In my last post, I talked about the importance of using immunization registries to increase vaccination rates and improve public health. Today, I’d like to focus on the future of these systems, and why their evolution is so important.
What Are Immunization Information Systems?
Immunization information systems (IIS), often called immunization registries (IR), first appeared in the early 1990s. Since then, they’ve been making patients’ immunization data increasingly useful, but we’re far from realizing their full utility.
IIS offer a wide range of benefits. They consolidate data into a single record that’s easily accessible by providers and parents, avoid duplicate vaccinations, reduce administrative work tracking down immunization history from other providers and make it easy to provide required information to daycare, schools and other institutions.
All good things. But when fully utilized, these systems can do so much more — they become powerful tools that can advance the quadruple aim of improving the patient experience, achieving better health outcomes, improving the clinician experience and lowering the cost of care.
Most states and providers are interested in updating their legacy systems that were built more than 20 years ago using now-outdated code and hardware. Machines with limited capacity sitting in a server room in a state office building can’t compare to a modern, fast and secure cloud-based solution that’s easily expanded, has near infinite capacity and can quickly be configured to exchange data with other systems.
Registries: Not Just for Kids Any More
Historically, most IIS have focused on tracking children’s immunizations, and that’s where the majority of funding goes. COVID-19, however, showed us the very real value of using these systems to record adult vaccinations. It also showed us that most current systems are overburdened, and they struggled to keep up with the additional load.
Every state currently operates an IIS that is capable of tracking adult immunizations, yet data is available for only about 60% of adults compared to 95% of children.
The CDC is invested in ensuring state registries can track vaccination status for all Americans, young and old. They are working with the American Immunization Registry Association (AIRA) to address gaps in current systems and practices. One component of this partnership is the “Landscape Analysis Report,” which presents a comprehensive view of the current adult vaccination environment. It examines practices, policies, challenges and successes. The report will be used to create a roadmap which will recommend strategies to improve provider use of IIS for adults. The report recommends the following:
· Capture of adult data must be a priority from the national level to the clinical setting, with adequate funding and staffing.
· Providers need motivation to comply with adult requirements. This could come from mandates, fiscal incentives, information campaigns, pressure from patients and peers, and tools that make reporting a part of their daily workflow.
· There must be automated data exchange between IIS and EHRs, without opt-in requirements.
· Confidence must be built amongst providers regarding data accuracy and quality.
The federal government has also made increasing the number of people captured in IIS an objective in its Healthy People 2030 plan.
The Time Is Now
This is the perfect time to modernize, expand and integrate these systems. COVID-19 provided both funds and motivation to improve IIS, but we still need to address inter-state interoperability, data standardization and minimum capture requirements.
Interoperability and Data Standardization
The lack of interoperability between states’ systems severely limits their potential value.
Consider the following scenario: A child is born in one state, then, years later, the family moves to another. The child gets older and goes away to college in a third state, then moves to a fourth for work … and so on. Each move between states currently means a blank slate in the IIS.
What’s needed is a comprehensive record that captures data throughout a person’s life, no matter the state or place of service, whether that’s a primary care provider, pharmacist, school or other setting.
Can Immunization Registries Address Social Determinants of Health?
IIS, in general, currently do a good job of identifying pockets and communities of the under-vaccinated. But if modernized, the hidden power of these systems would be uncovered.
Through collaboration with state health authorities, registries would allow identification of the social determinants of health that are impeding a patient, or a community, from receiving vaccinations. This could mitigate the barriers that are affecting not just immunization rates, but community health in general.
Bringing immunization registries into the 21st century is exciting, but unlocking their full potential will take visionary thinking and purposeful collaboration at all levels of health and human services. It’s a great opportunity, and investment made today will create a healthier future for everyone.