunization registry allows for automation of some of these procedures at the point of service.

3. EzVAC Immunization Registry
In 2000, we launched a private registry at NY Presbyterian Hospital
Populated by registration system
Web-based and point of service
30+ practices, 160,000+ children
Regular uploads to NY Citywide Immunization Registry
Types of clinics and settings

4. EzVAC Registry EzVAC Registry New York Presbyterian Hospital
Ambulatory Care Network
School Based
Clinics
Community
Providers
NYC DOH Citywide
Immunization Registry

5. Study Question
What is the impact of the immunization registry on the time spent on vaccine documentation?

6. Study Objective
To evaluate nursing time spent documenting vaccine administration before and after implementation of an immunization registry.

7. Study Method
Time-flow observational study of nursing time spent on vaccine documentation tasks
Data collection at Baseline and 2-years after implementation of the registry

8. Study Setting Pediatric hospital-affiliated practices network
Low income, minority community in New York City
By 2001, registry capture rate >95% of immunizations

9. Sequence of Manual Documentation
Signs order in Medical Record
Enters Data into IZ Flow Sheet
Complete VFC Eligibility Form
Updates Parents’Health Record
Fills out Health Ed Form Medical Record

10. EzVAC Features Nurses log on with ID and password
Child’s record accessed by number or name
Child’s VFC eligibility predetermined
Nurses select new vaccine to be administered
date, manufacturer, lot, exp date default
Nurse prints record for chart

11. Sequence of Registry Documentation
Updates Parents’Health Record
Complete VFC Eligibility Form
Fills out Health Ed Form Medical Record
Signs order in Medical Record
Enters Data into IZ Flow Sheet
3 steps are automated

12. Number of observations
Patient encounter unit of observation
December Pre-registry
85 encounters observed
average 2.3 vaccines per encounter
October Post-registry
66 encounters observed
average 2.4 vaccines per encounter

13. Comparison of Time Elapsed in Each Step of Immunization Documentation

14. Cumulative IZ Documentation Time
2’44”
2’04”

15. Results
Average time spent documenting immunizations increased slightly from 2’04” to 2’44”.
1 minute of the registry entry was consumed by log-on delays.

16. Nurses Prefer the Registry
Nurses highly satisfied with registry
Nurses would NOT go back to paper system
“Old habits are hard to break.”
There is still an adjustment period to gain confidence in the system. Some nurses are completing manual forms in addition to registry entry.

17. Registry Documentation Payoffs
Improved data quality
Consolidates documentation
Vaccine inventory tracking and management
Instant records retrieval for QA
Automated immunization reminder-recall
Registry entry has greater payoffs than manual entry:
Improved data quality (error checks built-in)
Consolidates documentation in one place
Vaccine inventory tracking and management
Instant retrieval of vaccine records for patient care and quality improvement activities
Automated immunization reminder-recall

18. Conclusions
The immunization registry slightly increased nursing time for vaccine documentation
Almost all additional time is due to system delays
Nursing staff highly value registry