Public health immunization information systems (IIS) in the United States are designed to support the collection of immunization information throughout the lifetime of an individual. They exist in all 50 states and are fully operational in 49. The road to their development was hard fought, and now, their ability to help reduce the impact of vaccine-preventable disease, to increase retail pharmacy customer satisfaction and revenue, and to empower physicians, payers, pharmacists, and their retail customers is invaluable.
In the early 1990s, the CDC challenged state health departments to develop childhood immunization registries that would allow family physicians to see which immunizations their patients had already received and which ones they still needed. Along with the CDC and state public health departments, organizations such as Every Child by Two, the Flinn Foundation, and the Annie B. Casey Foundation invested in early projects to design and create what would become the first-generation immunization data systems. Data were collected primarily from pediatricians and family practitioners and reported through paper procedures. With the growth of the Internet, second-generation data collection moved digital.
As new vaccines were approved and immunization schedules were updated, improvements in technology occurred and these data repositories continued to evolve. A significant milestone occurred during the 2009 H1N1 influenza pandemic, when the HITECH Act (Health Information Technology for Economic and Clinical Health) established goals for electronic data exchange. The goals including monetary incentives for providers who could show they were reporting data via their electronic health record (EHR). Patient immunization events were specifically identified as an example. The door also opened for pharmacists to provide immunizations, and as new and hard-toreach populations became accessible through local pharmacies, both the public and private sectors realized the value of these services to customers and the opportunity to increase immunization rates. The result was that vendors of EHR systems began to enhance their provider systems to include Health Level 7 standards for public health immunization reporting to state systems. This put into motion public health compliance policies for reporting, which applied to clinical providers and pharmacists.
In 2019, the original concept of a childhood immunization registry has evolved to become a comprehensive immunization system containing immunization events for all ages, from all types of immunization providers. The reporting of more than 75% of the data to public health systems is done electronically. Data quantity and quality are increasing rapidly, and the state IIS has become a gold mine of significant data and opportunity.
The following example illustrates the opportunity to use these systems to empower the immunization provider community:
In the past 5 years, about 50% of the nation’s retail pharmacy market has reported over 100 million immunization events to the appropriate
state IIS. A sampling of data from 11 state IIS indicates that over 95% of the states’ population had a record in the system. A total of 57 million individuals and over 571 million immunization events were in these systems averaging 9.9 immunization records per individual. These numbers can be used to project to all 50 states to determine that a significant percent of the US population has at least 1 immunization record online in a public health system.
Electronic reporting is expanding the data retained in these public health systems, and trusted data decision support tools are being used to assess patient immunization histories to identify past, due, and next-due immunizations. In addition, many state systems now provide direct consumer access to these records, further empowering individuals to become proactive with the knowledge of their immunization histories and increasing point-of-care conversations.
Despite the plethora of data available, however, these immunization registries are not linked state-to-state. Only 2 states have a structured agreement to support cross-border data sharing. This means that if a patient moves to another state, travels for the summer/winter, or receives an immunization while traveling, they no longer have a consolidated record in their home state. Because of this, as well as the fact that pharmacists provide the majority of nonchildhood immunizations, the pharmacists’ role in providing (and maintaining) immunizations is becoming more important than ever. IIS are no longer just data storage repositories. They are becoming data opportunity systems.
Part 2 of this series will be published in June 2019 and will explore data opportunities in more detail. The focus will be on the return of investment in immunization registries and the value the IIS bring to pharmacists and the consumer population when utilized to their full extent. It will attempt to show what happens when retail pharmacy customers are empowered and they become proactive in scheduling their next immunizations prior to the pharmacist encounter. This, and the power of partnering with public health, will reduce the impact of vaccine-preventable disease.
Mike Popovich is the CEO of Scientific Technologies Corporation.