Bulk FHIR Could Boost Access to Immunization Data for Population Health

Bulk FHIR could help providers access Immunization Information System (IIS) data for population health outreach, according to a study published in JAMIA.

In many advanced EHR systems, providers can query a state IIS system to check the vaccination status of a specific patient through existing application programming interfaces (APIs). However, population health management is more complex, as IIS interfaces to EHRs have not supported the bulk review of an entire patient panel in electronic queries.

Reviewing patients one at a time can negatively impact clinical efficiency and timeliness of care. Enhancing state IISs with the ability to perform Bulk FHIR would allow providers to submit lists of thousands of patients.

However, since the Bulk FHIR protocol was not specifically designed for this use case, extensions to the protocol are needed.

“Ideally, increased capacity for reporting would be coupled increased capacity for outreach by population health providers, including smaller community organizations, to reach those residing underserved communities,” the study authors wrote.

They suggested that an open-source population health database tool might allow non-traditional healthcare providers, like schools and churches, to check the vaccination status of their members to maintain an accurate list for community-based efforts. This tool might also use the Bulk FHIR protocol to synchronize the data in its system with the state immunization system.

The researchers created and tested two prototypes that formed VACtrac, a platform designed to enhance IIS Bulk response capabilities and to support both traditional and non-traditional providers’ use of these capabilities in population health management.

“A significant focus of work was the design of a bulk FHIR server to respond to immunization queries,” the study authors said. “We achieved this by replication of the data in an IIS in the HAPI standard FHIR server.”

Researchers used an agile development approach to test bulk queries against the database. They found the most significant issue with processing a Bulk query within an FHIR server was the need for prior access to the IIS’s unique patient identifier to use an unmodified Bulk FHIR Query.

“Vaccination data can come from a variety of providers. Most IIS systems have some form of master-person-index solution,” the study authors wrote. “However, a provider organization seeking access to IIS data may not have access to the IIS patient identifier, creating the need for matching algorithms embedded in the bulk query algorithm.”

“The need for patient matching resulted in a requirement for sufficient demographic data to implement probabilistic algorithms, further emphasizing the need for the use of FHIR Group functionality in bulk queries,” they explained.

The authors noted that the benefits of Bulk FHIR standards are probably greatest when a population health provider works in a border area of one or more states and has to query two or more different IIS systems.

“Here a standards-based approach make the query of multiple IIS systems, across state borders, much more feasible,” they wrote. “Bulk FHIR may make it easier to define groups of patients for follow-up, again by offering standards, and for merging records that crosses states that are flexible and powerful.”

“An additional benefit of the Bulk FHIR query method is computational, allowing asynchronous query and reporting, which can preserve limited computing resources for interactive queries for use within the context of one-on-one care of a patient, and for the application of vaccine forecasting algorithms,” the researchers said.

The study is limited as it did not test the Bulk FHIR protocol in a live clinical application.

“Ultimately, the acceptability of advanced tools such as FHIR servers to IIS systems will depend on funding to states to acquire such systems and the availability of skilled personnel to use and maintain them,” the researchers wrote.