Current Status of Immunization Information Systems in the U. S.

Gary Urquhart, MPH

Chief, Immunization Information Systems Support BranchImmunization Services Division

National Center for Immunization and Respiratory DiseasesCenters for Disease Control and Prevention

Atlanta, Georgia

November 2008

The Need for Immunization Information Systems in the U. S.

Births in the U. S. - 2006: 4.269 million live births (11,695 births every day).1

The U.S. Census Bureau reports that between 2006 and 2007, 38.7 million (13%) people moved in the United States - 11.7 million (30%) are < 19 years of age.2

Increasing Populations – Population Mobility

1U.S. National Center for Health Statistics, Vital Statistics of the United States, annual; and National Vital Statistics Reports (NVSR)

2U.S. Census Bureau

Patients with at least 1 immunization from Dane County Health Department

Consolidation ofImmunization Histories

Extra-Immunization

• A 2000 study published in JAMA found that 1 in 5 US children had received at least 1 extra vaccine dose by age 19 to 35 months.1

• Annual costs associated with extra-immunization were conservatively estimated to be $26.5 million.

1 Feikema, SM, Klevens, RM, Washington, ML, Barker, L. Extraimmunization Among US Children. JAMA 2000;283:1311-1317.

Public Health Emergencies

•Two recent papers describe the role of IIS during Hurricane Katrina:

• The Houston-Harris County Immunization Registry estimated cost savings of more than $1.6 million for vaccine alone and $3.04 million for vaccine plus administration fees was found.*

• A CDC assessment of more than 21,000 successful electronic immunization queries of children and adolescents estimated that more that $4.6 million was saved in revaccination expenses.**

* Boom, JA, Dragsbaek, AC, Nelson, CS. The Success of an Immunization Information Systems in the Wake of Hurricane Katrina. Pediatrics. 2007; 119:1213-1217.

** Urquhart GA, Williams W, Tobias J, Welch FJ. Immunization Information Systems Use During a Public Health Emergency in the United States. J Public Health Management Practice; September\October 2007.

New Vaccines Continue to be Added to the U. S. Immunization Schedule and Increasing Costs

1985 and 1995 represent the average federal contract price to account for price changes within the respective year. April 2008 represents the minimum cost to vaccinate children and adolescents and is based on the federal contract price as of April 2, 2008. The 2008 cost to vaccinate includes the new ACIP expanded recommendation for influenza vaccine for all children 0-18 year of age. Last updated April 8, 2008.

$45

$155

$1,105

$1,407

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

1985 1995 April 2008 Male April 2008Female

Do

llar

s

3 HPV

3 RV

2 Hep A

1 Mening

1 Td/Tdap

4 PCV7

20 Flu

2 Var

2-3 Hep B

3-4 Hib

1-2 MMR

4 Polio

5 DTP/DTaP

Immunization Program Operational Support

Immunization information systems provide operational support to immunization programs, providers, patients, and parents by:

o automating evidence-based strategies

o producing real-time data to ensure that children, adolescents, and adults are protected against vaccine preventable diseases, and by

o assisting programs to deploy their resources efficiently and effectively

Immunization Information Systems – Relevance to Electronic Health Records or Health

Information Exchanges

IIS EHR/HIE

Sophisticated functionality and decision support: deduplication; reminder/recall; coverage assessment; consolidation of records; vaccine validation and forecasting.

Many EHR products offer an immunization module that shows a patient's immunization history but very little decision support functionality.

Statutory support assures some financial sustainability; protection of privacy and security; governance; data is available to anyone entitled to access the IIS.

Health Information Exchanges are subsidy-based; pay to play. Data access limited to practices.

Immunization Information Systems – Relevance to Electronic Health Records or Health

Information Exchanges

IIS EHR/HIE

Master population index for a geopolitical area. Tracks children with and without vaccinations.

Master patient index for a practice or group of practices. Tracks clinical encounters only.

Web-based systems maintained by state or local governments.

Distributed systems. Software application maintained by the practice.

Current Status of U. S. Immunization Information Systems

Immunization Information SystemsAge Groups Participating in an IIS

Source: 2007 Immunization Information System Annual Report

US - 2000 US - 2007 TX - 2007

Participation of U.S. children < 6 years in an IIS with 2 or more immunizations.

21% 71% (16.5

million children < 6 years)

92% (1.5 million children < 6

years)

Participation of U.S. children 19-35 months in an IIS with 2 or more immunizations.

-

66% (4.0 million children 19-35

months)

71% (321, 757 children 19-35

months)

Participation of U.S. adolescents 11-18 years in an IIS with 2 or more immunizations.

-

64% (21.5 million

adolescents 11-18 years)

80% (1.7 million adolescents 11-

18 years)

Participation of U.S. adults >19 years in an IIS with 1 or more immunizations.

- 20% (45.5

million adults >19 years)

-

National Participation: 71%Source: 2007 IISAR

Immunization Information Systems – December 31, 2007 Participation Progress for U.S. Children aged < 6 years

95% Participation = 15 Grantees (27%)

80% Participation = 30 Grantees (54%)

60% Participation = 40 Grantees (71%) Challenges = 9 Grantees

Immunization Information SystemsProvider Site Participation in IIS

Source: 2007 Immunization Information System Annual Report

US - 2000 US - 2007 TX - 2007

Participation of public provider sites submitting data to an IIS in the past 6 months.

38%

73% (7,563 public

provider sites)

57% (520 public

provider sites)

Participation of private provider sites submitting data to an IIS in the past 6 months.

19%

48% (29,345 private

provider sites)

58% (1,460 private

provider sites)

IIS State Legislation (including Washington DC):

• Authorizes an IIS: 27 states (53%)

• Mandates reporting: 14 states (27%)

• Requires participation (Opt-Out): 44 states and Washington D.C. (86%)

Immunization Information SystemsState Legislation

Source: Survey of State Registry Legislation (updated 11-9-2005)

Immunization Information System Capacity to Track Adolescent and Adult Vaccinations

Data from the 2007 Immunization Information System Annual Report indicate that:

• About 17% (8 of 53 grantees) report that they include birth to < 23 years of age in their IIS.

• About 77% (43 of 53 grantees) report that they include all ages in their IISs.

Source: 2007 Immunization Information System Annual Report

• 77% of grantees have population-based IIS

• On average, 70% of newborn records are recorded in a grantee IIS within 6 weeks of birth

• 89% of grantees receive and process vaccine and other immunization data from their IIS within a month of vaccine administration

Immunization Information System Status on Selected Performance Measures As of December 31, 2007

Source: 2007 Immunization Information System Annual Report

Of those grantees with an IIS reporting:

• 94% of grantees have a written confidentiality policy for their IIS

• 88% of grantees have a written security policy for their IIS

• 43% of grantees can process and return an HL7 message as well as process and upload a record consistent with HL7 standards

Immunization Information System Status on Selected Performance Measures As of December 31, 2007

Source: 2007 Immunization Information System Annual Report

Of those grantees reporting:

% 4:3:1:3:3 Coverage for Children 19-35 Months of Age Participating in an IIS and the Impact of Completing 1 Dose

on Coverage - December 2007

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Idah

o

Illin

ois*

Colora

do

Monta

na

North C

arolin

a

Min

nesota

Rhode Is

land

Texas

Iowa

Was

hingto

n

Distri

ct o

f Colu

mbia

Wis

consi

n

South D

akota

Georg

ia

Arkan

sas

Mic

higan

Philadel

phia

North D

akota

Oregon

Louisia

na

Grantees

% II

S P

arti

cip

ants

wit

h 4

:3:1

:3:3

Co

vera

ge

% 4:3:1:3:3 Coverage for Children 19-35 Mths of Age Participating in an IISEstimated NIS - 2007 4:3:1:3:3 Coverage (Counting Valid Doses)

1 Dose Completed Effect on 4:3:1:3:3 IIS Participant Coverage

Percentage of Enrolled Females Aged 11-18 Years with ≥1 Dose of HPV Vaccine,

by Site and Quarter

0

5

10

15

20

25

MT DC MN MI AZ OR

Sentinel Sites

% v

ac

cin

ate

d

Q3 2006Q4 2006Q1 2007Q2 2007Q3 2007Q4 2007

Source: Data presented by Jim Lutz, KIDS IIS (Philadelphia, PA). 

Data and slide courtesy K. Enger

Immunization Coverage with MMR by Zip Code

Michigan Care Improvement Registry (MCIR), March 31, 2008

Contact Information:

Gary Urquhart, MPHChief, Immunization Information Systems Support BranchImmunization Services DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlanta, Georgia

Phone: 404-639-8277E-mail: gau5@cdc.gov