The Importance of Immunization Reporting

Vaccination records (sometimes called immunization records) provide a history of all the vaccines a patient has received. These records are important as they may be required for jobs, travel, or school. Immunization records are compiled by a patient’s medical providers consolidating their vaccinations and reporting them to Immunization Information Systems (IIS).  IIS’s are usually run by state, city, or regional public health agencies. 

Immunization reporting is important for two reasons: 

1. Supporting population Public Health by tracking immunizations from birth through adulthood. 
2. Point of care through Clinical Decision Support in following the CDC Advisory Committee on Immunization Practices (ACIP) Forecasting schedule which recommends what vaccine, levels, types, and timelines for delivery. 

J P Systems’ Lisa Erickson, an Immunization Subject Matter Expert and the JPSys CIO, shares her insights with our Social Media team on Immunization reporting and its importance in health care. Ms. Erickson has worked with IIS’s for over 20 years, contributing to the first state IIS, the Wisconsin Immunization Registry, through the development of HL7 2.x rule engines for automatic electronic generation and consumption of HL7 2.5.1 immunization reporting and querying. 

Question 1: How does immunization reporting occur? What is the process for reporting for states?

Many provider organizations report their immunization data to their State IIS using their EHR systems. This reporting can occur through web-based programs and bulk uploads of batch immunization records or through an automated system that reports vaccinations in real time. 

Question 2: Are the Immunization Information Systems interoperable and can IIS’ and EHRs connect? 

IIS’s are interoperable as they are standards-based data sources that enable providers to upload and report health information so it can be stored in a centralized location. This allows other organizations to query an IIS for vaccination reports, vaccine histories, and Clinical Decision Support. While providers can upload and query health information from their own state IIS, it will not initiate a query, nor does it exchange data with other state IIS for legal reasons.

IIS’s and EHRs can connect but in some cases, they do not have to. IIS’s and EHRs use HL7 coded messages so EHRs can report data to an IIS and consume it. Organizations that do not have an EHR such as universities, elementary schools, and small healthcare providers are able to connect to IIS too. By using a sophisticated web portal, these organizations can directly access patient health information 

Question 3: What are the barriers to immunization reporting?

Barriers to immunization reporting are similar to those of other interoperable data exchanges and include the challenge of poor data quality. This is a result of providers not conforming to Implementation Guides and a lack of continuance in the validation of the data payloads for both syntactic conformance (HL7 specification) and semantic conformance (terminology). Most immunization reporting requires human intervention by clinician rather than direct data store to data store integration. This is burdening on clinicians as it increases the time they spend with health data, decreases their time with the patients, and continues to give them low quality information.

For example, if two healthcare facilities use different EHR systems, and Facility A uses one type of code to exchange patient information while Facility B uses another. Without an implementation guide, Facility B cannot fully consume the coded data from facility A, which may result in missing, misplaced or miscoded data. The same situation occurs when healthcare facilities send immunization records to state IIS’s. If the message with the immunization data being sent does not conform to the agreed upon implementation guide, the IIS will not accept the patient’s information. 

Though data coming into the IIS’s may lack conformance, data coming out of the IIS’s is a trusted data source. This is because the Health Information Technology Economic and Clinical Health Care (HITECH) Act mandated the use of HL7 2.5.1 messaging, and the creation of a CDC American Immunization Registry Association (AIRA) published a guide for implementation when exchanging information between IIS’s. By standardizing the data exchange process, organizations submit properly formatted data for IIS’s to accept and redistribute.  Providers need the state IIS data to meet the ACIP schedule. 

Question 4: What does JPSYS do when it comes to Immunization Reporting and why is our work important? 

The J P Systems team provided subject matter expertise to develop and implement a Course Of Action (COA) to use HL7 2.5.1 for Immunization Messaging between EHRs and State IIS’s this implementation was through the Standard of Work for VHA’s VDIF system, which was used to implement the functionality. 

Team members enabled reporting of COVID-19 vaccinations and vaccine inventory to the CDC. When the CDC was rejecting COVID-19 reports which had poor data quality, resulting in missing information in patient records, it was not clear which VA provider had sent the immunization data to the CDC. Before JPSys was involved, clinicians spent multiple hours a day tracking down which VHA healthcare provider had originated the rejected record so it could be sent back and corrected. JPSys developed a semi-automated Access database that streamlined the identification process so the record could be analyzed and resent. By automating this process, JPSys saved clinicians 6 hours of manual work a day. We are eliminating the clinician need to intervene in obtaining vaccine history by making high quality state immunization information automatically available to the EHR thus saving clinicians’ time and thereby improving their work efficiency. 

JPSys is currently engaged in a pilot project involving immunization reporting between the VA and FDA. Through the usage of HL7 FHIR R4 bundles, these agencies will be able to report COVID-19 immunization adverse events in real time. This is important because by December of 2022, EHRs need to be able to exchange FHIR R4 messages to maintain their status as a certified system.