One way to increase immunization rates in the United States is via physician participation in state and regional immunization registries. However, although nearly three-quarters of physicians who practice in the public sector participated in these programs in 2008, only about one-third of private practice physicians participated.
The CDC began planning for immunization information systems in 1993. Today, the agency oversees a network of 64 immunization programs distributed throughout all 50 states, five American cities, the District of Columbia and eight U.S. territories.
The programs all receive funding under Section 317b of the Public Health Service Act and are working to meet the federal Healthy People 2010 target vaccination rates for children and adults.
America's physicians -- particularly family physicians and pediatricians, who administer a good number of the nation's vaccines -- need to embrace vaccine technology and view it as a valuable resource that will make medical practices more efficient and keep patients healthier, according to Anne Cordon, M.P.H., president-elect of the American Immunization Registry Association(www.immregistries.org).
"We need to get private providers who are outside of the public health realm using the registries; that's our big population we need to get in the next five years," Cordon told AAFP News Now. She added that she'd like to see large medical specialty organizations, such as the AAFP and the American Academy of Pediatrics, encourage their members to input data into their regional or state systems.
According to the CDC, only 37 percent of physicians in the private sector participated in registry programs in 2008. However, registry enrollment percentages may be deceptive, because some individuals enroll but don't actively participate in the system.
It's clear when comparing the CDC's 2008 Public Provider Participation Map with the 2008 Private Provider Participation Map that physicians and other health care professionals in the private sector lag behind their public-sector counterparts in registry usage.
Private practice physicians may not be aware that these registries exist, said Cordon, or they may not realize the efficiencies registries provide. She added that the registry system offers physicians free training and support. "Their end of the deal is to enter data and to use it," she said.
Donald Middleton, M.D., of Pittsburgh, is a family physician who, by his own accord, has been immersed in immunization issues for much of his career. He's a professor in the family medicine department at the University of Pennsylvania Medical Center St. Margaret in Pittsburgh and VP of residency education there.
In his private practice, Renaissance Family Practice, Middleton plans to link to his state's registry in conjunction with the implementation of an EHR system in the fall. Even so, he will continue to use a low-tech but highly effective method to keep his patients involved in their own preventive health care by distributing wallet-size immunization cards to his adolescent and adult patients.
The cards are available in bulk from the Immunization Action Coalition(www.immunize.org) for about 15 cents each, said Middleton. He noted that parents routinely receive immunization booklets to record childhood vaccines, but the practice generally is abandoned as children mature.
Middleton said the card enables patients to keep track of vaccines they've received and what immunizations they'll need in the future. He said he has seen patients become proactive regarding vaccines in recent years. One patient read the information on his card and promptly called Middleton's office to say, "I turned 65 …don't I need a Zostavax?"
And what do physicians who take the time to enter data into the system get in return? Registries have evolved to become much more than just data repositories that collect individual immunization records for children. Most registries now receive data on patients of all ages, and physicians are able to extract data that
- provides statistics on individual immunization coverage rates;
- helps physicians pinpoint where their practices are underimmunizing and overimmunizing;
- supplies ready access to the latest guidance from the CDC's Advisory Committee on Immunization Practices on new vaccines, vaccine combinations and immunization schedules;
- forecasts what shots a patient is due to receive at an office visit; and
- ensures the physician receives credit for patient immunizations given outside of the practice -- a factor that can affect a physician's quality performance rating from health plans that engage in pay-for-performance programs.
According to the CDC, registries also can help ease the administrative burden placed on physicians by parents asking for verification of pediatric immunizations for school enrollment purposes. Registries print patients' immunizations directly on official school immunization record cards.
Cordon said that most immunization information systems also have a vaccine inventory management system that helps physicians account for the vaccines they've purchased, stored and used. That function is essential to physicians who participate in the federal Vaccines for Children program because the program requires a high level of physician accountability for vaccines administered.
To make maximum use of the CDC's immunization system in America's highly mobile society, networks need to be able to share a patient's immunization information across state lines, regions and, ultimately, across the entire country. According to Cindy Sutliff, executive director of the American Immunization Registry Association, progress on sharing is slow but steady.
"We've done a lot of work on developing a model interagency agreement that allows for exchange between states," said Sutliff. The association has a pilot project close to launching that will connect two states in the Northeast region, she added.
Interface issues between registries and physicians' electronic health record, or EHR, systems also have been problematic. Some physicians reject the notion of entering patient data twice -- once into their own EHR and again into an immunization registry system.
Jeffrey Susman, M.D., professor and chair of the department of family medicine at the University of Cincinnati, is among those physicians who are waiting for improvements in the electronic systems. He said the disparate flow of information is a real problem and prevents his participation in the state immunization registry.
Susman also looks at the big picture. "In the patient-centered medical home, complete information, including immunization records, should be available with seamless information exchange among many health care settings," said Susman, who also serves on the AAFP's Commission on Quality and Practice. "Whether immunizations are provided at a community health center, a school-based clinic or a health department, the medical home should have access to, and coordinating responsibility for, this data."
The CDC is due to receive money from the federal economic stimulus package to enhance its immunization information systems program. "It's in the works as we speak," said Sutliff. "We're really all on the same page with building the capacity of (the immunization information system) to interface with EHRs and to get that all in place," she said.