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Clinical Decision Support

Updated 10/2015


Immunization clinical decision support (CDS), also known as evaluation and forecasting, is a feature offered through Immunization Information Systems and some Electronic Health Records (EHR). It helps determine which immunizations are recommended (according to the AAP/AAFP/CDC Recommended Immunization Schedule) for each patient and notifies the healthcare provider. Recommendations include age for vaccine administration, number of doses, dosing interval, and precautions and contraindications.

A robust immunization decision support system is critical for any pediatric provider using an electronic health record, leading to better patie​​nt outcomes and improved immunization rates for the practice.

While technical and clinical subject matter experts attempt to convert clinical recommendations that come from ACIP into technical logic that allows the evaluation and forecasting engines to operate, this is difficult and outputs do not always match expectations.

Practices may either test current or prospective systems using these cases or ask their EHR or IIS vendor to demonstrate how their systems would handle these test cases. The test cases in the CDC's guide have been written in technical verbiage. Below you can find a narrative summary of each chosen case with a link to the CDC technical specifications below. (The CDC test case numbers are listed in parenthesis after each case.)

  1. Minimum Interval: Female patient, DOB 12/01/2010, receives 3rd dose of PCV 13 (Prevnar) exactly 28 days after receiving her 2nd dose. The CDS should then recommend the 4th dose be administered when the patient is between 12 and 15 months of age, or approximately 12/01/2011. (2013-0611)
  2. Incomplete Series: Female patient, DOB 05/01/2000, receives 2nd dose of Gardasil at 11 years, 2 months of age. The CDS should then recommend the 3rd dose of Gardasil at 6 months after the first dose, based on the age of the patient and the valid administration of the previous dose. (2013-0403)
  3. Minimum Age: Male patient, DOB 05/01/2002, receives 2nd dose of Gardasil at 9 years, 4 weeks of age. The CDS should then recommend the 3rd dose of Gardasil at 6 months after the first dose, based on the age of the patient and the valid administration of the previous dose. (2013-0406)
  4. Simultaneous Administration: Female patient, DOB 07/07/2005, receives Varicella vaccine (Varivax) 27 days after receiving MMR. The Varicella dose is invalid due to the administration of a second live virus less than 28 days after the first (below minimum interval).  The CDS should recommend a varicella vaccine be re-administered 28 days after the incorrect dose of Varivax vaccine was received.  (2013-0815)
  5. Contraindications/Precautions: Female patient, DOB 02/01/2012, is due for 2nd Rotavirus vaccine, but had anaphylaxis following her first dose of Rotateq. CDS should not recommend vaccination for Rotavirus.  (2013-0787)
  6. Off Label Usage: Female patient, DOB 02/01/2010, incorrectly received Tdap as her 4th dose of DTaP at age 15 months. The first three doses administered had unspecified brands, the 4th dose being Boostrix. The CDS should recommend the 5th dose of DTaP be administered at 4 years of age (02/01/2014). (2013-0061)
  7. Extra Doses: Female patient, DOB 07/01/2006, receives 5th dose of Pediarix at 4 years, minus 5 days of age. The patient has received extra doses of the HepB vaccine because Pediarix (a combination vaccine) was administered 5 times for DTaP. CDS should not recommend any other HepB vaccines, the series has been complete.  (2013-0248)