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The Importance of EHR Quality Measures & Vaccination Status

Linda is a 38 year old woman with a 2 year old daughter. She also frequently cares for her 78 year old father. Every September Linda sees Dr. Lee, her primary care physician, for a routine visit. Caring for both a child and a parent can be stressful, so at her most recent visit Linda asked Dr. Lee what she could do keep herself and her family in good health. Dr. Lee advised Linda to make sure she and her family are all up to date on their vaccinations each year. Dr. Lee provides Linda with an influenza vaccination during the visit and Linda immediately schedules appointments with her daughter's pediatrician and her father's primary care physician to make sure each of them receives their required vaccinations.

Which Vaccination Status Quality Measures Count for Meaningful Use (Stage 1 & Stage 2)

Measuring & Improving Vaccination Status: A Real Impact on Your Patients

  • A 2007 study that compared morbidity and mortality before and after widespread implementation of national vaccine recommendations found since such widespread implementation: 1
    • Cases of diphtheria, measles, paralytic poliomyelitis, rubella, congenital rubella syndrome, and smallpox declined more than 99%;
    • Cases of mumps, tetanus, and pertussis declined more than 90%;
    • Deaths from tetanus and pertussis declined more than 99%;
    • Cases of and deaths from Hib, Hepatitis A, Hepatitis B, invasive pneumococcal disease, and varicella declined more than 90%, 86%, 80%, 25%, and 81% respectively; and
    • Hospitalizations related to Hepatitis A, Hepatitis B, and varicella declined more than 87%, 80%, and 88% respectively.
  • A study that examined National Hospital Discharge Survey for trends in hospital discharges for those 65 or older found that:2
    • Hospitalization for pneumonia increases the risk of death during the hospitalization 1.5 times when compared with the top ten causes for hospitalization
  • A probabilistic model of publicly available epidemiology data that estimated the total annual economic burden of influenza in 2003 found:3
    • 31% of the economic burden is born by those aged 18-64;
    • 88% of the economic burden is indirect, including lost productivity and wages; and
    • Per capita the annual economic burden ranges from $92 to $299 per year.
  • Reports issued by the Centers for Disease Control in 2009 stated:4
    • Only 33% percent of adults were vaccinated against influenza;
    • Only 60.6% of adults older than 65 were vaccinated against pneumonia; and
    • Only 64% of children under 2.9 years had received all recommended vaccinations


Appropriate vaccinations will not only help to protect Linda , her daughter, and her father from potentially fatal infectious diseases, but will help Linda be able to continue caring for her family.

Clinical Quality Measure Information

Childhood Immunization Status

NQF# Description Numerator Denominator Exclusions
NQF# Not Applicable Percentage of children 2 years of age who had DTaP/DT, 3 IPV, 1 MMR, 3 H Influenza Type B, 3 Hepatitis B, 1 chicken pox (VZV), and 4 pneumococcal conjugate vaccines by their 2nd birthday. All patients:
  • Evidence of the antigen or combination vaccine; or
  • History of the illness; or
  • Seropositive test result
Systematic sample of patients who:
  • Turn 2 years of age during the measurement year
  • None

Influenza Vaccination

NQF# Description Numerator Denominator Exclusions
0041e Percentage of patients who received an influenza vaccination. All patients:
  • Who received the influenza vaccination from September through February
Systematic sample of patients with:
  • Age > 50 years
  • None

Pneumonia Vaccination Status for Older Adults

NQF# Description Numerator Denominator Exclusions
NQF# Not Applicable Percentage of patients 65 years of age and older who ever received a pneumococcal vaccination All patients:
  • Who answer "yes" when asked if they have ever had the pneumococcal shot
Systematic sample of patients with:
  • Age > 65 years of age, &
  • Responded "yes" or "no" when asked if they have ever received the pneumococcal shot.
  • None

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.5

  1. Roush, SW, Murphy, TV. "Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States". JAMA. 2007 (298, 18): 2155-63
  2. Fry, AM., Shay, DK., Holman, RC.,Curns, AT., Anderson, LJ. "Trends in Hospitalizations for Pneumonia Among Persons Aged 65 Years or Older in the United States, 1998-2002". JAMA. 2005 (294, 21): 2712-19
  3. Molinari, NM, Ortega-Sanchez, IR, Messonnier, ML.,Thopmson WW., Wortley, PM, Weintraub, E., Bridges, CB. "The annual impact of influenza is the US: Measuring disease and burden costs". Vaccine. 2007 (25):5086-96
  4. http://www.cdc.gov/vaccines/stats-surv/nis/nis-2009-released.htm. Accessed March 2, 2012
  5. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed December 6, 2011

Produced by Meaningful Use Quality Workgroup - March 22, 2013

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