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HHS Plans to Strengthen Adult Immunization Health IT Infrastructure

February 12, 2016
by Heather Landi
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The U.S. Department of Health and Human Services (HHS) plans to improve adult vaccination rates through its National Adult Immunization Plan, which includes plans to improve the health IT infrastructure behind adult immunization registries.

In a press release announcing the new National Adult Immunization Plan (NAIP), HHS officials cited Centers for Disease Control and Prevention (CDC) data that indicates 80 percent of adults ages 19 and older have not received recommended vaccinations to protect them against tetanus, diphtheria and pertussis (whooping cough) and more than 70 percent of adults ages 60 and older have not received recommended shingles vaccinations.

“We’ve done a great job educating people about the importance of childhood vaccines, but we need to do a much better job making sure more adults are aware of the vaccines they should get in order to protect them from diseases that can have quite serious complications,” Karen DeSalvo, M.D., HHS acting assistant secretary for health, said in a statement. DeSalvo also serves as National Coordinator for Health Information Technology.

The new adult immunization plan, developed by the HHS National Vaccine Program Office, is comprised of four goals to increase adult immunization rates in the U.S.—strengthen the public health and healthcare systems involved in adult immunizations; improve access to adult vaccines; increase awareness of adult vaccine recommendations and use of recommended vaccines and foster innovation in adult vaccines, including new vaccines and new ways to provide them.

Health IT plays a large role in the first goal of the adult immunization plan as it involves strengthening the adult immunization infrastructure. In the 67-page NAIP, HHS officials state that the adult immunization infrastructure in the United States is complex and multifaceted, consisting of numerous components with unique functions. “Goal 1 of the NAIP focuses on high-level issues with the potential to have significant impact on adult vaccination rates in the next several years. One example is the increasing importance of health IT and the need for systems and providers to be able to exchange accurate, timely information by improving and leveraging elements that already exist, rather than creating new systems, programs and entities,” the plan stated.

To achieve this goal, HHS plans to enhance current vaccine safety monitoring systems and develop new methods to accurately and more rapidly assess vaccine safety and effectiveness in adult subpopulations, i.e. pregnant women.

HHS also plans to focus on increasing the use of electronic health records (EHRs) and immunization information systems (IIS) to collect and track adult immunization data.

“While IIS have the potential to act as a centralized repository of adult vaccination records, the maturation of EHRs, IIS, and interoperability will also play a critical role in ensuring coordination of adult vaccination activities and improving coverage. A centralized source of vaccination information is especially critical for adults who see a variety of providers and receive vaccinations in a variety of settings (e.g., medical settings, workplaces, schools, colleges, universities, pharmacies),” HHS stated in the immunization plan. “Many adult vaccination improvements are dependent on or would be accelerated by better data exchange, and interoperability between EHRs and IIS facilitates better health outcomes. In order to achieve these outcomes, EHRs must be able to electronically send data to IIS and to receive consolidated histories and forecasts from IIS in a secure manner.”

According to HHS, information technology enhancements can lead to better recordkeeping and submission to IIS that addresses the barrier of unknown vaccination history, avoids the administration of duplicate doses of vaccine and helps ensure that opportunities for vaccination are not missed.

To this end, specific EHR and IIS-related strategies include the following:

  • Increase the ability of EHRs to generate a query using nationally accepted standards and accept a standardized immunization history and forecast, consistent with the objectives and measures set forth in rulemaking for the Medicare and Medicaid EHR Incentive Program
  • Increase the ability of IIS to accept a query using nationally accepted standards and respond with a standardized immunization history and forecast to inform providers of needed vaccinations, consistent with the objectives and measures set forth in rulemaking for the Medicare and Medicaid EHR Incentive Programs.
  • Increase adoption of standardized transport methods, including use of CDC Web Services Definition Language (WSDL), by IIS and by EHRs to allow for more consistent information exchange across all in the health care system who provide vaccine services for adults
  • Expand IIS and EHR functionality to facilitate interstate immunization data exchange through a centralized hub
  • Develop and disseminate “model agreements” to address the documented legal and policy barriers that preclude data sharing between states and systems
  • Expand consumers’ access to their own vaccination data through secure IIS and EHR consumer portals
  • Encourage bidirectional exchange between EHRs and IIS for adult vaccinations among clinics and health systems already entering pediatric data (e.g., federally qualified health, center–funded clinics, health maintenance organizations)



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