Researcher working to improve process to update CDC vaccination recommendations in clinics’ computer systems, enhance patient care

When immunization guidelines from the Centers for Disease Control and Prevention aren’t updated in a health care setting, patients could suffer the consequences. Xia Jing, an assistant professor in the Clemson University Department of Public Health Sciences, is beginning a five-year project to help make updating these guidelines a little easier for providers in smaller primary care settings.

Jing’s project aims to provide publicly accessible, reusable, and machine-interpretable clinical decision support (CDS) rules, such as immunization schedules. Funding this work is a $1.67 million grant from the National Institute of General Medicine Science of the National Institutes of Health.

She is working with an interdisciplinary team of researchers, including Ron Gimbel and Lior Rennert, also of the Department of Public Health Sciences, and Nina Hubig of the School of Computing. The team is coordinating their work with a panel of 10 international health care professionals and experts in medical informatics.

The project’s goal is to make it easier for health care providers in small primary care settings to update their clinical decision support rules from the Centers for Disease Control and Prevention (CDC) independently. These clinical decision support rules for immunizations can help physicians provide the recommended immunizations for patients more consistently.

“This work will facilitate primary care delivery with constantly updated CDS rules,” Jing said. “This investigation has the potential to allow primary care providers to provide more consistent preventive services and improve CDC-recommended immunization compliance in primary care settings.”

Jing said currently these CDC recommendations are digital but in a PDF format, which most of health care information computer systems don’t integrate into their patient health record programs seamlessly. While there may be machine readable PDFs, it doesn’t work with every operating system in primary care settings.

The CDC states that translating the clinical information into language the computer will understand is time-consuming and a complex process. According to Jing, smaller primary care settings are usually under-resourced and go without in-house information technology support to help with this compatibility issue.

The team’s goal is to generate publicly accessible, reusable, machine-interpretable CDS rules and enable primary care providers to update the CDS rules without in-house IT support. Regular and consistent updates of these recommendations are essential to maintain the usefulness of clinical support decision systems.

This NIH project builds upon previous research Jing has done on the Semantic Web Technologies and clinical decision support in primary care settings. She and a majority of the members on the NIH project team started this work approximately four years ago when she realized her collaborators’ and her skill sets in informatics could fill a gap in the health care field. Informatics is computer science and information technologies applied to health care and is especially useful in managing patient information.

“Informatics can be a powerful tool to make the health care delivery better and more efficient and consistent,” Jing said. “Through teaching, I realized that primary care serves the majority of the population and needed more attention in informatics research, so I decided to focus my research there.”

During this five-year project, the team will develop upper-level ontology for CDS and publicly accessible, reusable, machine-interpretable CDS rules based on the ontology. They will also create a program that enables primary care providers to maintain CDS updates independently. The team will then train a pilot group of clinical staff in South Carolina, Virginia and Texas to use and evaluate this program. After this five year-project is complete, the team aims to implement this system into primary health care settings.

This work is laying the foundation for computer systems to share an individual’s immunization data between different health care information systems, so patient records are kept up to date no matter where the patient transfers their medical care. The work has the potential to shed light on achieving broader interoperability of patient’s health records in health care.

“We need interoperability, although immunization records are a starting point,” Jing said. “Our life would be so much easier in keeping track of all immunization records over a lifetime. The complete immunization history of the patient would be portable with the patient when he or she moved to a new health care setting.”

The Clemson University Department of Public Health Sciences is part of the University’s College of Behavioral, Social and Health Sciences (CBSHS). Established in July 2016, CBSHS is a 21^st-century, land-grant college that combines work in seven disciplines – communication; nursing; parks, recreation and tourism management; political science; psychology; public health sciences; sociology, anthropology and criminal justice – to further its mission of “building people and communities” in South Carolina and beyond.

Research reported in this publication was supported by the National Institute Of General Medical Sciences of the National Institutes of Health under Award Number R01GM138589. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.