Assessing immunization registry data completeness in Bexar County, Texas

BACKGROUND: Immunization information systems (or registries) are increasingly being used to promote and sustain high levels of vaccination coverage. However, the perception among many providers that registry data are too incomplete to be relied on when making immunization decisions has impeded the acceptance of registries. METHODS: To evaluate registry completeness, immunization coverage levels from the San Antonio Immunization Registry System (SAIRS) were compared with coverage levels derived from immunization records from 77 (37%) of the 210 clinics participating in the Vaccines for Children (VFC) program in 1998, 44 (21%) clinics in 1999, and 10 (5%) clinics in 2000. RESULTS: Clinic data indicated an average immunization coverage level for the 4:3:1 series of 39.8%. The overall coverage level for these clinics based on registry data was 64.1%. Registry-coverage levels for these clinics were < or =65% above the coverage levels based on clinic records. CONCLUSIONS: Immunization coverage levels based on SAIRS data were the same or higher than coverage levels based on clinic records. These data suggest that San Antonio's registry data were more complete than clinic records and may assist in changing provider perceptions regarding registry data completeness.     

Immunization registry progress--United States, 2002

Immunization registries are confidential, population-based, computerized information systems that collect vaccination data about all children within a geographic area. By providing complete and accurate information on which to base vaccination decisions, registries are key tools to increase and sustain high vaccination coverage. Registries consolidate vaccination records of children from multiple health-care providers, identify children who are due or late for vaccinations, generate reminder and recall notices to ensure that children are vaccinated appropriately, and identify provider sites and geographic areas with low vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate in fully operational, population-based immunization registries (objective 14.26). This report summarizes data from the calendar year 2001 Immunization Registry Annual Report (CY 2001 IRAR), a survey of registry activity among immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under Public Health Service Act 317b. Although these data indicate that approximately half of U.S. children aged <6 years are participating in a registry, achieving the national health objective will require increased immunization provider participation.     

Practice-based electronic billing systems and their impact on immunization registries.

Many providers rely on electronic billing systems to report information to immunization registries. If billing data fail to capture some administered immunizations, the registry will not reflect a child's true immunization status. Our objective was to assess differences between immunizations administered and immunizations reported to a registry from electronic billing systems. Philadelphia's Department of Public Health conducted chart audits in 45 providers serving 50 or more children aged 7-35 months and using electronic billing systems to report data to Philadelphia's immunization registry in 2001-2003. Chart records were compared to registry records to identify immunizations administered in these practices but not reported to the registry. The study practices administered 256,969 immunizations to 20,611 children. Of these 256,969 administered immunizations, 62,213 (24%) were not in the registry. The electronic billing systems submitted data for all administered immunizations for 69% of immunization visits, some but not all for 11% of visits, and none for 20% of visits. Immunizations administered but not billed cost these providers up to $980,477 in lost revenue from administrative fees alone. Improvement of billing data quality would result in more complete registries, higher reported immunization coverage rates, and recovered revenue for immunization providers.     

Immunization registries: progress and challenges in reaching the 2010 national objective.

Immunization registries are confidential, population-based, computerized information systems that contain data about children's immunizations and have been described as the cornerstone of immunization delivery in the 21st century. Work to ensure the privacy of registry participants and the confidentiality of their information, recruit provider participation, overcome technical and operational challenges, and identify sustainable funding streams has resulted in 24 percent of children less than 6 years of age currently in an immunization registry in the United States. New solutions will be needed before reaching the national health objective of increasing the proportion of children to 95 percent in a fully operational immunization registry by 2010.     

Immunization registry use and progress--United States, 2001

Immunization registries are confidential, population-based, computerized information systems that collect vaccination data about all children within a geographic area. Registries are key tools used to increase and sustain high vaccination coverage by providing complete and accurate information on which to base vaccination decisions. Registries consolidate vaccination records of children from multiple healthcare providers, identify children who are due or late for vaccinations, generate reminder and recall notices to ensure that children are appropriately vaccinated, and identify provider sites and geographic areas with low vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate in fully operational population-based immunization registries (objective 14-26). CDC analyzed data from 50 states and the District of Columbia (DC) from the calendar year 2000 Immunization Registry Annual Report (CY 2000 IRAR) to assess current registry activity. This report summarizes the results of those analyses, which indicate that 32 (63%) of the 51 grantees are operating population-based immunization registries (Figure 1). These 32 projects represent 49% of the U.S. population aged <6 years.     

Progress in development of immunization registries--United States, 2000

Immunization registries are confidential, population-based, computerized information systems that attempt to collect vaccination data about all children within a geographic area. Registries are an important tool to increase and sustain high vaccination coverage by consolidating vaccination records of children from multiple providers, generating reminder and recall vaccination notices for each child, and providing official vaccination forms and vaccination coverage assessments. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate in fully operational population-based immunization registries (objective 14.26). To assess the status of immunization registry development, CDC analyzed self-reported data from 62 immunization grantees on the basis of data from the 2000 Immunization Registry Annual Report (IRAR). This report summarizes the results of this analysis, which indicate that approximately half of the grantees are operating population-based immunization registries that target their entire catchment areas; however, approximately 75% of children aged <6 years still need to be included in an immunization registry to reach the national health objective.     

Determining immunization rates for inner-city infants: statewide registry data vs medical record review

OBJECTIVE: This study evaluated the benefit of consulting a statewide immunization registry for inner-city infants whose immunizations appeared, after single-site chart review, to have been delayed. METHODS: We prospectively enrolled 315 newborns in 3 inner-city pediatric clinics. When the infants turned 7 months old, we obtained immunization data from clinic charts and the state registry. RESULTS: On the basis of chart review, 147 infants (47%) were assessed to be delayed in their immunizations; of these, registry data revealed that 28 (19%) had received additional immunizations and 15 (10%) were actually up to date. CONCLUSIONS: A statewide registry can capture immunizations from multiple sources, improving accurate determination of immunization rates in a mobile, inner-city population.     

Immunization registry accuracy: improvement with progressive clinical application

BACKGROUND: Healthcare systems have been challenged to ensure the timely administration of immunizations. Immunization registries have been proposed to improve the accuracy and completeness of immunization information and to promote effective practice. METHODS: Comparison of randomly selected samples from two birth cohorts (1993 and 1998) from Denver Health Medical Center. Chart review and immunization registry information for these groups were compared; a composite immunization was recorded and up-to-date (UTD) status established. Registry data were compared with this composite using a sensitivity measure to assess completeness and accuracy. RESULTS: Among 818 children in the 1993 cohort and 1043 children in the 1998 cohort, there were 6386 and 6886 valid immunizations, respectively. The registry recorded 71.4% and 97.7% of these for the 1993 and 1998 cohorts, respectively (p <0.001). The apparent UTD rate, as measured with registry data alone, improved from 37% to 79% between the two time frames (p <0.001). Composite UTD status was 83.1% and 78.9% (1993 vs 1998, respectively). Accurate registry-defined UTD status improved from 44.4% to 100% between the two intervals. CONCLUSIONS: Immunization registry accuracy improved dramatically for recorded immunizations and UTD status. However, after 3 years of registry use, the overall proportion of children who were UTD had not significantly improved. The mere presence of a registry does not ensure more complete vaccination coverage. Other registry-based strategies, including use of the data for reminder, recall, and audit, may further improve immunization coverage.     

Immunization information system progress--United States, 2003

One of the national health objectives for 2010 is to increase to at least 95% the proportion of children aged <6 years who participate in fully operational, population-based immunization registries (objective 14-26). Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records (EMRs), is called an immunization information system (IIS). This report summarizes data from CDC's 2003 Immunization Registry Annual Report (IRAR), a survey of IIS grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. The findings of the 2003 IRAR indicate that approximately 44% of U.S. children aged <6 years participated in an IIS. In addition, 76% of public vaccination provider sites and 36% of private vaccination provider sites submitted immunization data to an IIS during the last 6 months of 2003. Increasing health-care provider participation by linking EMRs to IISs is vital to meeting the national health objective.     

Immunization registry progress--United States, January-December 2002

Immunization registries are confidential, computerized information systems that collect vaccination data within a geographic area. By consolidating vaccination records from multiple health-care providers, generating reminder and recall notifications, and assessing clinic and vaccination coverage, registries serve as key tools to increase and sustain high vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate (i.e., have two or more vaccinations recorded) in fully operational, population-based immunization registries. This report summarizes data from CDC's 2002 Immunization Registry Annual Report (2002 IRAR), a survey of registry activity among immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under section 317b of the Public Health Service Act. These data indicate that approximately 43% of children aged <6 years are enrolled in a registry; achieving the national health objective will require increased implementation of functional standards to improve data quality.     

Immunization information systems progress - United States, 2005

Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2005 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. These data indicated that approximately 56% of U.S. children aged <6 years participated in an IIS, an increase from 48% in 2004. Moreover, 75% percent of public vaccination provider sites and 44% of private vaccination provider sites submitted vaccination data to an IIS during July-December 2005. These findings underscore the need to increase the number of participating children, from the current 13 million to approximately 21 million, to assure 95% participation of children aged <6 years and improve the effectiveness of U.S. immunization programs.     

Measles immunization coverage determined by serology and immunization record from children in two Chicago communities

OBJECTIVES: We compared the prevalence of measles immunization determined by serology with the prevalence of measles immunization determined by immunization records, and identified factors predictive of measles immunization among a sample of children from two Chicago communities. METHODS: We collected demographic information and blood specimens from a sample of children aged 12-71 months in two Chicago communities at risk for low measles immunization coverage levels. We collected immunization information from provider records, parent-held records, and the statewide immunization registry. We compared evidence of immunization determined by serology with evidence of immunization from these three sources of immunization records. RESULTS: The sample of children from the two communities had serologic measles immunity levels of 85% and 90%. Significantly fewer children had evidence of immunization by record in both communities (45% and 63%, respectively). CONCLUSIONS: Immunization coverage levels determined using immunization records were significantly lower than immunization coverage determined using serology. A fully populated immunization registry used by all immunization providers could prevent the problems of record loss and scatter.     

Progress in development of immunization registries--United States, 1999

Community-based and state-based immunization registries are confidential, population-based, computerized information systems that contain data about children's vaccinations and represent an important tool to increase and sustain high vaccination coverage. Immunization registries consolidate vaccination records for children from multiple providers, provide a vaccination needs assessment for each child, generate reminder and recall vaccination notices, produce an official vaccination record, and provide practice-specific and community-based vaccination coverage assessments. One of the Healthy People 2010 national objectives is to increase to 95% the proportion of children aged <6 years who are enrolled in a fully operational population-based immunization registry. To assess the status of immunization registry development, CDC analyzed data from the 1999 Immunization Registry Annual Report (IRAR) of 64 jurisdictions (grantees) that receive federal immunization funds under section 317d of the Public Health Service Act. Findings from this analysis indicate that substantial progress has been made in the United States in developing and implementing community-based and state-based immunization registries.     

Immunization information system progress--United States, 2004

One of the national health objectives for 2010 is to increase to at least 95% the proportion of children aged <6 years who participate in fully operational, population-based immunization registries (objective no. 14-26). Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2004 IIS Annual Report, a survey of 56 grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. The findings indicate that approximately 48% of U.S. children aged <6 years participated in an IIS. Moreover, 76% of public vaccination provider sites and 39% of private vaccination provider sites submitted immunization data to an IIS during the last 6 months of 2004. Overcoming challenges and barriers to increasing the number of provider sites and the percentage of children aged <6 years participating in an IIS is critical to achieving the national health objective. CDC has developed a plan of action to address those challenges. Major components of the plan include, but are not limited to, a multiyear IIS business plan for each grantee and enhanced technical assistance to grantees with unresolved challenges.     

The vaccines for children program: Policies, Satisfaction, and Vaccine Delivery

OBJECTIVES: Characterize the Vaccines for Children (VFC) programs in Minnesota and Pennsylvania, assess providers' satisfaction with each state's program, and examine changes in doses administered in the public sector since implementation of the VFC. METHODS: Primary care providers participating in the VFC in Minnesota and Pennsylvania were surveyed. Doses administered were based on data from the National Immunization Survey. Outcome measures included satisfaction, ease of use of VFC, doses of immunizations administered through public health departments, and overall immunization coverage for the two states. RESULTS: Most participating providers in each state (80% to 94%) reported overall satisfaction with the VFC. Pennsylvania physicians were less satisfied with quarterly ordering of immunizations than were Minnesota providers with monthly ordering (56% vs 80%, p<0.05). The most common recommendation was to reduce paperwork. Doses administered in the public sector declined in Minnesota from approximately 146,000 in 1994 to 65,400 in 1999, and in Pennsylvania from approximately 250,000 to 79,300 during the same period. CONCLUSIONS: The VFC appears to increase the numbers of poor and uninsured children who receive necessary childhood immunizations within their medical homes. Providers are generally satisfied with the program.     

Impact of implementing a technology platform in community pharmacies to increase adult immunizations rates

Over the course of this project, we utilized pharmacists at 159 community pharmacies in Nebraska and Iowa to administer vaccinations to adults 19?years of age or older with the objective of improving immunization rates in both states. We implemented a pharmacy-based technology platform and partnered with public health via the state immunization registries of both states to ensure that immunizations provided at the pharmacy were transmitted to the statewide registry, for which reporting is currently voluntary for health care providers. After using the technology platform for one year, an increase of immunization rates for influenza, herpes zoster, and pertussis vaccination rates by 37%, 12%, and 74%, respectively, was recorded in comparison to the prior year numbers. However, there was about 16% decrease in vaccination rates for pneumococcal vaccine. For the first time, the project’s participating pharmacies in Nebraska reported immunization counts to their state’s immunization registries. This project leveraged community pharmacies as healthcare destinations to achieve further gains in increasing immunization rates, improving the health of adults, and creating a community-wide network for prevention.     

Costs of immunization registries: experiences from the All Kids Count II Projects

BACKGROUND: Immunization registries are tools to improve and sustain immunization coverage rates for our nation's preschool children. Developing a means of supporting registries over the long term requires information on costs to operate registries. METHODS: To determine the annual cost per child to operate immunization registries for the 16 All Kids Count (AKC) II projects, some of the most developed registry projects in the United States, we projected a national figure for operating registries and compared the figure with a variety of potential cost offsets. RESULTS: When the registries are fully operational, the average cost per child for the 16 AKC II projects will be $3.91 (range, $1.60 to $6.23; interquartile range, $2.91 to $4.81) per year. CONCLUSIONS: Based on the AKC study, maintaining a nationwide network of registries for children aged 0 to 5 will require an estimated $78.2 million. Cost offsets include not having to manually retrieve records for school entry, child care, change in provider, and Health Plan Employer Data Information Set reports; not having to carry out the National Immunization Survey; and prevention of overimmunization. We estimate these offsets at $113.8 million annually.     

The first national adult immunization summit 2012: Implementing change through action

To address lagging vaccine coverage among adults in the United States, over 150 organizations representing a wide range of immunization partners convened in Atlanta, GA from May 15–16, 2012 for the inaugural National Adult Immunization Summit. The meeting called for solution-oriented discussion toward improving current immunization levels, implementing the 2011 National Vaccine Advisory Committee adult immunization recommendations, and capitalizing on new opportunities to improve coverage. Provisions in the federal health reform law that increase access to preventive services, including immunizations, and the increasing numbers of complementary vaccine providers such as pharmacists, create new opportunities to increase access for immunization services and improve coverage for adults. The Summit organized around five focal areas: empowering providers, quality and performance measures, increasing access and collaboration, educating patients, and informing decision-makers. These focal areas formed the basis of working groups, charged to coordinate efforts by the participating organizations to address gaps in the current immunization system. Summit participants identified priority themes to address as tasks during the coming year, including better communicating the value of immunizations to increase demand for immunizations, creating a central repository of resources for providers, patients, and others interested in improving adult immunization levels, examining performance and quality measures and evaluating means to use such measures to motivate vaccine providers, increasing engagement with employer and employee groups to increase awareness and demand for vaccinations, improving the use of immunization information systems and electronic health reports, decreasing barriers to all vaccine providers including pharmacists and community vaccinators, decreasing the complexity of the adult vaccine schedule where possible, engaging adult immunization champions and leaders in key sectors, including adult healthcare provider groups, and encouraging more integration of immunization services with other preventive services.     

Immunization information systems: National Vaccine Advisory Committee progress report, 2007.

This article summarizes principal findings and recommendations of the National Vaccine Advisory Committee 2007 Progress report on Immunization Information Systems (IIS). Considerable progress has been made in each of the four primary objectives of the IIS: ensure appropriate protections of privacy and confidentiality for individuals and security for information included in the registry; ensure participation of all immunization providers and recipients; ensure appropriate functioning of registries; and ensure sustainable funding for registries. In addition, IIS use has been extended to deal with adolescent/adult immunization, preparedness, vaccine shortages, health information exchanges, and electronic medical records. Notwithstanding the progress, several factors impede smooth achievement of the 2010 goal. The three most critical are difficulties in exchanging information among different information systems, difficulties in exchanging information across state lines, and ensuring sustainable funding for registries. The committee has made a number of recommendations to address these issues.     

Fragmentation of immunization history among providers and parents of children in selected underserved areas

OBJECTIVE: We assessed fragmentation of children's immunization history among providers and parents of children aged 12 to 35 months in four selected underserved areas. STUDY DESIGN: Area probability cluster sample surveys were conducted in 1997-1998 in northern Manhattan, San Diego, Detroit, and rural Colorado. Surveys consisted of face-to-face interviews with parents followed by record checks with all named immunization providers. We used Advisory Committee on Immunization Practices recommendations to determine up-to-date (UTD) status with vaccinations. The UTD status for each child was determined in four ways: (1) according to the parent-held immunization records, (2) according to the records of the child's most recent provider, (3) according to the records of the child's second most recent provider, and (4) according to provider and parent-reconciled information. RESULTS: In all four areas, the majority of records of the most recent provider agreed with the reconciled information. However, in all areas, the percentage of children UTD according to provider- and parent-reconciled information was higher than the percentage of children UTD according to information from only the child's most recent provider or from only parent-held immunization records. Across all sites, the percentage of children UTD with the DTP/DTaP vaccine was 2% to 9% lower, according to the most recent provider's information than according to reconciled information. Similar results were seen for other vaccines. The most recent provider not having complete immunization history was significantly associated with not being UTD in New York and having received unnecessary immunizations in San Diego and Detroit. CONCLUSION: For most children, although the records of the most recent provider give accurate data for clinical decision making, the immunization histories of some children in these underserved areas are fragmented between providers and parents. This can limit the provider's ability to vaccinate children appropriately.