A Multi-state Pilot of Consumer Electronic Access to Official State Immunization Records

Each year there are over 50,000,000 visits to U.S. healthcare providers by consumers seeking an official paper immunization certificate in order to meet school entry, childcare registration, travel needs, and various employment requirements. Typically these certificates – which are state-specific in content and format – are generated when healthcare providers log-in to their state’s Immunization Information System (IIS), also referred to as their immunization “registry.” State immunization registries are electronic repositories of official immunization records consolidated through the reporting (either voluntary or required) of thousands of healthcare providers who administer immunizations in a particular state. Besides the economic and practical inefficiencies of traveling to healthcare providers to obtain official certificates, most state’s certificates only contain a partial immunization history – including just those vaccines specifically required by a state for school entry. A complete immunization history and current forecast (immunizations coming due or now due) is often not included on these certificates.

The recent federal Meaningful Use requirements incentivizing healthcare providers to adopt certified Electronic Medical Records systems has also embraced significant efforts to more fully engage consumers in their own health decision making. Key areas of emphasis include providing consumers direct access to their medical records and making clinical decision support tools available to them to help them monitor and intervene in matters relating to their health. Research has shown that consumer’s knowledge of their immunization history and forecast improves immunization rates. However, most consumers do not have direct access to their immunization records and thus are not empowered to further improve their health.

In 2013, the federal Office of the National Coordinator for Health Information Technology (ONC) launched a 5-state pilot, using a combination of technology and marketing and communications materials, to connect consumers to registry-based official immunization records and forecasts. Five states (Alaska, Arizona, Louisiana, Washington, and West Virginia) launched in May 2014, each pursuing a deployment of their own design. Technology used a cloud-based, registry-agnostic portal application, employing standard HL7 query and response, and offering consumers and healthcare providers multiple user workflows. Providers conduct a one-time consumer authentication during an in-person office visit. Consumers register for and subsequently access a free web-based account from any Internet-enabled device. Consumers can view, download, print and share official records in jurisdiction-specific formats. A single consumer account cohorts approved family members under one set of log-in credentials. A communications and marketing toolkit, developed with user- and consumer feedback, contains over 20 materials templates and guidance on deployment strategy and campaign tactics – it is freely available to any state.

The cloud-based portal application is HIPAA-compliant and does not store immunization data. Consumers have free accounts that afford them any-time anywhere access from any Internet-enabled device. Automated reminders are system-generated as e-mails and SMS text notifications, informing consumer users when any family member is coming due, now due, or past due for one or more immunizations. This forecasting is performed by an up-to-date ACIP-compliant forecasting engine, either in the registry or within the portal application. Weekly metrics are generated by the system and sent to each host-state’s Immunization Program. These are often shared with healthcare providers whose role is as a promoter of the system and as a consumer-authenticator, ensuring that the right records are accessible to the right individuals.

While an ongoing evaluation is in progress, providers report decreased administrative burdens, and consumers cite ease of use and anytime-availability of records as significant benefits. During the first seven (7) months of sub-state pilot implementation 274 healthcare provider sites enrolled 3,524 consumers (adult account-holders), including 7,319 ; consumers logged a total of 14,167 record pulls. Some evidence suggests that immunization rates may be improved through consumer’s knowledge of their immunization history and forecast. In a survey of consumer-users, among those who reported accessing the system to view their immunization forecast and detecting a need for one or more immunizations, 50% reported making an appointment with a healthcare provider within 60 days.