Immunization Information Systems

Abstract

Immunizations are important tools for reducing vaccine preventable diseases (Scharf et al., Acad Pediatr 21:S57, 2021) and by two years of age, over 20% of children in the United States (U.S.) have typically seen more than one healthcare provider (HCP), resulting in scattered paper medical records (CDC, Immunization Information Systems, 2019). Immunization information systems (IISs) are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a geopolitical area (Scharf et al., Acad Pediatr 21:S57, 2021.).

IISs need to be thought of in two ways: their value for patients, and their value for broader, social policy. IISs can be a valuable tool in supporting a patient from childhood to adulthood, and help ensure that a patient is fully immunized. Pediatric HCPs can access IISs to obtain a patient’s immunization records, which helps ensure that a patient is not over- or under-vaccinated. When a patient moves from pediatric care to adult care, IISs may facilitate the adult caregivers’ knowledge of which vaccines a patient needs. IISs also contain reminder recall functions which remind patients of upcoming vaccinations, hel** those patients stay up to date. Also, for a patient, IISs can help simplify transfer of immunization records when a patient moves between facilities or has to get treatment outside their usual doctor’s office. IISs are also very important for public health. IISs can help identify vaccination gaps in a community before an outbreak occurs, allowing public health to target immunization campaign and warning them of vaccination deserts (places where people have trouble accessing vaccines), which can help solve access problems. During an outbreak, IISs are critical in providing timely insight into vaccine coverage and areas where vaccines are more urgently needed. Opponents would have concerns about the effect of IISs on medical privacy—concerns about disclosure of the data or hacking—and some vaccine-hesitant or vaccine-resisting individuals will be concerned that IISs can be used in enforcing vaccine mandates against them.

Currently, there are 61 IISs across the U.S. These IISs operate within state and city health departments, and are overseen by the Center for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Disease (NCIRD) and Immunization Services Division (ISD) (Greenberger, The Imperative of Immunization Interoperability and Information Sharing, 2021.). Over two decades ago, a national immunization registry was explored but not ultimately enacted.

Filling its oversight role, the CDC has been publishing standards for IISs since the early 2000s. The most current version of these standards is Version 4.1, developed in 2019. The CDC also publishes the IIS Annual Report (IISAR) which measures progress towards meeting IIS standards. The IISAR is published annually, and assesses programs that receive funding under Section 317b of the Public Health Service Act (PHSA) (See Chap. 8 for a more thorough discussion of that program and other funding mechanisms. Over the years, IIS standards have focused on several core concepts. These are: data quality, provision of data to stakeholders, privacy and confidentiality, clinical decision support, data exchange with Electronic Health Records (EHRs), and support of immunization program operations. Currently, these core concepts focus on “system functionality,” but as IISs improve functionally, the emphasis will be placed on “data quality.” This is because HCPs “rely on high-quality data from IIS[s] to aid with clinical decisions, ensuring coverage estimates are reliable, and identifying vulnerable populations to target for interventions.” (Scharf et al., Acad Pediatr 21:S57, 2021.)