Immunization Information Systems Position Statement

I. ASTHO Supports Immunization Information Systems

The Association of State and Territorial Health Officials (ASTHO) supports the standardization and consistent use of immunization information systems (IIS) by state and territorial health agencies. ASTHO recognizes the ability of IIS to consolidate vaccination records from multiple providers, assist with vaccine supply management, provide accurate and updated vaccination schedules, generate patient reminders, assess community-wide immunization rates, and improve vaccination rates.

Rationale

• Benefits to the patient: IIS makes complete immunization histories available to providers and, increasingly, to patients and families, which increases the likelihood that patients will receive all age-appropriate immunizations and avoid unnecessary, duplicative shots.
• Benefits at the point of clinical care: IIS assists providers in adhering to the current U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommendations and reduces missed opportunities for vaccination.
• Benefits to the facility: IIS generates coverage reports for practices and managed care organizations, helps improve care coordination, increases office efficiency by reducing time needed to gather and review immunization records, creates recall/reminders, and tracks inventory. IIS allows an increasing number of facilities, including schools and camps, to view immunization records, thereby improving accuracy of vaccine history information and reducing provider time to duplicate and transfer records.
• Benefits for public health: IIS helps monitor vaccination trends and generates state and local coverage data to better identify and target under-immunized areas. IIS allows for quick identification of vaccine recipients throughout the state in the event of a vaccine recall or vaccine-preventable disease outbreak and is able to assist with identifying and targeting high-risk children during an outbreak. IIS data define Vaccines for Children (VFC) eligible populations and in doing so provide better estimates of federal vaccine needs.

II. Within This Context, ASTHO Recommends State and Territorial Health Agencies:

• Uniformly implement messaging and vocabulary standards, performance criteria, and business rules in partnership with federal agencies and public health associations to improve data quality, consistent vaccine forecasting, functions for third-party billing, and interoperability with a wide range of clinical, public health, and other information systems.
• Seek to enhance IIS interoperability with electronic health records (EHR) by sharing system requirements with EHR developers and supporting bidirectional exchange of information in a standardized way.
• Work toward cross-state, standards-based implementation of IIS-to-IIS interoperability.
• Encourage IIS participation among providers outside the medical home (e.g., pharmacies, community care settings, and schools).
• Work toward the goal of providing individuals, parents, and guardians secure and authenticated access to immunization records through EHR-IIS connections, direct access to an IIS, or practice-level health information exchange (HIE) portals in a way that aligns with the meaningful use requirement that providers give access to information from EHRs. Methods will vary based on state approach and may need additional resources.
• Search for ways that IIS data can support more complete electronic health records and aid in emergency response efforts.
• Collaborate with federal and local partners to invest in IIS maintenance, continued enhancement, and shared solutions. Work toward strengthening the capacity for mobile IIS accessibility, especially during mass vaccination clinics in response to an outbreak.
• Promote adoption of IIS by medical providers in state and develop standards of utility.
• Invest in informatics workforce development and increase immunization program staff competencies in informatics.

III. Background

An IIS is a confidential, population‐based, public health information systems that records immunization doses administered by participating providers within a defined geographic area. IIS is a vital public health tool for collecting, analyzing, and acting upon relevant data to manage immunization programs. The Community Preventive Services Task Force recommends IIS on the basis of strong evidence of effectiveness in increasing vaccination rates by creating or supporting effective interventions, generating and evaluating public health response to outbreaks, facilitating vaccine management and accountability, determining client vaccination status to aid clinician decision making, and aiding surveillance and investigation of vaccination rates.¹  

In the United States, minimum functional standards for the operation of immunization information systems were developed by the Centers for Disease Control and Prevention, the Department of Health and Human Services’ National Vaccine Advisory Committee, and immunization program grantees.² These standards approved core data elements and enabled individual states to develop their own IIS to retrieve and remit immunization data. A decentralized system has led to varied IIS capacity among states, and as a result, there is a great need to support implementation of accepted messaging, vocabulary, performance, and business standards to improve data quality and interoperability of systems.

Efforts to improve intrastate and interstate IIS interoperability are important given that residents often travel between jurisdictions for healthcare services; this approach would enable healthcare providers to access immunization data from an adjacent city or state. Interstate interoperability would take both efforts and resources to link systems across state borders, create laws, when necessary, to enable information sharing, and adhere to messaging standards between entities. Future support of the implementation of secure, electronic exchange of IIS records is needed to decrease immunization duplication, provide valuable information during a public health alert, and improve care coordination.

Encouraging vaccination providers outside of primary care, such as pharmacies, schools, and community-based clinics, to add immunization information to IIS would build a complete record, reduce the need for duplicate systems, and limit the chance for duplicate vaccinations. Immunization information from existing systems would help populate many IIS data sources; however, this is challenging due to current laws that strictly prohibit data sharing from schools, varied state systems, or federal facilities, such as the U.S. Department of Veterans Affairs. In addition, improving authentication capabilities to allow parents to search for their child’s immunization record using IIS could enhance reminder/recall functions and better engage the parent in their child’s health history.

Enhancing the interoperability among IIS, EHR, and HIE is one opportunity to increase data consistency and accuracy and increase available data for other public health functions. Further support is needed to ensure immunization  information systems improve interoperability and integrate with EHRs and HIEs in a bidirectional manner; that is, the IIS would respond to a provider query with both a patient’s immunization history and vaccine forecasting based on that patient’s age and immunization history. In addition, efforts to integrate IIS data with that of other information systems, notably the Women, Infants, and Children program (WIC) or screening systems for lead, early hearing, obesity, and communicable diseases, could enhance IIS to create a useful and comprehensive tool for both providers and public health.

As health information organizations (HIOs) continue to emerge to support HIE regionally or statewide, and as providers increasingly come to see the HIO as the preferred method of exchange, IISs will need to partner with HIOs to act as an intermediary for immunization information.

Future funding for IIS remains unclear, and with the high cost for maintenance, upgrades, technological advances, and migration to new systems, investment is necessary to maintain and improve operability for long-term preservation of records. CDC currently funds 56 immunization information systems in 50 states, Washington, DC, and five large cities. An additional incentive program, established by the Health Information Technology for Economic and Clinical Health (HITECH) Act, provides funding for eligible professionals, hospitals, and critical access hospitals when they adopt certified EHR technology and successfully demonstrate meaningful use of EHRs to improve quality, safety, and patient-centered care. While incentives have increased the number of providers sending data, there continues to be a need for ongoing funding to implement and sustain a standards-based system that can support interoperability with EHRs to accept that immunization data.

As public health agencies become more dependent on the use of information systems, the need for highly trained and specialized personnel, especially those with informatics skills in data exchange, data quality, and data use, will rapidly increase. Efforts to expand workforce development by providing additional funding to health departments, schools of public health, nursing, and medicine will strengthen the informatics infrastructure, leading to improved public health information systems.

To maximize the benefits of IIS, the system must strive to integrate population health into clinical medicine and become interoperable with electronic health systems to support clinical decision-making. The successful integration of public health data and clinical medicine can ultimately lead to improved immunization coverage rates and a lowered disease burden.

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Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a future development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position Statements are not voted on by the full ASTHO membership.

Infectious Disease Policy Committee Approval: February 2012

eHealth Policy Committee Review: January 2012 

Board Review and Approval: June 2012

Policy expires in June 2015. 

Related ASTHO Publications:

• Immunization Policy Statement
• Meaningful Use Position Statement

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Notes

1. Guide to Community Preventive Services. Universally recommended vaccinations: immunization information systems. Available at www.thecommunityguide.org/vaccines/universally/imminfosystems.html. Accessed 1/5/2012.
2. Centers for Disease Control and Prevention. IIS: 2001 Minimum Functional Standards for Registries. Available at www.cdc.gov/vaccines/programs/iis/stds/min-funct-std-2001.htm. Accessed 1/5/2012.