This document summarizes the current status of immunization information systems (IIS) in the United States. It finds that as of 2007, 71% of children under 6 years old had their immunization records in an IIS. While most states authorize or mandate IIS reporting, participation levels among providers vary significantly. The document also examines IIS capabilities for tracking adolescent and adult immunizations as well as performance measures like data timeliness and security policies. Overall IIS participation has increased in recent years but opportunities remain to improve coverage and functionality.

1. Current Status of Immunization Information Systems in the U. S. Gary Urquhart, MPH Chief, Immunization Information Systems Support Branch Immunization Services Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, Georgia November 2008

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

3. 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 1 U.S. National Center for Health Statistics, Vital Statistics of the United States, annual; and National Vital Statistics Reports (NVSR) 2 U.S. Census Bureau

4. Patients with at least 1 immunization from Dane County Health Department Consolidation of Immunization Histories

8. 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

10. Immunization Information Systems – Relevance to Electronic Health Records or Health Information Exchanges Health Information Exchanges are subsidy-based; pay to play. Data access limited to practices. Statutory support assures some financial sustainability; protection of privacy and security; governance; data is available to anyone entitled to access the IIS. Many EHR products offer an immunization module that shows a patient's immunization history but very little decision support functionality. Sophisticated functionality and decision support: deduplication; reminder/recall; coverage assessment; consolidation of records; vaccine validation and forecasting. EHR/HIE IIS

11. Immunization Information Systems – Relevance to Electronic Health Records or Health Information Exchanges Distributed systems. Software application maintained by the practice. Web-based systems maintained by state or local governments. Master patient index for a practice or group of practices. Tracks clinical encounters only. Master population index for a geopolitical area. Tracks children with and without vaccinations . EHR/HIE IIS

12. Current Status of U. S. Immunization Information Systems

13. Immunization Information Systems Age Groups Participating in an IIS Source: 2007 Immunization Information System Annual Report

14. 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

15. Immunization Information Systems Provider Site Participation in IIS Source: 2007 Immunization Information System Annual Report

20. % 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% Idaho Illinois* Colorado Montana North Carolina Minnesota Rhode Island Texas Iowa Washington District of Columbia Wisconsin South Dakota Georgia Arkansas Michigan Philadelphia North Dakota Oregon Louisiana Grantees % IIS Participants with 4:3:1:3:3 Coverage % 4:3:1:3:3 Coverage for Children 19-35 Mths of Age Participating in an IIS Estimated NIS - 2007 4:3:1:3:3 Coverage (Counting Valid Doses) 1 Dose Completed Effect on 4:3:1:3:3 IIS Participant Coverage

21. Percentage of Enrolled Females Aged 11-18 Years with ≥1 Dose of HPV Vaccine, by Site and Quarter

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

23. Data and slide courtesy K. Enger Immunization Coverage with MMR by Zip Code Michigan Care Improvement Registry (MCIR), March 31, 2008

24. Contact Information: Gary Urquhart, MPH Chief, Immunization Information Systems Support Branch Immunization Services Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, Georgia Phone: 404-639-8277 E-mail: [email_address]