PROS

• This is where immunizations are meant to be recorded – your EMR is built for this.

• You can document additional details such as lot number, injection site, etc.

• The coding system is clear and EMRs, if they are connecting out to other systems (e.g. for eReferrals), would share the immunizations correctly.

• If you want to search or query those who are immunized in the future, documentation in the ideal place will mean the data is retrievable.

CONS

• Many primary care offices do not consistently use the immunization module, so for some, this might be an unfamiliar area of your EMR.

PROS

• Many of us are used to putting issues on the problem list. They are often easier to see in the chart and can be structured / coded and even commented on.

• Many practices use the problem list already to generate recall lists (e.g. for diabetes, CHF, etc.) so your office probably can create a recall list using the problem list.

CONS

• Usually the code system in Canadian Primary Care EMRs is ICD9. ICD9 was not made for vaccines, so you have to hack in using a code that is close and relabel it for readability.

• Your problem list will quickly get cluttered – initially it makes sense but as 70+% of patients are immunized, most people will have 1-2 extra “problems” for their immunizations.

PROS

• You can design a focused immunization template that also covers off items like:
  • History – contraindications screening
  • Consent
  • Last dose / next dose

• This will help with the documentation needs for COVID immunization visits, ensuring consistency.

• You can, in some EMRs, include billing into your visit template to speed things up.

• You may find one already built by your EMR or in your EMR community form library that you can use.

CONS

• It may take a bit more time to set up.

• Requirements for documentation may shift.

• You still need to figure our how to code the immunization as some EMR template tools do not include coded information that can be searched.

• The biggest con is that it is just for immunizations given in your office and you cannot use it for recording immunization status (e.g. given at another clinic, hospital, etc.).

PROS

• Many of us are use to using codes in the encounter or visit diagnosis section of our EMR visit note, so this can be added easily into our workflow.

• They are date stamped at the visit, so easier to track when it was given.

• Often links to billing module, speeding up your workflow.

CONS

• Uses the same codes as the problem list, and these ICD-9 codes were not made for immunizations, so you have to hack it in using a code that is close and relabel it for readability.

• Over time, in patients with lots of visits, the immunization visit gets buried in the visit list.

• This is better used to document when you give an immunization vs status of immunization.

PROS

• Many provinces are adding specific billing codes for COVID-19 immunizations. In some provinces, billing is linked to provincial immunization registries, so doing this consistently is an absolute requirement.

• Many offices will be documenting this regardless in order to be paid.

• Generally, offices know how to run searches based on billing codes, if you are running fee-for-service.

CONS

• Billing is meant for activities in the office, so it is not good if you want to consistently document who in the office is immunized, independent of where they received it.

• Billing codes may not be useful if a different team member provided the immunization.

• Billings may not be used in alternate funding models – other tracking is needed.

• Billing codes will not likely distinguish the type of vaccine administered so in the case of recall or re-administration requirement based on lot number this information will not be enough.

PROS

• This is the simplest approach. The biggest PRO here is that we all can do this and you can start right away.

CONS

• All you have is an electronic paper record. This is not the recommended approach. While you have documented it, that is all you have done. You cannot really use any tools in your EMR to recall patients, find out how many patients have or have not had their immunizations etc.

• Typos are a huge problem, because you might record that you gave Pzifer, or Medorna, or AZ, AstraZ, AstrZinica, J&J, JandJ, JJ… you get the picture.